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

Yıl 2018, Cilt: 81 Sayı: 4, 106 - 114, 01.12.2018

Duygu Has Şimşek Yasemin Şanlı Serkan Kuyumcu Ebru Yılmaz Zeynep Gözde Özkan Cüneyt Türkmen İşık Adalet Ayşe Mudun Seher Nilgün Ünal

Öz

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.

Anahtar Kelimeler

radioactive, iodine, SPECT-CT

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

Öz

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.

Anahtar Kelimeler

Radyoaktif, iyot, SPECT-BT

Kaynakça

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