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Increased 131I Accumulation in the Gallbladder and High-grade Serous Ovarian Adenocarcinoma. Clin Nucl Med 2019; 44:61-63. [DOI: 10.1097/rlu.0000000000002339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Triggiani V, Giagulli VA, Iovino M, De Pergola G, Licchelli B, Varraso A, Dicembrino F, Valle G, Guastamacchia E. False positive diagnosis on (131)iodine whole-body scintigraphy of differentiated thyroid cancers. Endocrine 2016; 53:626-35. [PMID: 26499192 DOI: 10.1007/s12020-015-0750-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/19/2015] [Indexed: 02/07/2023]
Abstract
(131)Iodine is used both to ablate any residual thyroid tissue or metastatic disease and to obtain whole-body diagnostic images after total thyroidectomy for differentiated thyroid cancer (DTC). Even though whole-body scan is highly accurate in showing thyroid residues as well as metastases of DTC, false positive results can be found, possibly leading to diagnostic errors and unnecessary treatments. This paper reviews the physiological and pathological processes involved as well as the strategy to recognize and rule out false positive radioiodine images.
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Affiliation(s)
- Vincenzo Triggiani
- Interdisciplinary Department of Medicine. Endocrinology and Metabolic Diseases, University of Bari, Bari, Italy.
| | - Vito Angelo Giagulli
- Interdisciplinary Department of Medicine. Endocrinology and Metabolic Diseases, University of Bari, Bari, Italy
| | - Michele Iovino
- Endocrinology and Metabolic Diseases, Eboli Hospital, Eboli, Salerno, Italy
| | | | - Brunella Licchelli
- Interdisciplinary Department of Medicine. Endocrinology and Metabolic Diseases, University of Bari, Bari, Italy
| | - Antonio Varraso
- Nuclear Medicine, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Franca Dicembrino
- Nuclear Medicine, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Guido Valle
- Nuclear Medicine, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine. Endocrinology and Metabolic Diseases, University of Bari, Bari, Italy
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Ranade R, Thapa P, Basu S. Adrenal metastasis from differentiated thyroid carcinoma documented on post-therapy 131I scan: A case based discussion. World J Radiol 2014; 6:56-61. [PMID: 24765241 PMCID: PMC3986421 DOI: 10.4329/wjr.v6.i3.56] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Adrenal metastasis is an unusual site of disease involvement in the natural course of differentiated thyroid carcinoma (DTC). This paper discusses the clinical and imaging features of DTC with adrenal metastasis. An unusual case of unilateral solitary asymptomatic adrenal metastasis in the setting of DTC is described in this report with the imaging features including 131I scintigraphy and Fluorodeoxyglucose- Positron emission tomography/computed tomography. The adrenal metastasis was associated with other sites of metastatic disease involvement and was unidentified on initial pre-treatment evaluation studies. All such suspicious lesions should be further evaluated with clinicoradiological correlation by other imaging modalities. A post-radioiodine therapy scan revealed radioiodine uptake in the thyroid bed, sternum and a focus of intense radioiodine concentration in the left suprarenal region. Spot oblique images and single photon emission computed tomography of the upper abdomen was undertaken to ascertain the position and better characterization of the lesion. A subsequent whole body PET-CT (non-contrast) was done which revealed a well defined 6.5 cm × 5.0 cm left adrenal lesion with a SUVmax (standardized uptake value-maximum) of 9.5 in addition to a fluorodeoxyglucose avid osteolytic sternal lesion. The serum thyroglobulin level was significantly raised (more than 250 ng/mL) with thyroid stimulating hormone being 4.9 μΙU/mL (even following an adequate period of levothyroxine withdrawal), indicating the functioning nature of the metastases. In addition to demonstrating an atypical site of metastatic disease in DTC patients, this case emphasizes the importance of carefully interpreting and correlating a post radio-iodine therapy scan, particularly those with focal abdominal radio-iodine uptake which could aid in detecting metastatic lesions that are not characterized or identified on initial evaluation. The other important feature that can be deciphered from this report is that an adrenal metastasis could be unilateral and solitary, unlike that of renal metastases which are almost always bilateral and multiple at presentation, although both are usually asymptomatic.
