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Campennì A, Avram AM, Verburg FA, Iakovou I, Hänscheid H, de Keizer B, Petranović Ovčariček P, Giovanella L. The EANM guideline on radioiodine therapy of benign thyroid disease. Eur J Nucl Med Mol Imaging 2023; 50:3324-3348. [PMID: 37395802 PMCID: PMC10542302 DOI: 10.1007/s00259-023-06274-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/18/2023] [Indexed: 07/04/2023]
Abstract
This document provides the new EANM guideline on radioiodine therapy of benign thyroid disease. Its aim is to guide nuclear medicine physicians, endocrinologists, and practitioners in the selection of patients for radioiodine therapy. Its recommendations on patients' preparation, empiric and dosimetric therapeutic approaches, applied radioiodine activity, radiation protection requirements, and patients follow-up after administration of radioiodine therapy are extensively discussed.
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Affiliation(s)
- Alfredo Campennì
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, Messina, Italy
| | - Anca M Avram
- Departments of Radiology and Medicine, MetroHealth Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Frederik A Verburg
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
| | - Ioannis Iakovou
- Academic Department of Nuclear Medicine, University Hospital AHEPA, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Academic Department of Nuclear Medicine, General Hospital Papageorgiou, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Heribert Hänscheid
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Luca Giovanella
- Clinic for Nuclear Medicine, Ente Ospedaliero Cantonale, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
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2
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Abstract
Radioiodine uptake (RAIU) test with iodine-123 (Na[123I]I) or iodine-131 (Na[131I]I) enables accurate evaluation and quantification of iodine uptake and kinetics within thyroid cells. Thyroid Scintigraphy (TS) employing Na[123I]I or 99mTc-pertechnetate (Na[99mTc]TcO4) provides information regarding the function and topographical distribution of thyroid cells activity, including detection and localization of ectopic thyroid tissue. Destructive thyrotoxicosis is characterized by low RAIU with scintigraphically reduced radiotracer activity in the thyroid tissue, while productive thyrotoxicosis (i.e. hyperthyroidism "stricto sensu") is characterized by high RAIU with scintigraphically diffuse (i.e. Graves' Disease, GD and diffuse thyroid autonomy) or focal (i.e. autonomously functioning thyroid nodules, AFTN) overactivity. Accordingly, RAIU and/or TS are widely used to differentiate different causes of thyrotoxicosis. In addition, several radiopharmaceuticals are also available to help differentiate benign from malignant thyroid nodules and inform clinical decision-making: scintigraphic identification of AFTNs obviate fine-needle aspiration (FNA) biopsy, and [99mTc]Tc-hexakis-(2‑methoxy-2-isobutyl isonitrile ([99mTc]Tc-MIBI) and/or 18F-fluoro-d-glucose ([18F]FDG) may complement the work-up of cytologically indeterminate "cold" nodules for reducing the need for diagnostic lobectomies/thyroidectomies. Finally, RAIU studies are also useful for calculating the administered therapeutic activity of Na[131I]I to treat hyperthyroidism and euthyroid multinodular goiter. All considered, thyroid molecular imaging allows functional characterization of different thyroid diseases, even before clinical symptoms become manifest, and remains integral to the management of such conditions. Our present paper summarizes basic concepts, clinical applications, and potential developments of thyroid molecular imaging in patients affected by thyrotoxicosis and thyroid nodules.
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Affiliation(s)
- Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland.
| | - Anca M Avram
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Division of Endocrinology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre milosrdnice", Zagreb, Croatia
| | - Jerome Clerc
- Department of Nuclear Medicine, Cochin Hospital, Assistance Publique Hôpitaux de Paris, DMU Imagina, University of Paris France
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3
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Avram AM, Giovanella L, Greenspan B, Lawson SA, Luster M, Van Nostrand D, Peacock JG, Ovčariček PP, Silberstein E, Tulchinsky M, Verburg FA, Vrachimis A. SNMMI Procedure Standard/EANM Practice Guideline for Nuclear Medicine Evaluation and Therapy of Differentiated Thyroid Cancer: Abbreviated Version. J Nucl Med 2022; 63:15N-35N. [PMID: 35649660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- Anca M Avram
- Departments of Radiology and Medicine, MetroHealth Hospital, Case Western Reserve University, Cleveland, OH
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
| | | | - Susan A Lawson
- Department of Radiology, Division of Nuclear Medicine, University of Michigan
| | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Germany
| | - Douglas Van Nostrand
- MedStar Health Research Institute and Washington Hospital Center, Georgetown University School of Medicine, Washington, DC
| | - Justin G Peacock
- Department of Diagnostic Radiology, Brooke Army Medical Center, JBSA Fort Sam Houston, TX
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | | | - Mark Tulchinsky
- Milton S. Hershey Medical Center, Penn State University, Hershey, PA
| | - Frederik A Verburg
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands; and
| | - Alexis Vrachimis
- Department of Nuclear Medicine, German Oncology Center, University Hospital of the European University, Limassol, Cyprus
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4
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Ota Y, Avram AM. Nuclear medicine therapy of Plummer adenoma. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00176-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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5
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Ota Y, Avram AM. Graves’ disease. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00203-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Avram AM, Zukotynski K, Nadel HR, Giovanella LM. MANAGEMENT OF DIFFERENTIATED THYROID CANCER: THE STANDARD OF CARE. J Nucl Med 2021; 63:189-195. [PMID: 34413146 DOI: 10.2967/jnumed.121.262402] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/05/2021] [Indexed: 11/16/2022] Open
Abstract
In the past decade the management of differentiated thyroid cancer (DTC) underwent a paradigm shift towards the use of risk-stratification with the goal of maximizing benefit and minimizing morbidity of radioiodine (131I) therapy. 131I therapy is guided by information derived from surgical histopathology, molecular markers, postoperative diagnostic radioiodine scintigraphy and thyroglobulin (Tg) levels. 131I is used for diagnostic imaging and therapy of DTC based on physiologic sodium-iodine symporter expression in normal and neoplastic thyroid tissue. We summarize the essential information at the core of multidisciplinary DTC management, which emphasizes individualization of 131I therapy according to the patient's risk for tumor recurrence.
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Affiliation(s)
| | | | | | - Luca M Giovanella
- Clinic for Nuclear Medicine and Thyroid Competence Center, Imaging Institute of Southern Switzerland, Switzerland
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Sundin A, Hindié E, Avram AM, Tabarin A, Pacak K, Taïeb D. A Clinical Challenge: Endocrine and Imaging Investigations of Adrenal Masses. J Nucl Med 2021; 62:26S-33S. [PMID: 34230070 DOI: 10.2967/jnumed.120.246066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/26/2020] [Indexed: 11/16/2022] Open
Abstract
Incidentalomas are reported in 3%-4% of patients who undergo abdominal anatomic imaging, making adrenal mass evaluation a common occurrence. An adrenal mass can be caused by a variety of pathologies, such as benign cortical and medullary tumors, malignant tumors (primary or secondary), cysts, hyperplasia, hemorrhage, or more rarely infection/inflammation processes. Functioning tumors usually have increased hormonal production but they are less common. Regardless of their functional status, some tumors have the potential to behave aggressively. Anatomic and functional imaging together with biologic evaluation play a vital role in adrenal pathology subtyping. Most patients are initially evaluated by CT or MRI, which allows for tumor characterization (to a certain extent) and can rule out malignant behavior based on the absence of tumor growth during longitudinal follow-up. In the remaining patients for whom CT or MRI fail to characterize the pathogenesis of adrenal tumors, the use of specialized molecular imaging techniques should be performed after hormonal screening. This review emphasizes well-established and emerging nuclear medicine imaging modalities and describes their use across various clinical scenarios.
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Affiliation(s)
- Anders Sundin
- Section of Radiology & Molecular Imaging, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Elif Hindié
- Department of Nuclear Medicine, University Hospital of Bordeaux, Bordeaux, France
| | - Anca M Avram
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Antoine Tabarin
- Department of Endocrinology, University Hospital of Bordeaux, Bordeaux, France
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health, Bethesda, Maryland; and
| | - David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, France
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Hindié E, Schwartz P, Avram AM, Imperiale A, Sebag F, Taïeb D. Primary Hyperparathyroidism: Defining the Appropriate Preoperative Imaging Algorithm. J Nucl Med 2021; 62:3S-12S. [PMID: 34230072 DOI: 10.2967/jnumed.120.245993] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/21/2020] [Indexed: 11/16/2022] Open
Abstract
Primary hyperparathyroidism is a common and potentially debilitating endocrine disorder for which surgery is the only curative treatment. Preoperative imaging is always recommended, even in cases of conventional bilateral neck exploration, with a recognized role for 99mTc-sestamibi scintigraphy in depicting ectopic parathyroid lesions. Scintigraphy can also play a major role in guiding a targeted, minimally invasive parathyroidectomy. However, the ability to recognize multiple-gland disease (MGD) varies greatly depending on the imaging protocol used. Preoperative diagnosis of MGD is important to reduce the risks of conversion to bilateral surgery or failure. In this article we discuss imaging strategies before first surgery as well as in the case of repeat surgery for persistent or recurrent primary hyperparathyroidism. We describe a preferred algorithm and alternative options. Dual-tracer 99mTc-sestamibi/123I subtraction scanning plus neck ultrasound is the preferred first-line option. This approach should improve MGD detection and patient selection for minimally invasive parathyroidectomy. Second-line imaging procedures in case of negative or discordant first-line imaging results are presented. High detection rates can be obtained with 18F-fluorocholine PET/CT or with 4-dimensional CT. The risk of false-positive results should be kept in mind, however. Adding a contrast-enhanced arterial-phase CT acquisition to conventional 18F-fluorocholine PET/CT can be a way to improve accuracy. We also briefly discuss other localization procedures, including 11C-methionine PET/CT, MRI, ultrasound-guided fine-needle aspiration, and selective venous sampling for parathyroid hormone measurement.
