Differential diagnosis of thyroid nodules via real-time PET/ultrasound (US) fusion in a case of co-existing medullary thyroid cancer and adenoma.

Published on Sep 3, 2013in The Journal of Clinical Endocrinology and Metabolism5.399
· DOI :10.1210/JC.2013-2566
Falk Gühne4
Estimated H-index: 4
,
Thomas Winkens9
Estimated H-index: 9
+ 1 AuthorsMartin Freesmeyer14
Estimated H-index: 14
Sources
Abstract
A 52-year-old woman presented with apparent carcinoid syndrome. Gallium 68 (Ga)-DOTATOC positron emission tomography (PET)/computed tomography (CT) found a 2.5-cm somatostatin receptor (SR)positive nodule in the left thyroid lobe. Basal serum calcitonin was 5184 ng/L, TSH was 0.63 mU/L, and free T4 was 16.98 pmol/L, so medullary thyroid cancer was suspected. Ultrasonography (Figure 1, A and B), F-fluorodeoxyglucose (FDG) PET/CT, and iodine 124 (I) PET/ CT, performed to allocate thyroid nodules to GaDOTATOC PET findings and exclude metastases, revealed an adjacent nodule 1 cm (Figures 1 and 2), believed to be adenoma. The patient provided informed consent for all procedures. To unambiguously characterize the nodules, we used a magnetic navigation system (VNav; GE Healthcare) to perform live fusion of metabolic/functional images acquired through PET and morphological images obtained with ultrasound (PET/ultrasonography) (1). Live fusion recently was reported to be a problem-solving tool in cases of unclear PET findings (2); although CT shows anatomical landmarks facilitating PET image interpretation, ultrasonography offers superior soft-tissue resolution to that of CT. Moreover, real-time coregistration allows immediate, interactive investigation. PET/CT data are acquired according to standard protocol, then loaded onto an ultrasonography system located in a separate room; images are aligned using anatomical landmarks, and three-dimensional PET/CT views are then automatically reoriented and fused to live ultrasonographic images according to ultrasound probe positioning (3) (Figure 2, A–C, and Movie 1). After thyroidectomy, histology confirmed our hypothesis regarding the lesions. Real-time fusion of PET/ultrasonography images thus differentiated an F-FDG-positive, I-negative, and SR-positive thyroid nodule, which proved to be medullary thyroid cancer, from an adjacent F-FDG-negative, I-positive, and SR-negative nodule, which turned out to be a compensated autonomous adenoma (Figure 2).
📖 Papers frequently viewed together
2011
4 Authors (Pelin Ozcan Kara, ..., Orhan Özbek)
4 Citations
References2
Newest
#1R. DrescherH-Index: 1
#2A. MüllerH-Index: 1
Last. M. FreesmeyerH-Index: 1
view all 4 authors...
PET/ultrasound fusion for differentiation of Vox implant silicone particles from recurrent cancer -
9 CitationsSource
PURPOSE: The aim of this study was to show the number of cases in which the use of fusion-guided ultrasonography (US) provided conclusive diagnosis of lesions in the liver seen on CT or MRI or PET/CT. A lesion is defined as a region that has suffered damage due to injury or disease. MATERIALS AND METHODS: Forty patients of whom 34 had confirmed neoplastic disease, referred to US evaluation or US-guided biopsy of liver lesions seen on CT (n = 35), MRI (n = 2) or PET/CT (n = 3), were prospectively...
43 CitationsSource
Cited By11
Newest
#1Philipp SeifertH-Index: 9
#2Falk GühneH-Index: 4
Last. Martin FreesmeyerH-Index: 14
view all 3 authors...
AbstractA 49-year-old woman presented with a multinodular goiter, causing local symptoms and hyperthyroisdism. Besides a hypofunctioning benign nodule (TIRADS 3, benign in FNAC), the conventional diagnostic revealed another small hyperfunctioning nodule with suspicious ultrasound features (TIRADS 4C
6 CitationsSource
Abstract Side-by-side evaluation of thyroid ultrasound (US) and 99mTcO4 scintigraphy can lead to uncertainties in the correct topographic assignment of thyroid nodules. The aim of this study was to evaluate 99mTcO4 single-photon emission computed tomography/ultrasound (SPECT/US) fusion imaging. Seventy-nine patients were prospectively investigated. If conventional diagnostics of the thyroid gland (B-mode-US, scintigraphy) produced unclear findings, SPECT was performed and transferred to a US dev...
