technetium-tc-99m-tetrofosmin and Adenocarcinoma--Follicular

The purpose of this study was to assess the detectability of metastatic lesions by 99Tcm-tetrofosmin in differentiated thyroid cancer, and to compare the results with those obtained using 201Tl-chloride and tracer doses of 131I. Twenty-four thyroidectomized patients with metastases were studied. There were 34 metastases, including 16 lung, nine lymph node and nine bone. Radiological studies (chest X-ray, computed tomography and magnetic resonance imaging), serum thyroglobulin assays and histopathological examinations were performed to verify the presence of metastases with positive uptake of the three radionuclides. Increased accumulation of 99Tcm-tetrofosmin was observed in 11 of 16 (68.8%) lung metastases, eight of nine (88.9%) lymph node metastases and eight of nine (88.9%) bone metastases. Increased accumulation of 201Tl and 131I was observed in 11 of 16 (both) (68.8%) lung metastases, eight (88.9%) and three (33.3%), respectively, of lymph node metastases and eight (88.9%) and nine (100%), respectively, of bone metastases. The detectability of thyroid cancer metastases using 99Tcm-tetrofosmin, 201Tl and 131I was 79.4%, 79.4% and 67.6%, respectively. The combined detectabilities of 99Tcm-tetrofosmin and 131I and of 201Tl and 131I were both 88.2%. 99Tcm-tetrofosmin and 201Tl imaging were found to be more sensitive than 131I for the detection of differentiated thyroid cancer metastases, particularly for regional lymph node. The combination of 99Tcm-tetrofosmin and 131I imaging may be a more sensitive and effective method for detecting metastases in differentiated thyroid cancer.

Topics: Adenocarcinoma, Follicular; Adolescent; Adult; Aged; Bone Neoplasms; Carcinoma, Papillary; Diagnostic Errors; Female; Humans; Iodine Radioisotopes; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Thallium Radioisotopes; Thyroid Neoplasms

Determination of thyroglobulin (Tg) levels, determined under endogenous thyroid-stimulating hormone stimulation after withdrawal of L-thyroxin treatment (off-T4), has been proven to be the most sensitive method for evaluation of patients with recurrent malignancy or distant metastases. This study uses a comparative approach between low-dose 131I scan and the previously reported highly sensitive 99mTc-tetrofosmin whole-body scintigraphy, using Tg-off-T4 as a basis for comparison.. Fifty-eight consecutive patients of our follow-up program with primary thyroid carcinoma ablated with thyroidectomy and radioiodine therapy were examined after L-thyroxin withdrawal over 3-4 wk with 131I (185 MBq) and 99mTc-tetrofosmin whole-body scintigraphy and Tg determination (off-T4) within 5 days. Patients with Tg levels above 0.5 ng/ml were defined as Group A (n = 29). Group B (n = 29) comprised patients who had Tg levels (off-T4) below 0.5 ng/ml.. Iodine-131 revealed only 19 of 44 tumor sites (43.18%). Additionally, three remnants could be demonstrated. Sensitivity showed decreasing values for local recurrences (4 of 7, 57.1%), bone lesions (7 of 13, 53.85%) and mediastinal (2 of 4, 50%), lung parenchymal (3 of 7, 42.85%) and lymph node (2 of 9, 22.2%) metastases. Whole-body scintigraphy with 99mTc-tetrofosmin revealed a total of 39 of 44 malignant lesions (88.6%). Sensitivity was superior for lung parenchymal metastases (9 of 9, 100%), mediastinum (4 of 4, 100%) and lymph nodes (9 of 10, 90%) and inferior for bone metastases (11 of 13, 84.6%). Local recurrences could be detected in 6 of 7 patients (85.7%), and thyroid remnants were detected in 2 cases (2 of 11, 18.2%). One liver metastasis could not be detected because of the physiologic tracer distribution of 99mTc-tetrofosmin. Thyroglobulin-off-T4 detected malignant recurrence or metastases in 18 of 19 patients (94.7%) when a cutoff of 3 ng/ml was used and in 16 of 19 patients (84.2%) when a cutoff of 10 ng/ml was used. Specificity was calculated as 71.8% when a cutoff of 0.5 ng/ml was used, 89.7% when a cutoff of 3 ng/ml was used and 100% when a cutoff of 10 ng/ml was used.. Scintigraphy with 99mTc-tetrofosmin showed clear advantages concerning sensitivity in most metastatic lesions when compared with low-dose 131I scan. Despite a slight lower specificity, 99mTc-tetrofosmin whole-body scintigraphy has, therefore, been proven to be a useful tool in the assessment of metastatic lesions in differentiated thyroid carcinoma.