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Affiliation(s)
- Elif Hindié
- Department of Nuclear Medicine, University Hospitals of Bordeaux, TRAIL, University of Bordeaux, Bordeaux, France;
| | - Paul Schwartz
- Department of Nuclear Medicine, University Hospitals of Bordeaux, TRAIL, University of Bordeaux, Bordeaux, France
| | - Anca M Avram
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Alessio Imperiale
- Nuclear Medicine and Molecular Imaging, ICANS, University Hospitals of Strasbourg, University of Strasbourg, IPHC, Strasbourg, France
| | - Frederic Sebag
- Endocrine Surgery, La Timone Hospital, Aix-Marseille University, Marseille, France; and
| | - David Taïeb
- Nuclear Medicine, La Timone Hospital, CERIMED, Aix-Marseille University, Marseille, France
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Gulec SA, Ahuja S, Avram AM, Bernet VJ, Bourguet P, Draganescu C, Elisei R, Giovanella L, Grant F, Greenspan B, Hegedüs L, Jonklaas J, Kloos RT, Luster M, Oyen WJG, Smit J, Tuttle RM. A Joint Statement from the American Thyroid Association, the European Association of Nuclear Medicine, the European Thyroid Association, the Society of Nuclear Medicine and Molecular Imaging on Current Diagnostic and Theranostic Approaches in the Management of Thyroid Cancer. Thyroid 2021; 31:1009-1019. [PMID: 33789450 DOI: 10.1089/thy.2020.0826] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: The American Thyroid Association (ATA), the European Association of Nuclear Medicine, the European Thyroid Association, and the Society of Nuclear Medicine and Molecular Imaging have established an intersocietal working group to address the current controversies and evolving concepts in thyroid cancer management and therapy. The working group annually identifies topics that may significantly impact clinical practice and publishes expert opinion articles reflecting intersocietal collaboration, consensus, and suggestions for further research to address these important management issues. Summary: In 2019, the intersocietal working group identified the following topics for review and interdisciplinary discussion: (i) perioperative risk stratification, (ii) the role of diagnostic radioactive iodine (RAI) imaging in initial staging, and (iii) indicators of response to RAI therapy. Conclusions: The intersocietal working group agreed that (i) initial patient management decisions should be guided by perioperative risk stratification that should include the eighth edition American Joint Committee on Cancer staging system to predict disease specific mortality, the modified 2009 ATA risk stratification system to estimate structural disease recurrence, with judicious incorporation of molecular theranostics to further refine management recommendations; (ii) diagnostic RAI scanning in ATA intermediate risk patients should be utilized selectively rather than being considered mandatory or not necessary for all patients in this category; and (iii) a consistent semiquantitative reporting system should be used for response evaluations after RAI therapy until a reproducible and clinically practical quantitative system is validated.
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Affiliation(s)
- Seza A Gulec
- Aventura Hospital and Medical Center, Aventura, Florida, USA
- Miami Cancer Research Center, North Miami, Florida, USA
- Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia, USA
| | - Sukhjeet Ahuja
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia, USA
| | - Anca M Avram
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia, USA
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Victor J Bernet
- Mayo Clinic College of Medicine, Jacksonville, Florida, USA
- American Thyroid Association, Falls Church, Virginia, USA
| | - Patrick Bourguet
- University Hospital of Martinique, University of Antilles, Pointe-à-Pitre, France
| | - Ciprian Draganescu
- University Hospital of Martinique, University of Antilles, Pointe-à-Pitre, France
| | - Rosella Elisei
- Department of Endocrinology, University of Pisa, Pisa, Italy
- The European Thyroid Association, Altdorf, Germany
| | - Luca Giovanella
- Clinic of Nuclear Medicine and Thyroid Centre, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Nuclear Medicine, University of Zürich, Zürich, Switzerland
- The European Association of Nuclear Medicine, Vienna, Austria
| | - Frederick Grant
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia, USA
- Joint Program in Nuclear Medicine, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bennett Greenspan
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia, USA
| | - Laszlo Hegedüs
- The European Thyroid Association, Altdorf, Germany
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Jacqueline Jonklaas
- American Thyroid Association, Falls Church, Virginia, USA
- Division of Endocrinology, Georgetown University, Washington, District of Columbia, USA
| | | | - Markus Luster
- The European Association of Nuclear Medicine, Vienna, Austria
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Wim J G Oyen
- The European Association of Nuclear Medicine, Vienna, Austria
- Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Biomedical Sciences and Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
- Department of Nuclear Medicine, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
- Department of Radiology and Nuclear Medicine and Radboud UMC, Nijmegen, The Netherlands
| | - Johannes Smit
- The European Thyroid Association, Altdorf, Germany
- Department of Internal Medicine, Radboud UMC, Nijmegen, The Netherlands
| | - R Michael Tuttle
- American Thyroid Association, Falls Church, Virginia, USA
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Bartel Chair TB, Magerefteh S, Avram AM, Balon HR, De Blanche LE, Dadparvar S, Johnston M, Moreau S. SNMMI Procedure Standard for Scintigraphy for Differentiated Thyroid Cancer. J Nucl Med Technol 2021; 48:202-209. [PMID: 32883775 DOI: 10.2967/jnmt.120.243626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - Anca M Avram
- University of Michigan Medical Center, Ann Arbor, Michigan
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11
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Verburg FA, Ahuja S, Avram AM, Bardiès M, Bernet V, Bourguet P, Führer-Sakel D, Draganescu C, Daniels GH, Greenspan B, Gulec S, Hegedüs L, Jonklaas J, Luster M, Oyen W, Smit J, Tuttle RM, Zerdoud S, Van Nostrand D. Brief progress report from the intersocietal working group on differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 2021; 47:1345-1347. [PMID: 32166513 PMCID: PMC7188695 DOI: 10.1007/s00259-020-04744-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Frederik A Verburg
- Department of Nuclear Medicine, University Hospital Marburg, Baldinger Straße, 35043, Marburg, Germany.
| | | | - Anca M Avram
- University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Manuel Bardiès
- Centre de Recherches en Cancérologie de Toulouse and UMR 1037, INSERM, Université Toulouse III Paul Sabatier, Toulouse, France
| | | | - Patrick Bourguet
- University Hospital of Martinique, University of Antilles, Pointe-à-Pitre, France
| | | | - Ciprian Draganescu
- University Hospital of Martinique, University of Antilles, Pointe-à-Pitre, France
| | - Gilbert H Daniels
- Thyroid Unit and Cancer Center Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Seza Gulec
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | | | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Baldinger Straße, 35043, Marburg, Germany
| | - Wim Oyen
- European Association of Nuclear Medicine, Vienna, Austria
- Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Nuclear Medicine, Humanitas Clinical and Research Center, Milan, Italy
- Department of Radiology and Nuclear Medicine, Radboud UMC, Nijmegen, The Netherlands
| | - Johannes Smit
- Department of Internal Medicine, Radboud UMC, Nijmegen, The Netherlands
| | - R Michael Tuttle
- Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Slimane Zerdoud
- Department of Nuclear Medicine, University Cancer Center Toulouse Oncopole, Toulouse, France
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Abstract
CONTEXT Adrenal tumors in noncancer patients are common. OBJECTIVE Evaluate performance of 18F-fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG-PET/CT) in distinguishing between benign and malignant adrenal tumors. DESIGN Retrospective chart review 2010-2019. SETTING Academic institution. PATIENTS One hundred and seventeen noncancer patients, defined as having no history of cancer or with cancer in remission for ≥5 years, completed 18F-FDG-PET/CT to evaluate adrenal masses, with pathologic diagnoses or imaging follow-up (≥12 months). INTERVENTION 18F-FDG-PET/CT of 117 indeterminate adrenal masses. MAIN OUTCOME MEASURES Receiver operator characteristic curve of the ratios of adrenal lesion standardized uptake value (SUV)max to liver SUVmean and of adrenal lesion SUVmax to aortic arch blood pool SUVmean were constructed. RESULTS Seventy benign and 47 malignant masses (35 adrenocortical carcinomas [ACCs], 12 adrenal metastases) were identified. Malignant masses had higher median liver SUV and blood pool SUV ratios than benign masses (6.2 and 7.4 vs 1.4 and 2.0, P < .001). Median liver and blood pool SUV ratios of ACC (6.1 and 7.3, respectively) and metastases (6.7 and 7.7, respectively) were higher than those of than adenomas (1.4 and 2.2, P < .05 for all comparisons). Optimal liver SUV ratio to discern between benign and malignant masses was 2.5, yielding 85% sensitivity, 90% specificity, and 7 false negative results (including 3 ACCs). Optimal blood pool SUV ratio was 3.4, yielding 83% sensitivity, 90% specificity, and 8 false negative results (including 4 ACCs). CONCLUSION When used in conjunction with other clinical assessments, 18F-FDG-PET/CT can be a valuable tool in evaluating adrenal masses in noncancer patients.