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Buton L, Morel O, Gault P, Illouz F, Rodien P, Rohmer V. False-positive Iodine-131 whole-body scan findings in patients with differentiated thyroid carcinoma: Report of 11 cases and review of the literature. ANNALES D'ENDOCRINOLOGIE 2013; 74:221-30. [DOI: 10.1016/j.ando.2013.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/03/2013] [Accepted: 05/03/2013] [Indexed: 11/17/2022]
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Incidental gallbladder visualization on nonhepatobiliary nuclear medicine studies: case series and review of the literature. Clin Nucl Med 2008; 32:915-9. [PMID: 18030040 DOI: 10.1097/rlu.0b013e31815976e0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Gallbladder uptake is occasionally encountered with commonly used nonhepatobiliary radiopharmaceuticals. Identification of the biliary tract by a nonhepatobiliary agent can identify disease, such as uptake of labeled white blood cells. However, in most cases, gallbladder uptake of nonhepatobiliary tracers is not due to pathology in these cases. It is important to avoid attributing gallbladder uptake to disease in the gallbladder or adjacent anatomic structures. We present 3 cases of unexpected gallbladder tracer uptake and provide a review of the literature describing incidental gallbladder uptake on nonhepatobiliary nuclear medicine studies. The potential for misdiagnosis and the steps taken to avoid this are discussed.
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Radioiodine Therapy: Malignant Thyroid Disease. Clin Nucl Med 2008. [DOI: 10.1007/978-3-540-28026-2_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
A 52-year-old woman with follicular thyroid carcinoma presented for ablative radioiodide and whole body I-131 imaging following subtotal thyroidectomy. An abnormal focus of increased activity was present in the region of the gallbladder fossa, persistent on delayed imaging. Subsequent CT revealed no hepatic metastases. Contemporaneously, the patient described right upper quadrant abdominal pain. Abdominal ultrasound demonstrated cholelithiasis. Cholecystectomy revealed extensive cholelithiasis and evidence of chronic cholecystitis; no hepatic metastases were identified. This case demonstrates the potential pitfall of gallbladder activity on I-131 whole body imaging secondary to cholecystitis mimicking hepatic metastases.
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De la Riva Pérez PA, Castro Montaño J, Iglesias Jerez R, López Muñoz N, Gil Martínez EM, Rodríguez de Quesada B. [Atypical uptake of gallbladder as cause of False-positive iodine-131 in post-surgical removal scanning of thyroid remains]. REVISTA ESPANOLA DE MEDICINA NUCLEAR 2007; 26:52-3. [PMID: 17286950 DOI: 10.1016/s0212-6982(07)75282-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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Jong I, Taubman K, Schlicht S. Bronchiectasis simulating pulmonary metastases on iodine-131 scintigraphy in well-differentiated thyroid carcinoma. Clin Nucl Med 2005; 30:688-9. [PMID: 16166845 DOI: 10.1097/01.rlu.0000178242.69075.64] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Differentiated thyroid cancer is an uncommon disease that carries a good prognosis when treated adequately. Radioiodine treatment is often used as an adjunct to surgery because this has been associated with increased survival, particularly in the presence of iodine-avid soft tissue metastases. Multiple different false-positive scans can occur in the absence of residual thyroid tissue or metastases. Recognition of these potential false-positive iodine-131 (I-131) scans is critical to avoid the unnecessary exposure to further radiation from repeated therapeutic doses of radioactive iodine. We report a case of physiological uptake of radioactive iodine in the bronchiectatic bronchial tree bilaterally, potentially masquerading as pulmonary metastases.
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Affiliation(s)
- Ian Jong
- Department of Medical Imaging, St. Vincent's Hospital, Melbourne, Victoria, Australia
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Kumar A, Nadig M, Patra V, Srivastava DN, Verma K, Bal CS. Adrenal and renal metastases from follicular thyroid cancer. Br J Radiol 2005; 78:1038-41. [PMID: 16249606 DOI: 10.1259/bjr/24024066] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Patients with differentiated thyroid cancer may have asymptomatic involvement of renal and/or adrenal gland, particularly if they are elderly and have associated metastases to other organs, which may remain undetected if these patients are not subjected to radioiodine treatment. Our experience also emphasises the role of routine post-radioiodine therapy whole body scan with high degree of clinical suspicion, which may reveal lesions otherwise not discernable in low dose whole body scan. All suspicious lesions should be subjected to structural imaging like ultrasound, CT or MRI for confirmation. In this setting, the role of radioiodine therapy is primarily aimed at palliation that might prolong their survival, probably reduce further spread and thus overall improve the quality of life.
