POST-THERAPY IMAGING AFTER RADIOACTIVE IODINE THERAPY FOR DIFFERENTIATED THYROID CANCER: THE CONTRIBUTION OF SPECT-CT IMAGING TO PLANAR IMAGING

Abstract

DOI: 10.26650/IUITFD.345626

Objective: The aim of this study was to investigate the contribution of SPECT-CT to planar imaging in patients with differentiated thyroid carcinoma (DTC) following radioiodine therapy.

Materials and Methods: Post-therapy scan was performed on 325 patients (254 women, 71 men; age range 15-81 years) who were operated on for DTC and treated with radioactive iodine (100-200 mCi) therapy. Whole-body planar imaging and neck–chest planar + SPECT-CT imaging were performed on all patients. Additional SPECT-CT scans were performed in other areas where suspicious findings were observed on the planar images. The iodine-positive areas on the planar images were classified as benign, equivocal, or malignant and were also reevaluated by two nuclear medicine physicians using SPECT-CT images. The final diagnosis was verified by histology, other imaging modalities, and clinical–serological follow-up.

Results: Based on patient-based analysis, SPECT/CT altered the interpretation of the planar scans by detecting the following findings: additional metastatic lymph nodes in 21 (21/50) patients, lung metastases in 2 (2/10) patients, and bone metastases in 2 (2/12) patients. Furthermore, SPECT/CT confirmed that equivocal focal uptakes were benign in 83 patients and malign in 48 patients. The sensivity, specificity, positive predictive value, negative predictive value, and accuracy were 63.4%, 92.7%, 67.7%, 91.3%, and 87%, respectively, for the planar imaging and 96.8%, 100%, 100%, 99.2%, and 99.3%, respectively, for the SPECT-CT imaging. Overall, SPECT-CT affected therapy management in 76 patients (23.3%).

Conclusion: SPECT-CT imaging improves diagnostic accuracy by reducing false-negative or -positive results in planar imaging in the post-therapy scan in patients with DTC. Our findings suggest that neck-thorax SPECT-CT imaging should be incorporated into the routine imaging protocol for detecting the most metastatic sites of DTC.

Keywords

• radioactive,iodine,SPECT-CT

DİFERANSİYE TİROİD KANSERLERİNDE RADYOAKTİF İYOT TEDAVİSİ SONRASI GÖRÜNTÜLEME: SPECT-BT GÖRÜNTÜLEMENİN PLANAR GÖRÜNTÜLEMEYE KATKISI

Abstract

DOI: 10.26650/IUITFD.345626

Amaç: Bu çalışmada differansiye papiller tiroid kanseri (DTK) olan hastalarda tedavi sonrası görüntülemede SPECT-BT’nin planar görüntülemeye katkısını araştırdık.

Gereç ve Yöntem: DTK tanısı ile opere olan ve radyoaktif iyot tedavisi (100-200mCi)  uygulanan toplam 325 hastaya tedavi sonrası görüntüleme yapıldı (254 kadın, 71 erkek; yaş aralığı: 15-81). Tüm hastaların tüm vücut planar ile boyun-toraks bölgesinden planar + SPECT-BT görüntüleri alındı. Ek olarak planar görüntülerde şüpheli tutulum saptanan alanlardan SPECT-BT görüntüleme yapıldı. Planar görüntülemede benign, şüpheli ve malign olarak sınıflandırılan iyot pozitif alanlar iki nükleer tıp uzmanı tarafından SPECT-BT görüntüleri ile yeniden değerlendirildi. Nihai tanı histoloji, diğer görüntüleme yöntemleri, klinik-serolojik takipler ile doğrulandı.

Bulgular: Hasta bazlı sonuçlara göre SPECT-BT planar görüntülemeye ek olarak 21 (21/50) hastada metastatik lenf nodları, 2 (2/10) hastada akciğer metastazları, 2 (2/12) hastada kemik metastazları tespit ederek;  83 hastada benign, 48 hastada malign olmak üzere şüpheli tutulumları açıklığa kavuşturarak planar görüntüleme yorumunu değiştirdi.   Duyarlılık, özgüllük, pozitif prediktif değer, negatif prediktif değer ve doğruluk planar görüntüleme için sırasıyla %63,4, %92,7, %67,7, %91,3, %87 iken SPECT-BT için sırasıyla % 96,8, % 100, %100, %99,2 ve %99,3 olarak hesaplandı. SPECT-BT toplamda 76 hastanın (%23,3) tedavi yönetimini etkiledi.

Sonuç: SPECT-BT görüntüleme, DTC hastalarında tedavi sonrası taramada planar görüntülemenin yanlış negatif/pozitif sonuçlarını azaltarak tanısal doğruluğu artırmaktadır. Sonuçlarımız DTC’nin en sık metastaz yaptığı boyun ve toraks bölgesinin değerlendirilmesinde SPECT-BT görüntülemenin rutin görüntüleme protokolüne alınmasını önermektedir.

Keywords

• Radyoaktif,iyot,SPECT-BT

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