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Affiliation(s)
- Xin He
- Department of Internal Medicine, Division of Metabolism, Endocrinology & Diabetes University of Michigan, Ann Arbor, MI, USA
| | - Elaine M Caoili
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Anca M Avram
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Barbra S Miller
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Tobias Else
- Department of Internal Medicine, Division of Metabolism, Endocrinology & Diabetes University of Michigan, Ann Arbor, MI, USA
- Correspondence: Tobias Else, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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13
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Jha A, Taïeb D, Carrasquillo JA, Pryma DA, Patel M, Millo C, de Herder WW, Del Rivero J, Crona J, Shulkin BL, Virgolini I, Chen AP, Mittal BR, Basu S, Dillon JS, Hope TA, Mari Aparici C, Iagaru AH, Hicks RJ, Avram AM, Strosberg JR, Civelek AC, Lin FI, Pandit-Taskar N, Pacak K. High-Specific-Activity- 131I-MIBG versus 177Lu-DOTATATE Targeted Radionuclide Therapy for Metastatic Pheochromocytoma and Paraganglioma. Clin Cancer Res 2021; 27:2989-2995. [PMID: 33685867 DOI: 10.1158/1078-0432.ccr-20-3703] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/14/2020] [Accepted: 03/03/2021] [Indexed: 12/17/2022]
Abstract
Targeted radionuclide therapies (TRT) using 131I-metaiodobenzylguanidine (131I-MIBG) and peptide receptor radionuclide therapy (177Lu or 90Y) represent several of the therapeutic options in the management of metastatic/inoperable pheochromocytoma/paraganglioma. Recently, high-specific-activity-131I-MIBG therapy was approved by the FDA and both 177Lu-DOTATATE and 131I-MIBG therapy were recommended by the National Comprehensive Cancer Network guidelines for the treatment of metastatic pheochromocytoma/paraganglioma. However, a clinical dilemma often arises in the selection of TRT, especially when a patient can be treated with either type of therapy based on eligibility by MIBG and somatostatin receptor imaging. To address this problem, we assembled a group of international experts, including oncologists, endocrinologists, and nuclear medicine physicians, with substantial experience in treating neuroendocrine tumors with TRTs to develop consensus and provide expert recommendations and perspectives on how to select between these two therapeutic options for metastatic/inoperable pheochromocytoma/paraganglioma. This article aims to summarize the survival outcomes of the available TRTs; discuss personalized treatment strategies based on functional imaging scans; address practical issues, including regulatory approvals; and compare toxicities and risk factors across treatments. Furthermore, it discusses the emerging TRTs.
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Affiliation(s)
- Abhishek Jha
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland
| | - David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, Marseille, France
| | - Jorge A Carrasquillo
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Daniel A Pryma
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mayank Patel
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland
| | - Corina Millo
- Department of Positron Emission Tomography, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Wouter W de Herder
- Section of Endocrinology, Department of Internal Medicine, ENETS Centre of Excellence, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, the Netherlands
| | - Jaydira Del Rivero
- Developmental Therapeutics Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Joakim Crona
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Irene Virgolini
- Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Alice P Chen
- Division of Cancer Treatment and Diagnosis, NCI, NIH, Bethesda, Maryland
| | - Bhagwant R Mittal
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Joseph S Dillon
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Carina Mari Aparici
- Divisions of Nuclear Medicine and Molecular Imaging, Stanford University School of Medicine, Stanford, California
| | - Andrei H Iagaru
- Divisions of Nuclear Medicine and Molecular Imaging, Stanford University School of Medicine, Stanford, California
| | - Rodney J Hicks
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Anca M Avram
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Jonathan R Strosberg
- Division of Neuroendocrine Tumor/Department of Gastrointestinal Medicine, Moffitt Cancer Center, Tampa, Florida
| | - Ali Cahid Civelek
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Baltimore, Maryland
| | - Frank I Lin
- Molecular Imaging Program, NCI, NIH, Bethesda, Maryland
| | - Neeta Pandit-Taskar
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York. .,Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland.
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14
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Donohoe KJ, Aloff J, Avram AM, Bennet KG, Giovanella L, Greenspan B, Gulec S, Hassan A, Kloos RT, Solórzano CC, Stack BC, Tulchinsky M, Tuttle RM, Van Nostrand D, Wexler JA. Appropriate Use Criteria for Nuclear Medicine in the Evaluation and Treatment of Differentiated Thyroid Cancer. J Nucl Med 2020; 61:375-396. [PMID: 32123131 DOI: 10.2967/jnumed.119.240945] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
- Kevin J Donohoe
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | | | - Anca M Avram
- American College of Nuclear Medicine, Reston, Virginia
| | - K G Bennet
- American College of Nuclear Medicine, Reston, Virginia
| | | | | | - Seza Gulec
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Aamna Hassan
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | | | | | | | - Mark Tulchinsky
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
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15
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Abstract
PURPOSE OF REVIEW Ectopic adrenocorticotropic hormone (ACTH)-secreting tumors are commonly small, yet they often lead to fulminant forms of Cushing syndrome. High-resolution functional imaging modalities, such as [Ga]-DOTATATE, have been recently introduced in clinical practice for the identification of neuroendocrine tumors. In this review, we focus on the performance of [Ga]-DOTATATE as a tool for localizing primary and metastatic sources of ectopic Cushing syndrome (ECS). RECENT FINDINGS Prompt surgical removal of ectopic ACTH-secreting tumors is the mainstay of therapy in patients with ECS. Detecting such tumors with conventional cross-sectional imaging is often unsuccessful, owing to their small size. [Ga]-DOTATATE has been approved in 2016 by the Federal Drug Administration for imaging well differentiated neuroendocrine tumors. Data regarding the performance of [Ga]-DOTATATE for detecting ectopic ACTH-secreting tumors remain limited, in part owing to the recent introduction of this imaging modality in clinical practice, and in part because of the low prevalence of ECS. Nevertheless, [Ga]-DOTATATE has been reported to be useful in identifying primary and metastatic ectopic ACTH-secreting lesions that were not apparent on other imaging studies, impacting the clinical care of many patients with ECS. SUMMARY [Ga]-DOTATATE-based imaging, which targets the somatostatin receptors abundantly expressed in neuroendocrine tumors, has generally high, although variable resolution in detecting the source(s) of ECS.
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Affiliation(s)
- Seda Grigoryan
- Department of Internal Medicine, Michigan State University, East Lasing
| | | | - Adina F Turcu
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, USA
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16
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Hindié E, Ain KB, Zerdoud S, Avram AM. Association of Radioactive Iodine Treatment of Hyperthyroidism With Cancer Mortality: An Unjustified Warning? J Clin Endocrinol Metab 2020; 105:5687008. [PMID: 31875905 DOI: 10.1210/clinem/dgz305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/21/2019] [Indexed: 02/13/2023]
Affiliation(s)
- Elif Hindié
- Department of Nuclear Medicine, Bordeaux University Hospitals, Hôpital Haut-Lévêque, Pessac, France
| | - Kenneth B Ain
- Department of Internal Medicine, Thyroid Oncology Program, University of Kentucky, Lexington, Kentucky, US
| | - Slimane Zerdoud
- Department of Nuclear Medicine, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Anca M Avram
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, University of Michigan, Ann Arbor, Michigan, US
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17
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Giovanella L, Avram AM, Iakovou I, Kwak J, Lawson SA, Lulaj E, Luster M, Piccardo A, Schmidt M, Tulchinsky M, Verburg FA, Wolin E. EANM practice guideline/SNMMI procedure standard for RAIU and thyroid scintigraphy. Eur J Nucl Med Mol Imaging 2019; 46:2514-2525. [DOI: 10.1007/s00259-019-04472-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 07/29/2019] [Indexed: 12/15/2022]
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18
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Wannachalee T, Turcu AF, Bancos I, Habra MA, Avram AM, Chuang HH, Waguespack SG, Auchus RJ. The Clinical Impact of [ 68 Ga]-DOTATATE PET/CT for the Diagnosis and Management of Ectopic Adrenocorticotropic Hormone - Secreting Tumours. Clin Endocrinol (Oxf) 2019; 91:288-294. [PMID: 31066920 PMCID: PMC6689243 DOI: 10.1111/cen.14008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/17/2019] [Accepted: 05/07/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Localization of ectopic ACTH-secreting tumours causing Cushing syndrome (ECS) is essential for clinical management, yet often difficult. [68 Ga]-DOTATATE PET/CT ([68 Ga]-DOTA-(Tyr3 )-octreotate)] is an FDA-approved high-resolution diagnostic tool for imaging neuroendocrine tumours. Data on the clinical utility of [68 Ga]-DOTATATE in patients with ECS, however, are scarce. The objectives of this study were to determine the efficacy for ECS localization and the clinical benefit of [68 Ga]-DOTATATE imaging. METHOD We conducted a retrospective review of all cases with ECS evaluated with [68 Ga]-DOTATATE from November 2016 through October 2018 at three referral centres. The clinical benefit of [68 Ga]-DOTATATE was based on detection of new tumours and resultant changes in management. RESULTS Over the study period, 28 patients with ECS underwent [68 Ga]-DOTATATE: 17 for identification of the primary tumour and 11 during follow-up. [68 Ga]-DOTATATE identified the suspected primary ECS in 11/17 patients (65%). Of these, nine patients underwent surgery: eight with confirmed ECS (5 bronchial, 1 thymic, 1 pancreatic and 1 metastatic neuroendocrine tumour of unknown primary origin) and one patient with a false-positive scan (adrenal gland). Of the 11 patients with ECS who underwent [68 Ga]-DOTATATE evaluation during follow-up, the study led to changes in clinical management in 7/11 (64%) patients. CONCLUSIONS [68 Ga]-DOTATATE is sensitive in detecting primary and metastatic ECS, often identifies occult tumours after conventional imaging, and impacts clinical care in the majority of patients.