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Affiliation(s)
- A Kumar
- Department of Nuclear Medicine, at All India Institute of Medical Sciences, New Delhi, India
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Carlisle MR, Lu C, McDougall IR. The interpretation of 131I scans in the evaluation of thyroid cancer, with an emphasis on false positive findings. Nucl Med Commun 2003; 24:715-35. [PMID: 12766609 DOI: 10.1097/00006231-200306000-00015] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Radioiodine has aided the management of differentiated thyroid cancer for several decades. Most thyroid cancers retain the ability to trap iodine, and radionuclides of iodine can be used both diagnostically and therapeutically. The availability of sensitive diagnostic tests, coupled with the ability to deliver targeted therapy, gives physicians the ability to manage thyroid cancer better than with any other type of cancer. The correct interpretation of radioiodine scans is critical in the appropriate management of patients with thyroid cancer. False positive findings do occur. A radioiodine scan showing abnormal uptake outside the thyroid bed must be studied carefully and alternative reasons for the finding must be considered. The scan should be analysed systematically. Is there residual thyroid? If so, what is the 48 or 72 h neck uptake? Radioiodine uptake in the salivary glands, stomach, gastrointestinal and urinary tracts should be acknowledged as physiological. Diffuse uptake is seen in the liver in most patients with functioning thyroid at the time of their post-therapy scan. When there is uptake of the radioiodine outside these regions, contamination must be considered. A variety of cases illustrating true positive, true negative, and false positive findings is presented in this review, and the causes and consequences of misinterpretation of radioiodine scans are discussed.
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Affiliation(s)
- M R Carlisle
- Division of Nuclear Medicine, Stanford University Medical Center, California 94305, USA
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Smallridge RC, Castro MR, Morris JC, Young PR, Reynolds JC, Merino MJ, Sarlis NJ. Renal metastases from thyroid papillary carcinoma: study of sodium iodide symporter expression. Thyroid 2001; 11:795-804. [PMID: 11525275 DOI: 10.1089/10507250152484664] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Kidney metastases from thyroid cancer are rare. We report two such patients and demonstrate that the in vivo 131I uptake by the kidney metastasis is associated with high levels of sodium iodide (Na+/I-) symporter (NIS) expression in the first case. Case 1: A 61-year-old woman with papillary thyroid carcinoma-follicular variant (PTC-FV) presented with scapular metastasis. After thyroidectomy and scapulectomy, a 131I posttherapy scan showed left upper quadrant uptake. A 3.0-cm metastatic PTC-FV deposit was removed by partial nephrectomy. Case 2: A 53-year-old woman presented with back pain. A computed tomography (CT) scan showed a 3.5-cm renal mass, a multinodular goiter, and lung metastases thought secondary to a renal cell carcinoma. A unilateral nephrectomy revealed metastatic PTC-FV. After thyroidectomy, a 131I posttherapy scan showed lung and skeletal metastases. NIS immunoreactivity in tumoral tissue was strongly positive in the primary tumor, shoulder, and kidney metastasis in case 1, as well as in the primary tumor in case 2. Spotty, low-level NIS expression was observed in the kidney metastasis in case 2. In conclusion, kidney metastases of PTC-FV may occasionally retain adequate levels of NIS expression, enabling their detection during life. Thus, intense uptake in the abdomen during 131I imaging should not be assumed to be physiological gastrointestinal tract residual radionuclide activity.
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Affiliation(s)
- R C Smallridge
- Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Shapiro B, Rufini V, Jarwan A, Geatti O, Kearfott KJ, Fig LM, Kirkwood ID, Gross MD. Artifacts, anatomical and physiological variants, and unrelated diseases that might cause false-positive whole-body 131-I scans in patients with thyroid cancer. Semin Nucl Med 2000; 30:115-32. [PMID: 10787192 DOI: 10.1053/nm.2000.5414] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The whole body 131-I scan remains an important component in the postoperative treatment of patients with well-differentiated thyroid cancer. Because normal thyroid tissue remnants and residual or metastatic foci of well-differentiated thyroid cancer have the unique ability to concentrate, organify, and store 131-I, the whole body scan provides a depiction of those tissues that can be ablated with therapeutic doses of 131-I. Over time, it has become obvious that the whole body scan may also reveal foci of 131-i uptake owing to a wide variety of other causes. We provide a detailed pathophysiological classification of the artifacts, anatomic and physiological variants, and nonthyroidal diseases that may give rise to false-positive whole body scans in postoperative patients with thyroid cancer. These include ectopic foci of normal thyroid tissue; nonthyroidal physiological sites (eg, choroid plexus, salivary glands, gastric mucosa, urinary tract); contamination by physiological sections; ectopic gastric mucosa; other gastrointestinal abnormalities; urinary tract abnormalities; mammary abnormalities; serous cavities and cysts; inflammation and infection; nonthyroidal neoplasms; and currently unexplained causes. This article also provides a detailed review of the widely scattered English language literature in which these phenomena were originally described.
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Affiliation(s)
- B Shapiro
- University of Michigan, Department of Veterans' Affairs Health Systems, Department of Internal Medicine, Ann Arbor 48109-0028, USA
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