Topics: Adenocarcinoma, Follicular; Carcinoma, Papillary; Case-Control Studies; Combined Modality Therapy; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Thyroglobulin; Thyroid Neoplasms; Thyroidectomy; Thyroxine

The purpose of this study was to asses the detectability of differentiated thyroid carcinoma (DTC) metastases by 99mTc-tetrofosmin and to compare the results of 99mTc-tetrofosmin with 131I and 201Tl. The reliability of 201Tl and 99mTc-tetrofosmin scanning during suppression therapy also has been studied.. A prospective study was performed on 41 patients (30 females, 11 males) with DTC (30 papillary, 11 follicular) who had undergone total thyroidectomy and received an average dose of 117 mCi (4329 MBq) of radioiodine for ablation of postsurgical residual thyroid tissue. All patients (n = 41) had 201Tl, 99mTc-tetrofosmin or 131I whole-body imaging after discontinuation of thyroid hormone replacement (thyroxine-off group). Eight of 14 patients with distant metastases also were imaged when they were on thyroxine therapy both with 201Tl and 99mTc-tetrofosmin (thyroxine on-and-off group). Radiologic studies (chest radiography, CT and MRI), serum thyroglobulin assays and histopathologic examinations were performed to clarify the presence of metastases with positive uptake on any of three radionuclide studies.. In 26 of 41 patients all three scans were negative. These patients also clinically didn't show any evidence of metastases. Fourteen patients were considered to have distant metastases on the basis of clinical, radiologic and histopathologic findings. The sensitivities of 201Tl, 99mTc-tetrofosmin and 131I in diagnosing distant metastases were comparable (0.85, 0.85 and 0.78, respectively). Iodine-131 was much more sensitive than 201Tl and 99mTc-tetrofosmin for demonstrating residual thyroid tissue after surgery (1.00, 0.33 and 0.33, respectively). The only false-positive case involved radioiodine uptake in a tuberculoma. Thyroxine-on images of 8 patients with distant metastases showed no difference from their thyroxine-off images regarding the site, number and uptake of metastases.. Technetium-99m-tetrofosmin and 201Tl imaging are highly sensitive for detecting differentiated thyroid carcinoma metastases and do not require prior withdrawal of thyroid hormone suppressive therapy.

Topics: Adenocarcinoma, Follicular; Adult; Carcinoma, Papillary; Case-Control Studies; Female; Humans; Iodine Radioisotopes; Male; Organophosphorus Compounds; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Thallium Radioisotopes; Thyroid Neoplasms; Thyroxine

We prospectively studied 26 patients with cold thyroid nodules (five malignant and 21 benign nodules) on Tc-99m pertechnetate scintigraphy to investigate the diagnostic value of Tc-99m tetrofosmin scintigraphy and color-Doppler sonography in differentiating malignant from benign thyroid nodules. In each patient, Tc-99m Tetrofosmin uptake in the nodule and intranodule vascularity were assessed semiquantatively. Both the uptake and vascularity were classified as low, Iso or high. Eight out of 26 nodules showed high Tc-99m tetrofosmin uptake; five of them were malignant. Eight (including four malignant tumors) out of 26 nodules showed increased vascularity compared with normal thyroid tissue on color-Doppler sonography. In six out of eight patients with high uptake of Tc99m-tetrofosmin, increased vascularity was observed. The sensitivity, specificity, negative predictive value, and positive predictive value of Tc-99m tetrofosmin scintigraphy and color-Doppler sonography were determined to be 100% and 80%, 85% and 80%, 62% and 50%, and 100% and 94%, respectively. We conclude that color-Doppler sonography seems to have limited value in the detection of malignant thyroid nodules. However, Tc-99m tetrofosmin scintigraphy is a sensitive method to use in diagnosing malignant nodules, although it is not specific for the detection of malignant nodules.