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Affiliation(s)
- Taweesak Wannachalee
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
- Division of Endocrinology and Metabolism, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Adina F. Turcu
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism & Nutrition, Mayo Clinic Rochester, MN, USA
| | - Mouhammed Amir Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anca M. Avram
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Hubert H. Chuang
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven G. Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard J. Auchus
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA
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19
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20
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Greenspan BS, Ahuja S, Avram AM, Gulec S, Van Nostrand D. Overview of the Martinique Meetings: What Has Been Established and Where Are We Going? J Nucl Med 2019; 60:15N. [PMID: 31160431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
| | | | | | - Seza Gulec
- Florida International University, Miami, FL
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21
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Hindié E, Giovanella L, Taïeb D, Avram AM. Thyroid cancer recurrence in the HiLo trial. Lancet Diabetes Endocrinol 2019; 7:252. [PMID: 30902264 DOI: 10.1016/s2213-8587(19)30070-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/16/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Elif Hindié
- Nuclear Medicine Department, Bordeaux University Hospital, Pessac 33604, France.
| | - Luca Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - David Taïeb
- Department of Nuclear Medicine, Aix-Marseille University, France
| | - Anca M Avram
- Department of Nuclear Medicine, University of Michigan, Ann Arbor, MI, USA
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22
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Tuttle RM, Ahuja S, Avram AM, Bernet VJ, Bourguet P, Daniels GH, Dillehay G, Draganescu C, Flux G, Führer D, Giovanella L, Greenspan B, Luster M, Muylle K, Smit JWA, Van Nostrand D, Verburg FA, Hegedüs L. Controversies, Consensus, and Collaboration in the Use of 131I Therapy in Differentiated Thyroid Cancer: A Joint Statement from the American Thyroid Association, the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the European Thyroid Association. Thyroid 2019; 29:461-470. [PMID: 30900516 DOI: 10.1089/thy.2018.0597] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Publication of the 2015 American Thyroid Association (ATA) management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer was met with disagreement by the extended nuclear medicine community with regard to some of the recommendations related to the diagnostic and therapeutic use of radioiodine (131I). Because of these concerns, the European Association of Nuclear Medicine and the Society of Nuclear Medicine and Molecular Imaging declined to endorse the ATA guidelines. As a result of these differences in opinion, patients and clinicians risk receiving conflicting advice with regard to several key thyroid cancer management issues. SUMMARY To address some of the differences in opinion and controversies associated with the therapeutic uses of 131I in differentiated thyroid cancer constructively, the ATA, the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the European Thyroid Association each sent senior leadership and subject-matter experts to a two-day interactive meeting. The goals of this first meeting were to (i) formalize the dialogue and activities between the four societies; (ii) discuss indications for 131I adjuvant treatment; (iii) define the optimal prescribed activity of 131I for adjuvant treatment; and (iv) clarify the definition and classification of 131I-refractory thyroid cancer. CONCLUSION By fostering an open, productive, and evidence-based discussion, the Martinique meeting restored trust, confidence, and a sense of collegiality between individuals and organizations that are committed to optimal thyroid disease management. The result of this first meeting is a set of nine principles (The Martinique Principles) that (i) describe a commitment to proactive, purposeful, and inclusive interdisciplinary cooperation; (ii) define the goals of 131I therapy as remnant ablation, adjuvant treatment, or treatment of known disease; (iii) describe the importance of evaluating postoperative disease status and multiple other factors beyond clinicopathologic staging in 131I therapy decision making; (iv) recognize that the optimal administered activity of 131I adjuvant treatment cannot be definitely determined from the published literature; and (v) acknowledge that current definitions of 131I-refractory disease are suboptimal and do not represent definitive criteria to mandate whether 131I therapy should be recommended.
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Affiliation(s)
- R Michael Tuttle
- 1 Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Sukhjeet Ahuja
- 2 Evidence and Quality, Society of Nuclear Medicine and Molecular Imaing, Reston, Virginia
| | - Anca M Avram
- 3 Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Victor J Bernet
- 4 Division of Endocrinology, Mayo Clinic College of Medicine, Jacksonville, Florida
| | - Patrick Bourguet
- 5 Department of Nuclear Medicine, University Hospital of Martinique, Fort de France, Martinique
- 6 University of Antilles, Pointe-à-Pitre, Guadeloupe
| | - Gilbert H Daniels
- 7 Thyroid Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Gary Dillehay
- 8 Department of Nuclear Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Ciprian Draganescu
- 5 Department of Nuclear Medicine, University Hospital of Martinique, Fort de France, Martinique
| | - Glenn Flux
- 9 Department of Physics, Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
| | - Dagmar Führer
- 10 Department of Endocrinology and Metabolism, University Hospital Essen, Essen, Germany
| | - Luca Giovanella
- 11 Clinic of Nuclear Medicine and Thyroid Center, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- 12 Clinic for Nuclear Medicine, University of Zürich, Zürich, Switzerland
| | | | - Markus Luster
- 14 Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Kristoff Muylle
- 15 Department of Nuclear Medicine, University Hospital Brussels (UZ Brussel, VUB), Brussels, Belgium
- 16 European Association of Nuclear Medicine, Vienna, Austria
| | - Johannes W A Smit
- 17 Department of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Douglas Van Nostrand
- 18 Georgetown University School of Medicine, Washington Hospital Center, Washington, DC
| | - Frederik A Verburg
- 14 Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Laszlo Hegedüs
- 19 Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
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23
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Wong KK, Shulkin BL, Gross MD, Avram AM. Efficacy of radioactive iodine treatment of graves' hyperthyroidism using a single calculated 131I dose. Clin Diabetes Endocrinol 2018; 4:20. [PMID: 30505461 PMCID: PMC6260735 DOI: 10.1186/s40842-018-0071-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 11/12/2018] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate the success rate of therapeutic administration of a single calculated 131I activity for eliminating hyperthyroidism due to Graves’ disease. Methods and materials Patients with Graves’ hyperthyroidism underwent pinhole thyroid imaging, 24-h radioactive iodine uptake (RAIU) measurements and clinical examination and received a calculated 131I activity of 0.2 mCi per estimated gram of thyroid tissue, adjusted for the 24-h RAIU. The goal of RAI treatment was to achieve hypothyroidism within 3–6 months of 131I administration. Response to RAI therapy was assessed at 7 weeks and 3 months by clinical and biochemical follow-up. Results The study included 316 hyperthyroid patients with Graves’ disease (F238:M78, mean age 42.1 ± 16 y, 4–94). 179 patients (56.6%) had no prior therapeutic intervention (treatment-naive patients), whereas 6 patients had prior thyroid surgery, and 131 (41.5%) had been treated with anti-thyroid medications. The mean estimated thyroid gland size was 50.2 g ± 18, range 15–100. Mean RAIU was 0.57 ± 0.17 (normal 0.07–0.30). RAI doses ranged from 5 to 70 mCi (mean dose = 18.1 mCi). Successful treatment of hyperthyroidism at our institution was obtained after a single therapeutic 131-I activity administration in 295 of 316 (93.3%) patients. Multivariate logistic regression analysis demonstrated that failure of 131I therapy was associated with previous PTU therapy (p < 0.001). The mean response time after successful RAI therapy was 110.2 days, with cumulative response of 25% at 61 days, 50% by 84 days and 75% by 118 days after radioiodine administration. The mean time to respond for those on prior PTU medications was 297 days compared to 116 days for those on MMI and 109 days for those not previously treated with antithyroid medications. In patients with persistent hyperthyroidism, failure of RAI therapy was documented in 16 patients (76.2%) within (less than) one year after 131I administration and in 5 patients (23.8%) more than one year after initial therapy, considered late failure. Conclusion Successful 131I therapy for Graves’ hyperthyroidism with a single calculated dose can be achieved in the majority (> 90%) of patients, adjusting for the thyroid size and 24 h uptake measurement.
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Affiliation(s)
- Ka Kit Wong
- 1Nuclear Medicine/Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5028 USA
| | - Barry L Shulkin
- 2Nuclear Medicine/Radiology, St. Jude Children's Research Hospital, Memphis, TN 38105 USA
| | - Milton D Gross
- 1Nuclear Medicine/Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5028 USA.,Nuclear Medicine Service, Department of Veterans Affairs Health System, Ann Arbor, MI 48105 USA
| | - Anca M Avram
- 1Nuclear Medicine/Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5028 USA
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24
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Affiliation(s)
- Elif Hindié
- Nuclear Medicine Department, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - David Taïeb
- Department of Nuclear Medicine, Aix-Marseille University, La Timone University Hospital, 13005 Marseille, France.
| | - Anca M Avram
- Department of Nuclear Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Luca Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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25
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Abstract
Radiotheragnostics represents the systematic integration of diagnostic imaging and therapeutics using radionuclides targeting specific characteristics of tumor biology. Radioiodine (131I) is the classic radiotheragnostic agent used for the diagnosis and treatment of differentiated thyroid cancer (DTC) based on sodium-iodine symporter expression in normal and neoplastic thyroid tissue. Application of radiotheragnostics principles in thyroid cancer involves using pre-ablation diagnostic scans (Dx Scans) for detection of iodine-avid regional and distant metastatic disease and patient-individualized targeted 131I therapy with goal of maximizing the benefits of the first therapeutic 131I administration. Clinically available nuclear medicine imaging technology has significantly evolved over the past 10 years with the introduction of hybrid SPECT/CT and PET/CT systems, as well as advances in iterative image reconstruction with modeling of image degrading physical factors. This progress makes possible the acquisition of accurate diagnostic radioiodine scintigraphy capable of identifying regional and distant metastatic disease, which can be used for 131I treatment planning and delivery of activity adjusted 131I therapy for achieving intended treatment goals (e.g. remnant ablation, adjuvant 131 I treatment and targeted 131-I treatment). The overarching aim of thyroid cancer radiotheragnostics is to optimize the balance between 131I therapeutic efficacy and potential side-effects on non-target tissues.
