Assessment of Minimum 124I Activity Required in Uptake Measurements Before Radioiodine Therapy for Benign Thyroid Diseases

Published on Aug 1, 2016in The Journal of Nuclear Medicine10.057
· DOI :10.2967/JNUMED.115.171066
Anja Sophie Gabler1
Estimated H-index: 1
(FSU: University of Jena),
Christian Kühnel5
Estimated H-index: 5
(FSU: University of Jena)
+ 1 AuthorsMartin Freesmeyer15
Estimated H-index: 15
(FSU: University of Jena)
Sources
Abstract
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-mode PET datasets (including 15 intervals up to 600 s and 5 different reconstruction algorithms: filtered-backprojection and 4 iterative techniques) acquired 30 h after administration of 1 MBq of (124)I. The Bland-Altman method was used to compare mean (124)I RAIU levels versus mean 3-MBq (131)I RAIU levels (clinical standard). The data of 37 patients with benign thyroid diseases were assessed. The impact of different reconstruction lengths on pixel noise was investigated for all 5 of the (124)I PET reconstruction algorithms. A hypothetical minimum activity was sought by means of a proportion equation, considering that the length of a reconstruction interval equates to a hypothetical activity.Mean (124)I RAIU and (131)I RAIU already showed high levels of agreement for reconstruction intervals of as short as 10 s, corresponding to a hypothetical minimum activity of 0.017 MBq of (124)I. The iterative algorithms proved generally superior to the filtered-backprojection algorithm. (124)I RAIU showed a trend toward higher levels than (131)I RAIU if the influence of retrosternal tissue was not considered, which was proven to be the cause of a slight overestimation by (124)I RAIU measurement. A hypothetical minimum activity of 0.5 MBq of (124)I obtained with iterative reconstruction appeared sufficient both visually and with regard to pixel noise.This study confirms the potential of (124)I RAIU measurement as an alternative method for (131)I RAIU measurement in benign thyroid disease and suggests that reducing the administered activity is an option. CT information is particularly important in cases of retrosternal expansion. The results are relevant because (124)I PET/CT allows additional diagnostic means, that is, the possibility of performing fusion imaging with ultrasound. (124)I PET/CT might be an alternative, especially when hybrid (123)I SPECT/CT is not available.
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References30
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This report provides a compendium of current information relating to radiation dose to patients, including biokinetic models, biokinetic data, dose coefficients for organ and tissue absorbed doses, and effective dose for major radiopharmaceuticals based on the radiation protection guidance given in Publication 60 (ICRP, 1991). These data were mainly compiled from Publications 53 , 80, and 106 (ICRP, 1987, 1998, 2008), and related amendments and corrections. This report also includes new informat...
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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.
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Background Benign thyroid diseases are widely common in western societies. However, the volumetry of the thyroid gland, especially when enlarged or abnormally formed, proves to be a challenge in clinical routine. The aim of this study was to develop a simple and rapid threshold-based isocontour extraction method for thyroid volumetry from 124I-PET/CT data in patients scheduled for radioactive iodine therapy.
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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...
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Background The purpose of this study is to describe a clinical relation of noise equivalent count rate (NECR) - an objective measurement of positron emission tomography (PET) systems - measured in a large number of patients, to clinical image quality of PET and their relation to 18F-fluoro-2-deoxyglucose (FDG) activity and patient's weight.
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Abstract A precise estimate of thyroid volume is necessary for making adequate therapeutic decisions and planning, as well as for monitoring therapy response. The goal of this study was to compare the precision of different volumetry methods. Thyroid-shaped phantoms were subjected to volumetry via 2-D and 3-D ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI). The 3-D US scans were performed using sensor navigation and mechanical sweeping methods. Volumetry calcu...
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Abstract The impact of acquisition time on reconstructed PET image quality is analyzed for different acquisition times (1, 2, 3 and 4 min). Image quality was tested according to the National Electrical Manufacturers Association (NEMA) NU 2-2007, the evaluation for the signal to noise ratio (SNR) and the reconstructed activity ratio (RAR) for three algorithms, i.e. OSEM, TrueX and TOF applying different effective iteration numbers. The present work shows that the image quality of 3 and 4 min acqu...
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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...
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Purpose of the ReportThe standard thyroid functional imaging method, 99mTc-pertechnetate (99mTc-PT) planar scintigraphy, has technical drawbacks decreasing its sensitivity in detecting nodules or anatomical pathology. 124I-PET, lacking these disadvantages and allowing simultaneous CT, may have great
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Both, ultrasonography but also radionuclide imaging using [99mTc]Pertechnetate or radioactive iodine isotopes are essential tools used during the diagnostic workup of hyperthyroidism with or without structural alterations of the thyroid. Colour duplex sonography and ultrasound elastography may add important information in order to find the cause of the hormone excess. During the last years, also hybrid imaging using SPECT/-(CT) or PET-based methods, such as [124]Iodine-PET/CT or [124]Iodine-PET/...
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The incidence of thyroid cancer ranks top among all endocrine cancers, which has increased worldwide. Some patients suffer from recurrent/residual diseases after primary treatment. The recurrent/residual disease often turns out to be radioiodine refractory and shows poor response to radioiodine therapy. A lot of studies have explored the precise appraisal of radioiodine refractory disease in recent years. The mechanism of iodine uptake and the definition of radioiodine refractory disease have be...
: To assess the radiation exposure of the investigator during navigated fusion of nuclear medicine images with ultrasound after application of I-124. Dosimetry with two different types of thermoluminescent detectors (TLD) was performed in 25 patients. The dose rate at the patient's neck was measured with a calibrated dose rate meter (DRM) and served as the standard of reference. The average exposure per investigation at the patient's neck measured by LiF:Mg,Cu,P TLDs (cumulative: 212 μSv), LiF:M...
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In current practice, thyroid scintigraphy is predominantly used for thyroid nodules in patients with subnormal TSH. We present radiopharmaceuticals used for imaging and therapy and describe imaging procedures and interpretation of findings. Differences between European and US practices are addressed. Patient preparation and instructions prior to nuclear thyroid imaging and therapy are described. We discuss the current indications for radioiodine therapy of benign nodular disease, how the adminis...
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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...
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#1Falk GühneH-Index: 5
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Purpose 124I-PET/CT can be used for pre-therapeutic assessment of radioactive iodine uptake in benign thyroid disorders, however systematic comparisons with intra-therapeutic uptake are still lacking for these disorders. The goals of this study were to compare 124I RAIU and conventional 131I RAIU tests with each other; to compare both tests with intra-therapeutic uptake (reference); and to verify the time course of radioactive iodine uptake at three time points (30, 102, and 336 h [14 days] post...
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