Topics: Adenocarcinoma, Follicular; Adenoma; Adolescent; Adult; Carcinoma, Papillary; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule; Thyroiditis; Ultrasonography, Doppler, Color

The purpose of this study was to evaluate prospectively the reliability of the new nonspecific tumor-searching tracer tetrofosmin in the postoperative follow-up of differentiated thyroid carcinoma (DTC) during TSH suppressive thyroid hormone treatment.. Whole-body scintigraphy was performed in 114 patients under TSH suppressive L-T4 treatment 20 min after intravenous injection of 370 MBq 99mTc-tetrofosmin by means of a dual-head gamma camera followed by three-dimensional SPECT in case of suspicious tracer uptake. The results of serum thyroglobulin, ultrasonography of the neck, 131I whole-body scintigraphy, chest radiograph, transmission CT or MRI, and bone scintigraphy were also available.. A group of 68 patients without thyroid remnants who were tumor free and had no history of metastases or tumor recurrence showed a negative 99mTc-tetrofosmin whole-body scan. Another 24 patients (papillary carcinoma pT1NOMO) were also in complete remission, but had sonographically proven remnants (echonormal). Sixteen of them (67%) exhibited 99mTc-tetrofosmin accumulation in the thyroid bed, which corresponded excellently to the localization of the remnant. The third group comprises seven cases of local recurrence confirmed by histopathology after reoperation or by cytology after fine-needle aspiration where tetrofosmin scintigraphy clearly revealed relapse of malignancy in all cases. A total of 17 patients had distant metastases (11 pulmonary, 3 bone, 2 bone and pulmonary, 1 bone and soft tissue) discovered by different modalities, resulting in 44 lesions to be evaluated. Of the 23 radioiodine negative metastases, 17 were detected by tetrofosmin (74%), whereas all 21 radioiodine accumulating lesions also showed tetrofosmin positive scans. The overall sensitivity of 99mTc-tetrofosmin in detecting distant metastatic lesions was 86%. Four additional cases with radioiodine-negative disseminated lung metastases showed diffuse pulmonary tetrofosmin uptake.. Technetium-99m-tetrofosmin is a promising tracer to detect malignant recurrence and distant metastases in the follow-up of DTC without the necessity of thyroid hormone withdrawal.

Topics: Adenocarcinoma, Follicular; Adult; Aged; Aged, 80 and over; Bone Neoplasms; Carcinoma, Papillary; Female; Follow-Up Studies; Humans; Lung Neoplasms; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Thyroid Neoplasms

Technetium-99m tetrofosmin, a lipophilic cationic complex molecule, was introduced for myocardial imaging. In some biodistribution studies it has also been reported to accumulate in the thyroid gland. Our objectives were to determine which thyroid nodules retain tetrofosmin and whether preoperative evaluation of malignancy is possible. Tetrofosmin scintigraphy was performed in 57 patients with a cold thyroid nodule on previously performed pertechnetate scintigraphy. All patients had undergone ultrasonography and sonographically guided fine-needle aspiration biopsy. The tetrofosmin scintigrams were obtained 5 min (early image) and 1 h (late image) after intravenous injection of 370 MBq. Only nodules that showed clear tracer retention after 1 h in comparison with retention at 5 min were classified as TETRO positive. Nodules without late retention were classified as TETRO negative. All patients underwent surgery and the histological results were compared with the results of tetrofosmin scintigraphy. Ten out of 11 patients with thyroid carcinoma (two pT1, three pT2, five pT4) were TETRO negative. One patient with papillary carcinoma (pT2) was TETRO positive. The mean nodular to thyroid tissue (N/T) ratio for the late scan was 1.0+/-0.20. There were 21 patients with thyroid adenomas (seven follicular, seven microfollicular and seven oxyphilic); 15 of these patients were TETRO positive and six TETRO negative. The mean N/T ratio for the late images was 1.34+/-0.41. All patients with degenerative goitre (24 cases) and the one patient with Hashimoto's disease were TETRO negative after 1 h and the N/T ratio was 0.92+/-0.12 on the late scan. Our results indicate that 99mTc-tetrofosmin scanning is of little value preoperatively in distinguishing thyroid carcinoma from other thyroid nodules. Tetrofosmin tends to demonstrate thyroid adenomas but does not have a routine role in the assessment of thyroid nodules.