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Affiliation(s)
- Anca M Avram
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yuni K Dewaraja
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
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26
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Hindié E, Récher C, Zerdoud S, Leenhardt L, Avram AM. Risk of Hematologic Malignancies After Radioactive Iodine Treatment of Thyroid Cancer: An Unjustified Warning. J Clin Oncol 2018; 36:1881-1882. [PMID: 29723097 DOI: 10.1200/jco.2018.78.1096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Elif Hindié
- Elif Hindié, Bordeaux University Hospitals, Hôpital Haut-Lévêque, Pessac, France; Christian Récher and Slimane Zerdoud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Laurence Leenhardt, Pitié Salpêtrière University Hospital, Paris, France; and Anca M. Avram, University of Michigan, Ann Arbor, MI
| | - Christian Récher
- Elif Hindié, Bordeaux University Hospitals, Hôpital Haut-Lévêque, Pessac, France; Christian Récher and Slimane Zerdoud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Laurence Leenhardt, Pitié Salpêtrière University Hospital, Paris, France; and Anca M. Avram, University of Michigan, Ann Arbor, MI
| | - Slimane Zerdoud
- Elif Hindié, Bordeaux University Hospitals, Hôpital Haut-Lévêque, Pessac, France; Christian Récher and Slimane Zerdoud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Laurence Leenhardt, Pitié Salpêtrière University Hospital, Paris, France; and Anca M. Avram, University of Michigan, Ann Arbor, MI
| | - Laurence Leenhardt
- Elif Hindié, Bordeaux University Hospitals, Hôpital Haut-Lévêque, Pessac, France; Christian Récher and Slimane Zerdoud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Laurence Leenhardt, Pitié Salpêtrière University Hospital, Paris, France; and Anca M. Avram, University of Michigan, Ann Arbor, MI
| | - Anca M Avram
- Elif Hindié, Bordeaux University Hospitals, Hôpital Haut-Lévêque, Pessac, France; Christian Récher and Slimane Zerdoud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Laurence Leenhardt, Pitié Salpêtrière University Hospital, Paris, France; and Anca M. Avram, University of Michigan, Ann Arbor, MI
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27
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Lager CJ, Koenig RJ, Lieberman RW, Avram AM. Rare Clinical Entity: Metastatic malignant struma ovarii diagnosed during pregnancy - Lessons for management. Clin Diabetes Endocrinol 2018; 4:13. [PMID: 29946481 PMCID: PMC6006564 DOI: 10.1186/s40842-018-0064-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/30/2018] [Indexed: 02/08/2023] Open
Abstract
Background Malignant struma ovarii is an ovarian teratoma containing at least 50% thyroid tissue which has the potential to metastasize and produce thyroid hormone. Given its rarity, management strategies are not well-established. We report a case of metastatic malignant struma ovarii discovered during pregnancy with lessons for evaluation and management. Case presentation A 30-year-old woman who was two months pregnant was discovered to have struma ovarii with over half of the struma comprised of papillary thyroid cancer. Following tumor resection, delivery, and thyroidectomy, she underwent evaluation with stimulated thyroglobulin testing and diagnostic staging sodium iodide-131 scan (I-131), which revealed the presence of skeletal metastases. Following administration of 320 mCi I-131, post-therapy scan also showed miliary pulmonary metastases with improved ability to localize the bony and pulmonary metastases with concurrent SPECT/CT imaging. A second dosimetry-guided I-131 therapy resulted in complete resolution of pulmonary metastases; however, small foci of residual bone disease persisted. Post-therapy scans demonstrated additional findings not shown on diagnostic I-131 scans obtained prior to both her initial and second I-131 therapy. Conclusions SPECT/CT provides accurate anatomic correlation and localization of metastatic foci and can serve as a baseline study to assess interval response to treatment. Post-therapy scans should always be obtained when I-131 treatment is administered, as additional findings may be revealed versus low dose I-131 activity diagnostic scans. This patient had a high metastatic burden that would not have been discovered in a timely fashion with the conservative approach advocated by others. Thyroidectomy followed by a diagnostic staging radioiodine scan and a stimulated thyroglobulin level should be considered in patients with malignant struma ovarii for guiding therapeutic I-131 administration as metastatic risk is difficult to predict based on histopathologic examination.
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Affiliation(s)
- Corey J Lager
- 1Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, 24 Frank Lloyd Drive, SPC 451. Domino's Farms Lobby C, Suite 1300, Ann Arbor, MI 48106 USA
| | - Ronald J Koenig
- 2Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Cancer Center Floor 1, 1500 E Medical Center Dr SPC 5354, Ann Arbor, MI 48109 USA
| | - Richard W Lieberman
- 3Department of Obstetrics and Gynecology and Department of Anatomic Pathology, University of Michigan, Von Voigtlander Hospital Floor 9 Clinic B, 1540 E Hospital Dr SPC 4276, Ann Arbor, MI 48109 USA
| | - Anca M Avram
- 4Department of Nuclear Medicine, University of Michigan, 1500 E Medical Center Dr, B1G505, Ann Arbor, MI 48109-5028 USA
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28
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Miller JE, Al-Attar NC, Brown OH, Shaughness GG, Rosculet NP, Avram AM, Hughes DT. Location and Causation of Residual Lymph Node Metastasis After Surgical Treatment of Regionally Advanced Differentiated Thyroid Cancer. Thyroid 2018; 28:593-600. [PMID: 29562827 DOI: 10.1089/thy.2017.0434] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND After initial surgical treatment of differentiated thyroid cancer (DTC) residual lymph node metastases are often found at the time of radioactive iodine (131I) therapy. Recurrence of DTC is due to persistent disease not removed at initial surgery which also did not respond to 131I treatment. This study aimed at determining locations of, and reasons for, residual nodal metastases detected by 131I scans with single-photon emission computed tomography (SPECT/CT) obtained prior to radioiodine therapy following surgical treatment of DTC. METHODS This is a retrospective study of 352 patients with intermediate and high-risk DTC treated with 131I therapy at the University of Michigan from 2007 to 2014. All patients underwent total thyroidectomy with or without lymph node dissection followed by radioiodine therapy. Pre-ablation diagnostic 131I scans with SPECT/CT were used postoperatively to localize nodal metastases, which were then compared with the cervical lymph node basins dissected at the time of surgery to determine the reason for residual nodal metastases: incomplete nodal dissection versus preoperative unrecognized nodal metastases. RESULTS Of the 352 patients in the study, 146 (41.5%) had residual nodal metastases detected on 131I scans with SPECT/CT following initial surgery but prior to 131I therapy. Among the 146 patients with residual disease, there were a total of 218 distinct nodal metastases. Relative to the primary tumor, 71.6% (n = 156) of metastases were ipsilateral, 22.0% (n = 48) were contralateral, and 6.4% (n = 14) were non-sided in the central neck (level VI/VII). Cervical lymph node levels VI, III, and II had the greatest frequencies of residual metastases (33.9%, 22.9%, 18.8%, respectively). Residual metastases occurred because of incomplete nodal dissection (49.3%), lack of preoperative identification (37.7%), or a combination of both (13%). CONCLUSION Residual nodal metastasis following initial surgical treatment for regionally advanced differentiated thyroid cancer is rather common on highly sensitive 131I scans with SPECT/CT and is due to both unrecognized nodal involvement preoperatively and incomplete removal of metastatic lymph nodes during compartment-orientated nodal dissection. The surgical management of high-risk DTC should include preoperative imaging to evaluate for nodal metastases in the central and lateral neck and compartment-orientated nodal dissection of involved compartments. Attention should be given to complete dissection in levels VI, III, and II, particularly when dissecting compartments ipsilateral to the primary tumor.