8 CitationsSource
#1Philipp SeifertH-Index: 9
#2Robert DrescherH-Index: 5
Last. Martin FreesmeyerH-Index: 14
view all 4 authors...
2 CitationsSource
2 CitationsSource
#1Martin FreesmeyerH-Index: 14
#2Anja Sophie GablerH-Index: 1
Last. Thomas WinkensH-Index: 9
view all 4 authors...
PURPOSE: This study aimed at investigating the performance of late I PET/CT for radioiodine uptake (RAIU) measurement at 336 hours after administration in patients with benign thyroid diseases requiring radioiodine therapy. Special attention was paid to the comparability of I uptake (I-RAIU) to the clinical standard (I-RAIU, probe measurement). Considering cost aspects, we sought to establish an economically reasonable examination protocol based on scan duration and administered activity. METHOD...
1 CitationsSource
#1Anja Sophie Gabler (FSU: University of Jena)H-Index: 1
#2Christian Kühnel (FSU: University of Jena)H-Index: 5
Last. Martin Freesmeyer (FSU: University of Jena)H-Index: 14
view all 4 authors...
This study aimed to assess a hypothetical minimum administered activity of (124)I required to achieve comparability between pretherapeutic radioiodine uptake (RAIU) measurements by (124)I PET/CT and by (131)I RAIU probe, the clinical standard. In addition, the impact of different reconstruction algorithms on (124)I RAIU and the evaluation of pixel noise as a parameter for image quality were investigated.Different scan durations were simulated by different reconstruction intervals of 600-s list-m...
7 CitationsSource
The role of 124Iodine-PET/US Fusion technique is demonstrated in a 52-year-old woman with De Quervain's subacute thyroiditis. A small and adversely located lesion not detected by thyroid scintigraphy could be unambiguously matched with a hypofunctional PET finding. The presented case supports the clinical potential of PET/US Fusion technique in thyroid disease especially in small and uncertain findings.
6 CitationsSource
#1Tobias Lasser (TUM: Technische Universität München)H-Index: 14
#2José Gardiazabal (TUM: Technische Universität München)H-Index: 8
Last. Nassir Navab (TUM: Technische Universität München)H-Index: 92
view all 7 authors...
Thyroid imaging using radioactive tracers is a common task in clinics and is usually performed using 2D gamma cameras (scintigraphy). In this work we present a setup for 3D imaging of the thyroid using a mini gamma camera mounted on a robotic arm. Several images are acquired moving the mini gamma camera along a trajectory around the thyroid. Afterwards, a tomographic reconstruction computes a 3D SPECT-like image of the thyroid. First results are shown of a thyroid phantom using a conventional st...
1 CitationsSource
A euthyroid 42-year-old female (TSH, 3.9 mU/L; free T3, 4.51 pmol/L; free T4, 11.16 pmol/L) was referred for thyroid diagnostics due to hypothyreosis and a single thyroid nodule. On ultrasound (US), a small (15[ap] 6[rl] 8[cc] mm), inhomogeneous hypoechoic area (Figure 1, B and E) had been found on the lateral margin of the right thyroid lobe. Although ultrasonography suggested potential malignancy, a thyroid scan (Figure 1A, scintigram 20 min after administration of 70 MBq TcO4) had shown norma...
8 CitationsSource
Context: Radioiodine therapy of benign thyroid diseases requires pretherapy assessment of radioactive iodine uptake (RAIU) for reliable therapy planning. Objective: Our objective was to assess RAIU by low-activity 124I-positron emission tomography/low-dose computed tomography (124I-PET/CT) in comparison with standard 131I probe measurements. Design/Setting: This prospective comparative study was conducted at the Jena University Hospital, Jena, Germany, in a referral center setting. Patients: A t...
9 CitationsSource