Topics: Adenocarcinoma, Follicular; Adenoma; Carcinoma, Papillary; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule

Since many years TI-201, as non-specific tumor-searching radionuclide, plays a certain although somewhat controversial role in the follow-up of differentiated thyroid carcinoma (DTC). Recently some Tc-99m labeled myocardial perfusion agents were introduced, that might be more important for nuclear oncology in the future. Aim of this study was to evaluate prospectively the reliability of the new non-specific tumor searching tracer tetrofosmin (Myoview) in the post operative follow-up of differentiated thyroid carcinoma during TSH suppressive thyroid hormone treatment and to compare the results in patients with metastasizing DTC to Tc-99m sestamibi (Cardiolite) and TI-201. In a pilot study 12 patients with elevated thyroglobulin (Tg) levels of more than 10 ng/ml and known metastatic disease were examined under TSH suppressive L-Thyroxine treatment comparing TI-201, Tc-99m sestamibi and Tc-99m terofosmin whole body scintigraphy (WBS). Furthermore in 146 consecutive follow up patients tetrofosmin WBS was performed under TSH-suppressive L-T4 treatment. The results were compared to serum thyroglobulin (Tg), ultrasonography (US) of the neck, I-131 whole body scintigraphy (I-131 WBS), transmission computed tomography (TCT) or magnetic resonance imaging (MRI) and bone scintigraphy. Whole body scans were performed with TI-201 (74 MBq; 20 min post injection), Tc-99m sestamibi (370 MBq; 20-60 min post injection) and Tc-99m tetrofosmin (370 MBq; 20-60 min post injection). Tumor/background ratios and optional time/activity analyses (up to 120 min post injection) were evaluated using the region of interest approach. In the pilot study tetrofosmin showed the highest T/BG ratios and detection rates (T/BG: 1.76 +/- 0.345) followed by TI-201 (T/BG: 1.59 +/- 0.396) and sestamibi (1.51 +/- 0.31 p = 0.05). From the 146 patients investigated consecutively with Tc-99m tetrofosmin WBS for the routine follow up of DTC, 88 patients (no thyroid remnants, no history of metastases or tumor recurrence) were tumor free. All of them resulted in negative Tc-99m tetrofosmin WBS. Another 32 patients (papillary carcinoma pT1) were also in complete remission, but had sonographically proven remnants (echonormal). Twenty one of them exhibited certain Tc-99m tetrofosmin accumulation in the thyroid bed. In 9 cases with local recurrence as confirmed by histopathology after reoperation or by cytology after fine needle aspiration, the tetrofosmin scintigraphy clearly revealed relapse of malignancy i

Topics: Adenocarcinoma, Follicular; Adult; Aged; Aged, 80 and over; Carcinoma, Papillary; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Sestamibi; Thyroid Neoplasms; Whole-Body Counting

A 79-year-old male with follicular thyroid carcinoma metastasizing to the lung, bone and lymph nodes was subjected to whole-body scintigraphy using technetium-99m tetrofosmin and 99mTc-sestamibi. Both agents delineated the metastatic lesions and the two image qualities were comparable. We believe that 99mTc-tetrofosmin and 99mTc-sestamibi images may be helpful in localizing metastatic foci and substitute for thallium-201 in the follow-up of patients with differentiated thyroid carcinoma.

Topics: Adenocarcinoma, Follicular; Aged; Bone Neoplasms; Humans; Iodine Radioisotopes; Lung Neoplasms; Lymphatic Metastasis; Male; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Sestamibi; Thyroid Neoplasms