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Affiliation(s)
- Jessa E Miller
- 1 University of Michigan Medical School, University of Michigan Health System , Ann Arbor, Michigan
| | - Neal C Al-Attar
- 1 University of Michigan Medical School, University of Michigan Health System , Ann Arbor, Michigan
| | - Owen H Brown
- 1 University of Michigan Medical School, University of Michigan Health System , Ann Arbor, Michigan
| | - Gabrielle G Shaughness
- 1 University of Michigan Medical School, University of Michigan Health System , Ann Arbor, Michigan
| | - Natalja P Rosculet
- 1 University of Michigan Medical School, University of Michigan Health System , Ann Arbor, Michigan
| | - Anca M Avram
- 1 University of Michigan Medical School, University of Michigan Health System , Ann Arbor, Michigan
- 2 Department of Nuclear Medicine, University of Michigan Health System , Ann Arbor, Michigan
| | - David T Hughes
- 1 University of Michigan Medical School, University of Michigan Health System , Ann Arbor, Michigan
- 3 Department of Surgery, University of Michigan Health System , Ann Arbor, Michigan
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Roberson PL, Smith LB, Morgan MA, Schipper MJ, Wilderman SJ, Avram AM, Kaminski MS, Dewaraja YK. Beyond Dose: Using Pretherapy Biomarkers to Improve Dose Prediction of Outcomes for Radioimmunotherapy of Non-Hodgkin Lymphoma. Cancer Biother Radiopharm 2017; 32:309-319. [PMID: 29083933 DOI: 10.1089/cbr.2017.2182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Non-Hodgkin Lymphoma patients respond differently to therapy according to inherent biological variations. Pretherapy biomarkers may improve dose-response prediction. MATERIALS AND METHODS Hybrid single-photon emission computed tomography (SPECT)/computed tomography (CT) three-dimensional imaging at multiple time points plus follow-up positron emission tomography (PET)/CT or CT at 2 and 6 months post therapy were used to fit tumor response to combined biological effect and cell clearance models from which three biological effect response parameters (radiosensitivity, cold effect sensitivity, and proliferation potential) were determined per patient. A correlation of biological effect parameters and pretherapy biomarker data (ki67, p53, and phospho-histone H3) allowed a dose-based equivalent biological effect (EBE) to be calculated for each patient. RESULTS Significant correlations were found between biological effect parameters and pretherapy biomarkers. Optimum correlations were found by splitting the patient data according to p53 status. Response correlation of progression free survival (PFS) and EBE were significantly improved compared with PFS and absorbed dose alone. CONCLUSIONS It is possible and desirable to use pretherapy biomarkers to enhance the predictive potential of dose calculations for patient-specific treatment planning.
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Affiliation(s)
- Peter L Roberson
- 1 Department of Radiation Oncology, University of Michigan , Ann Arbor, Michigan
| | - Lauren B Smith
- 2 Department of Pathology, University of Michigan , Ann Arbor, Michigan
| | - Meredith A Morgan
- 1 Department of Radiation Oncology, University of Michigan , Ann Arbor, Michigan
| | - Matthew J Schipper
- 1 Department of Radiation Oncology, University of Michigan , Ann Arbor, Michigan
| | - Scott J Wilderman
- 3 Department of Radiology, University of Michigan , Ann Arbor, Michigan
| | - Anca M Avram
- 3 Department of Radiology, University of Michigan , Ann Arbor, Michigan
| | - Mark S Kaminski
- 4 Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan , Ann Arbor, Michigan
| | - Yuni K Dewaraja
- 3 Department of Radiology, University of Michigan , Ann Arbor, Michigan
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Ginat DT, Avram AM. Chapter 4 Thyroid Malignancy: Staging and Restaging. Semin Ultrasound CT MR 2017; 38:495-505. [PMID: 29031366 DOI: 10.1053/j.sult.2017.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Determining the extent of disease is necessary for guiding the management of thyroid carcinomas. Diagnostic imaging, including ultrasound, computed tomography, magnetic resonance imaging, and nuclear medicine scans, plays an essential role in staging and restaging of thyroid carcinomas. This article reviews the approaches and imaging findings for evaluating the primary tumor, regional lymph node metastases, and distant metastases. In addition, potential pitfalls are discussed and depicted.
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Affiliation(s)
- Daniel Thomas Ginat
- Department of Radiology, University of Chicago, Pritzker School of Medicine, Chicago, IL.
| | - Anca M Avram
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
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Tulchinsky M, Avram AM. Re: "Long-Term Outcomes of Patients with Papillary Thyroid Cancer Undergoing Remnant Ablation with 30 Millicurie Radioiodine" by Mujammami et al. (Thyroid 2016;26:951-958): Patient Cohort Definition Makes No Sense. Thyroid 2017; 27:591. [PMID: 27750025 DOI: 10.1089/thy.2016.0455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mark Tulchinsky
- 1 Department of Radiology, PennState Health, Milton S. Hershey Medical Center , Hershey, Pennsylvania
| | - Anca M Avram
- 2 Department of Radiology, University of Michigan Health System , University Hospital, Ann Arbor, Michigan
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Manohar P, Brandel D, Bellile EL, Worden FP, Avram AM. FDG PET/CT imaging for prognosis of metastatic non-iodine avid differentiated thyroid cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e17555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Anca M Avram
- University of Michigan Division of Nuclear Medicine/Radiology, Ann Arbor, MI
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Abstract
BACKGROUND Lingual thyroid is a rare abnormality of thyroid development that is usually treated conservatively with levothyroxine replacement. Rarely, it becomes large enough to cause obstructive symptoms in the oral cavity, requiring definitive treatment. PATIENT FINDINGS This study reports on three patients with lingual thyroid treated with radioactive iodine-131 ((131)I) with successful radioablation of their ectopic thyroid tissues. Measurement of 24-hour radioactive iodine uptake within thyroidal tissues and hybrid single-photon emission computed tomography/computed tomography imaging using either iodine-123 or technetium-99m pertechnetate scans were performed in all patients demonstrating the location and size of lingual thyroid and absence of an orthotopic thyroid gland. SUMMARY The aim of this study was to describe nonsurgical management of obstructive lingual thyroid tissue with (131)I therapy for lingual thyroid radioablation. Patients were prepared with a low-iodine diet and levothyroxine withdrawal prior to radioablation for optimizing (131)I uptake in ectopic thyroid tissues. Hybrid single-photon emission computed tomography/computed tomography measurement of anatomic size of lingual thyroid tissue and radioactive iodine uptake guided the selection of therapeutic doses, resulting in administration of 10.7, 17.5, and 15.4 mCi of (131)I, respectively. There were no post-therapy complications, and clinical follow-up demonstrated resolution of obstructive oropharyngeal symptoms. CONCLUSIONS Ectopic lingual thyroid tissue is rarely associated with obstructive oropharyngeal symptoms due to progressive enlargement. Radioiodine therapy with (131)I is an effective treatment modality for ablation of ectopic thyroid tissue as an alternative to surgery.
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Affiliation(s)
- Arpit Gandhi
- 1 Nuclear Medicine/Radiology, University of Michigan , Ann Arbor, Michigan
| | - Ka Kit Wong
- 1 Nuclear Medicine/Radiology, University of Michigan , Ann Arbor, Michigan
- 2 Nuclear Medicine Service , Department of Veterans Affairs Health System, Ann Arbor, Michigan
| | - Milton D Gross
- 1 Nuclear Medicine/Radiology, University of Michigan , Ann Arbor, Michigan
- 2 Nuclear Medicine Service , Department of Veterans Affairs Health System, Ann Arbor, Michigan
| | - Anca M Avram
- 1 Nuclear Medicine/Radiology, University of Michigan , Ann Arbor, Michigan
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Michalsky R, Avram AM, Peterson BA, Pfromm PH, Peterson AA. Chemical looping of metal nitride catalysts: low-pressure ammonia synthesis for energy storage. Chem Sci 2015; 6:3965-3974. [PMID: 29218166 PMCID: PMC5707470 DOI: 10.1039/c5sc00789e] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/28/2015] [Indexed: 12/21/2022] Open
Abstract
Design principles for reducible metal nitride catalysts are developed and demonstrated for ambient-pressure solar-driven N2 reduction into NH3.
The activity of many heterogeneous catalysts is limited by strong correlations between activation energies and adsorption energies of reaction intermediates. Although the reaction is thermodynamically favourable at ambient temperature and pressure, the catalytic synthesis of ammonia (NH3), a fertilizer and chemical fuel, from N2 and H2 requires some of the most extreme conditions of the chemical industry. We demonstrate how ammonia can be produced at ambient pressure from air, water, and concentrated sunlight as renewable source of process heat via nitrogen reduction with a looped metal nitride, followed by separate hydrogenation of the lattice nitrogen into ammonia. Separating ammonia synthesis into two reaction steps introduces an additional degree of freedom when designing catalysts with desirable activation and adsorption energies. We discuss the hydrogenation of alkali and alkaline earth metal nitrides and the reduction of transition metal nitrides to outline a promoting role of lattice hydrogen in ammonia evolution. This is rationalized via electronic structure calculations with the activity of nitrogen vacancies controlling the redox-intercalation of hydrogen and the formation and hydrogenation of adsorbed nitrogen species. The predicted trends are confirmed experimentally with evolution of 56.3, 80.7, and 128 μmol NH3 per mol metal per min at 1 bar and above 550 °C via reduction of Mn6N2.58 to Mn4N and hydrogenation of Ca3N2 and Sr2N to Ca2NH and SrH2, respectively.
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Affiliation(s)
- R Michalsky
- Department of Chemical Engineering , Kansas State University , 1005 Durland Hall , Manhattan , Kansas 66506 , USA . ; Tel: +41-44-6338383.,School of Engineering , Brown University , 184 Hope Street , Providence , Rhode Island 02912 , USA.,Department of Mechanical and Process Engineering , ETH Zürich , 8092 Zürich , Switzerland
| | - A M Avram
- Department of Chemical Engineering , Kansas State University , 1005 Durland Hall , Manhattan , Kansas 66506 , USA . ; Tel: +41-44-6338383
| | - B A Peterson
- Department of Chemical Engineering , Kansas State University , 1005 Durland Hall , Manhattan , Kansas 66506 , USA . ; Tel: +41-44-6338383
| | - P H Pfromm
- Department of Chemical Engineering , Kansas State University , 1005 Durland Hall , Manhattan , Kansas 66506 , USA . ; Tel: +41-44-6338383
| | - A A Peterson
- School of Engineering , Brown University , 184 Hope Street , Providence , Rhode Island 02912 , USA
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Avram AM, Esfandiari NH, Wong KK. Preablation 131-I scans with SPECT/CT contribute to thyroid cancer risk stratification and 131-I therapy planning. J Clin Endocrinol Metab 2015; 100:1895-902. [PMID: 25734251 DOI: 10.1210/jc.2014-4043] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT The use of preablation diagnostic radioiodine scans for risk stratification and radioiodine therapy planning for differentiated thyroid cancer (DTC) remains controversial. OBJECTIVE The objective was to assess the contribution of preablation diagnostic 131-I scans with SPECT/CT (Dx 131-I scan) to (1) the risk stratification and (2) the postoperative management of DTC. DESIGN The study was designed as a prospective sequential patient series. SETTING The study was conducted at a University hospital. PATIENTS Three hundred twenty patients (pts) with DTC (219F; 101M, mean age 47.3 ± 16.4 y, range 10-90) were studied. INTERVENTION Using clinical and histopathology information an endocrinologist performed risk stratification and determined postoperative management with respect to radioiodine therapy (RAI) planning. The decision to withhold or to administer RAI, and the recommended low, medium or high therapeutic 131-I activity were recorded. Dx 131-I scans were performed and interpreted by two nuclear medicine physicians as showing thyroid remnant, cervical nodal, or distant metastases. The endocrinologist then reperformed risk stratification and reformulated management after consideration of Dx 131-I scans and stimulated thyroglobulin (Tg) information. MAIN OUTCOME MEASURE Main outcome measures were changes in risk stratification and management after Dx 131-I scans. RESULTS Detection of unsuspected nodal and distant metastases and elevated stimulated Tg levels resulted in a change in the estimated risk of recurrence in 15% of patients, and management in 31% of patients, as compared to initial risk stratification and management based on histopathology alone. CONCLUSIONS Both imaging data and stimulated thyroglobulin levels acquired at the time of Dx 131-I scans are consequential for 131-I therapy planning, providing information that changes risk stratification in 15% of patients as compared to recurrence risk estimation based on histopathology alone. Dx 131-I scans contribute to risk stratification by defining residual nodal and distant metastatic disease, changing clinical management in 29.4% of patients.
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Affiliation(s)
- Anca M Avram
- Nuclear Medicine, Department of Radiology (A.M.A., K.K.W.), and Endocrinology, Department of Internal Medicine (N.H.E.), University of Michigan, Ann Arbor, Michigan; and Nuclear Medicine Service, Department of Veterans Affairs Health System (K.K.W.), Ann Arbor, Michigan 48109
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Leung AM, Avram AM, Brenner AV, Duntas LH, Ehrenkranz J, Hennessey JV, Lee SL, Pearce EN, Roman SA, Stagnaro-Green A, Sturgis EM, Sundaram K, Thomas MJ, Wexler JA. Potential risks of excess iodine ingestion and exposure: statement by the american thyroid association public health committee. Thyroid 2015; 25:145-6. [PMID: 25275241 PMCID: PMC4321767 DOI: 10.1089/thy.2014.0331] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Angela M. Leung
- Division of Endocrinology, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Anca M. Avram
- Division of Nuclear Medicine/Radiology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Alina V. Brenner
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Leonidas H. Duntas
- Unit of Endocrinology, Metabolism, and Diabetes, Evgenidion Hospital, University of Athens, Athens, Greece
| | - Joel Ehrenkranz
- Department of Medicine, Intermountain Healthcare, Salt Lake City, Utah
| | - James V. Hennessey
- Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Stephanie L. Lee
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Elizabeth N. Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts
| | - Sanziana A. Roman
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | | | - Erich M. Sturgis
- Department of Head and Neck Surgery, UT MD Anderson Cancer Center, Houston, Texas
| | | | | | - Jason A. Wexler
- Division of Endocrinology and Metabolism, Georgetown University School of Medicine, Washington, District of Columbia
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Dewaraja YK, Schipper MJ, Shen J, Smith LB, Murgic J, Savas H, Youssef E, Regan D, Wilderman SJ, Roberson PL, Kaminski MS, Avram AM. Tumor-Absorbed Dose Predicts Progression-Free Survival Following (131)I-Tositumomab Radioimmunotherapy. J Nucl Med 2014; 55:1047-53. [PMID: 24842891 PMCID: PMC4237694 DOI: 10.2967/jnumed.113.136044] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 03/21/2014] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The study aimed at identifying patient-specific dosimetric and nondosimetric factors predicting outcome of non-Hodgkin lymphoma patients after (131)I-tositumomab radioimmunotherapy for potential use in treatment planning. METHODS Tumor-absorbed dose measures were estimated for 130 tumors in 39 relapsed or refractory non-Hodgkin lymphoma patients by coupling SPECT/CT imaging with the Dose Planning Method (DPM) Monte Carlo code. Equivalent biologic effect was calculated to assess the biologic effects of nonuniform absorbed dose including the effects of the unlabeled antibody. Evaluated nondosimetric covariates included histology, presence of bulky disease, and prior treatment history. Tumor level outcome was based on volume shrinkage assessed on follow-up CT. Patient level outcome measures were overall response (OR), complete response (CR), and progression-free survival (PFS), determined from clinical assessments that included PET/CT. RESULTS The estimated mean tumor-absorbed dose had a median value of 275 cGy (range, 94-711 cGy). A high correlation was observed between tracer-predicted and therapy-delivered mean tumor-absorbed doses (P < 0.001; r = 0.85). In univariate tumor-level analysis, tumor shrinkage correlated significantly with almost all of the evaluated dosimetric factors, including equivalent biologic effect. Regression analysis showed that OR, CR, and PFS were associated with the dosimetric factors and equivalent biologic effect. Both mean tumor-absorbed dose (P = 0.025) and equivalent biologic effect (P = 0.035) were significant predictors of PFS whereas none of the nondosimetric covariates were found to be statistically significant factors affecting PFS. The most important finding of the study was that in Kaplan-Meier curves stratified by mean dose, longer PFS was observed in patients receiving mean tumor-absorbed doses greater than 200 cGy than in those receiving 200 cGy or less (median PFS, 13.6 vs. 1.9 mo for the 2 dose groups; log-rank P < 0.0001). CONCLUSION A higher mean tumor-absorbed dose was significantly predictive of improved PFS after (131)I-tositumomab radioimmunotherapy. Hence tumor-absorbed dose, which can be estimated before therapy, can potentially be used to design radioimmunotherapy protocols to improve efficacy.
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Affiliation(s)
- Yuni K Dewaraja
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Matthew J Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Jincheng Shen
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Lauren B Smith
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Jure Murgic
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Hatice Savas
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Ehab Youssef
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Denise Regan
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Scott J Wilderman
- Department of Nuclear Engineering, University of Michigan, Ann Arbor, Michigan; and
| | - Peter L Roberson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Mark S Kaminski
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Anca M Avram
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
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Abstract
CONTEXT Oral activity on radioiodine scintigraphy is commonly seen and may cause diagnostic dilemma. Determining the precise mechanism of oral uptake on radioiodine scintigraphy will increase the accuracy and confidence of interpretation and avoid possible misinterpretation. OBJECTIVE To determine the etiology of focal persistent radioiodine oral uptake seen on radioiodine scans. DESIGN Retrospective sequential series at a university clinic and a phantom study experiment. METHODS Preablation iodine-131 planar and single photon emission computed tomography/computed tomography (SPECT/CT) scans of 216 patients after total thyroidectomy were reviewed. Planar images were inspected for the presence of oral activity above the salivary gland background and SPECT/CT was reviewed to determine the location and nature of oral activity. A post-hoc phantom study was designed using typodont stone models fitted with various dental materials, immersed in a diluted iodine-131 solution, and imaged with SPECT/CT to characterize radioiodine uptake by high-attenuation dental materials. RESULTS Oral activity was seen on planar images in 123 of 216 (57%) patients; 12 patients were excluded from analysis because the SPECT/CT field of view did not cover the entire oral cavity. In the remainding 111 patients SPECT/CT images demonstrated focal uptake localizing to high-attenuation dental material on the CT in 95 of 111 (86%) patients. All cases of oral activity on planar imaging were interpreted as benign etiology on SPECT/CT. The phantom study confirmed focal in vitro uptake within high-attenuation dental materials representing a range of commonly used metal alloys. CONCLUSION Focal oral activity on diagnostic radioiodine scans frequently localizes to high-attenuation dental material on SPECT/CT. We postulate that an affinity between negatively charged iodide ions (I(-)) in saliva and positively charged metal ions (eg, Ag(+), Hg(+), Au(2+), Pd(2+)) within the dental materials is at the basis of persistent focal radioiodine uptake in the oral cavity. This represents a new mechanism underlying benign radioiodine activity not previously described in the medical literature.
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Affiliation(s)
- Hatice Savas
- University of Michigan, B1G505G University Hospital, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5028.
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Roberson PL, Wilderman SJ, Avram AM, Kaminski MS, Schipper MJ, Dewaraja YK. Biological-effect modeling of radioimmunotherapy for non-hodgkins lymphoma: determination of model parameters. Cancer Biother Radiopharm 2013; 29:26-33. [PMID: 24102174 DOI: 10.1089/cbr.2012.1467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Treatment with Tositumomab and 131I tositumomab anti-CD20 radioimmunotherapy (Bexxar) yields a nonradioactive antibody antitumor response (the so-called cold effect) and a radiation response. Numerical parameter determination by least-squares (LS) fitting was implemented for more accurate parameter estimates in equivalent biological-effect calculations. METHODS One hundred thirty-two tumors in 37 patients were followed using five or six SPECT/CT studies per patient, three each (typical) post-tracer (0.2 GBq) and post-therapy (∼3 GBq) injections. The SPECT/CT data were used to calculate position- and time-dependent dose rates and antibody concentrations for each tumor. CT-defined tumor volumes were used to track tumor volume changes. Combined biological-effect and cell-clearance models were fit to tumor volume changes. Optimized parameter values determined using LS fitting were compared to previous fitted values that were determined by matching calculated to measured tumor volume changes using visual assessment. Absorbed dose sensitivity (α) and cold-effect sensitivity (λp) parameters were the primary fitted parameters, yielding equivalent biological-effect (E) values. RESULTS Individual parameter uncertainties were approximately 10% and 30% for α and λp, respectively. LS versus previously fit parameter values were highly correlated, although the averaged α value decreased and the averaged λp value increased for the LS fits compared to the previous fits. Correlation of E with 2-month tumor shrinkage data was similar for the two fitting techniques. The LS fitting yielded improved fit quality and likely improved parameter estimation.
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Affiliation(s)
- Peter L Roberson
- 1 Department of Radiation Oncology, University of Michigan , Ann Arbor, Michigan
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Glazer DI, Brown RKJ, Wong KK, Savas H, Gross MD, Avram AM. SPECT/CT evaluation of unusual physiologic radioiodine biodistributions: pearls and pitfalls in image interpretation. Radiographics 2013; 33:397-418. [PMID: 23479704 DOI: 10.1148/rg.332125051] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Radioiodine imaging has a well-established role in depicting metastatic disease after thyroidectomy in patients with well-differentiated thyroid cancer. Uptake of radioiodine in thyroid metastases depends on expression of sodium-iodide symporter (NIS) by tumor tissues. However, because radioiodine may also accumulate in normal structures and tissues, it is important to distinguish physiologic radioiodine activity from metastatic disease. Furthermore, secretions that contain radioiodine may also simulate pathologic uptake. A spectrum of physiologic distributions, normal variants, and benign mimics of disease have been described in the literature; yet, even when armed with a comprehensive knowledge of these patterns, interpreting radiologists and nuclear physicians may still encounter diagnostic uncertainty. Single-photon emission computed tomography (SPECT) with integrated computed tomography (CT) is a novel technology that, when applied to diagnostic iodine 123 or iodine 131 ((131)I) radioiodine scintigraphy, may accurately localize and help distinguish benign mimics of disease, with the potential to alter the management plan. SPECT/CT is increasingly being used with radioiodine scintigraphy to evaluate patients with thyroid cancer and shows promise for improving imaging specificity and reducing false-positive results.
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Affiliation(s)
- Daniel I Glazer
- Department of Nuclear Medicine/Radiology, University of Michigan Health System, 1500 E Medical Center Dr, B1 G505, Ann Arbor, MI 48109-5030, USA
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Lebovic D, Avram AM, Dewaraja Y, Estes J, Jacobi K, Goeman S, Kyle S, Chapman E, Griffith KA, Kaminski MS. Phase II study of low-dose methotrexate to reduce the incidence of human anti-mouse antibodies in patients receiving I-131 tositumomab as first-line treatment for follicular lymphoma. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e19519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19519 Background: I-131 tositumomab is a radiolabeled murine anti-CD20 antibody. In a frontline phase II follicular lymphoma (FL) trial, treatment with I-131 tositumomab produced a 95% ORR with 75% CR (NEJM 352:441, 2005). Median PFS was 6.1 yrs. However, 30% of patients (pts) developed high levels of human anti-mouse antibodies (HAMA) and a serum sickness syndrome within 7 weeks of treatment (early onset HAMA). The 5-yr PFS for this group was 35% compared to 70% for the others (p = 0.003). Low-dose oral methotrexate (mtx) reduces the incidence of human anti-chimeric antibody (HACA) formation in rheumatoid arthritis pts receiving infliximab. We hypothesized that low-dose mtx would likewise reduce the incidence of early onset HAMA when given in combination with I-131 tositumomab. Methods: This is a single arm, phase II study in pts with FL, grade 1-2, stage III or IV disease without limits on marrow involvement, and ≥ 1 of the GELF criteria. Prior therapy, other than focal radiotherapy, is not allowed. Pts must have adequate hematologic, hepatic and renal function, and serum HAMA levels ≤ ULN. I-131 tositumomab is given as a dosimetric dose followed within 1-2 weeks by a therapeutic dose of 75cGy of total body radiation. Pts take mtx 7.5 mg orally once weekly for 3 weeks prior to their dosimetric dose, followed by 7 additional weekly doses. The primary endpoint is the rate of HAMA formation within 7 wks of I-131 tositumomab treatment. Secondary endpoints are overall HAMA incidence, ORR, CR, PFS OS, and safety. Results: Between 8/2011 and 10/2012, 15 pts were enrolled. Median age was 56 (39-83); 11 were male. Three pts had serum HAMA levels >ULN at baseline. One pt had a spontaneous remission prior to starting treatment, leaving 11 evaluable pts. One pt developed early onset HAMA (9%). ORR = 82%, CR = 64%. Two pts progressed with DLBCL. Grade 3 or 4 toxicities included thrombocytopenia n = 3, neutropenia n = 2 and pain n = 3. Conclusions: These preliminary results show that concurrent low-dose oral mtx appears to reduce the incidence of early onset HAMA in FL patients receiving first- line I-131 tositumomab (9% vs. 30% in historical controls) while preserving efficacy. Clinical trial information: NCT01389076.
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Affiliation(s)
| | - Anca M Avram
- University of Michigan Division of Nuclear Medicine/Radiology, Ann Arbor, MI
| | - Yuni Dewaraja
- Department of Radiology, University of Michigan, Ann Arbor, MI
| | | | | | | | | | | | - Kent A. Griffith
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
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Schipper MJ, Koral KF, Avram AM, Kaminski MS, Dewaraja YK. Prediction of therapy tumor-absorbed dose estimates in I-131 radioimmunotherapy using tracer data via a mixed-model fit to time activity. Cancer Biother Radiopharm 2013; 27:403-11. [PMID: 22947086 DOI: 10.1089/cbr.2011.1053] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND For individualized treatment planning in radioimmunotherapy (RIT), correlations must be established between tracer-predicted and therapy-delivered absorbed doses. The focus of this work was to investigate this correlation for tumors. METHODS The study analyzed 57 tumors in 19 follicular lymphoma patients treated with I-131 tositumomab and imaged with SPECT/CT multiple times after tracer and therapy administrations. Instead of the typical least-squares fit to a single tumor's measured time-activity data, estimation was accomplished via a biexponential mixed model in which the curves from multiple subjects were jointly estimated. The tumor-absorbed dose estimates were determined by patient-specific Monte Carlo calculation. RESULTS The mixed model gave realistic tumor time-activity fits that showed the expected uptake and clearance phases even with noisy data or missing time points. Correlation between tracer and therapy tumor-residence times (r=0.98; p<0.0001) and correlation between tracer-predicted and therapy-delivered mean tumor-absorbed doses (r=0.86; p<0.0001) were very high. The predicted and delivered absorbed doses were within ± 25% (or within ± 75 cGy) for 80% of tumors. CONCLUSIONS The mixed-model approach is feasible for fitting tumor time-activity data in RIT treatment planning when individual least-squares fitting is not possible due to inadequate sampling points. The good correlation between predicted and delivered tumor doses demonstrates the potential of using a pretherapy tracer study for tumor dosimetry-based treatment planning in RIT.
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Affiliation(s)
- Matthew J Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Avram AM, Fig LM, Frey KA, Gross MD, Wong KK. Preablation 131-I scans with SPECT/CT in postoperative thyroid cancer patients: what is the impact on staging? J Clin Endocrinol Metab 2013; 98:1163-71. [PMID: 23430789 DOI: 10.1210/jc.2012-3630] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
CONTEXT The utility of preablation radioiodine scans for the management of differentiated thyroid cancer remains controversial. OBJECTIVE To determine the contribution of preablation Iodine 131 (131-I) planar with single-photon emission computed tomography/computed tomography (SPECT/CT; diagnostic [Dx] scans) to differentiated thyroid cancer staging. DESIGN Prospective sequential series at university clinic. METHODS Using American Joint Committee on Cancer (AJCC) tumor, node, metastasis (TNM) staging, seventh edition 320 patients post-total thyroidectomy were initially staged based on clinical and pathology data (pTN) and then restaged after imaging (TNM). The impact of Dx scans with SPECT/CT on N and M scores, and TNM stage, was assessed in younger, age <45 years, n = 138 (43%), and older, age ≥ 45 years, n = 182 (57%) patients, with subgroup analysis for T1a and T1b tumors. RESULTS In younger patients Dx scans detected distant metastases in 5 of 138 patients (4%), and nodal metastases in 61 of 138 patients (44%), including unsuspected nodal metastases in 24 of 63 (38%) patients initially assigned pathologic (p) N0 or pNx. In older patients distant metastases were detected in 18 of 182 patients (10%), and nodal metastases in 51 of 182 patients (28%), including unsuspected nodal metastases in 26 of 108 (24%) patients initially assigned pN0 or pNx. Dx scans detected distant metastases in 2 of 49 (4%) T1a, and 3 of 67 (4.5%) T1b patients. CONCLUSIONS Dx scans detected regional metastases in 35% of patients, and distant metastases in 8% of patients. Information acquired with Dx scans changed staging in 4% of younger, and 25% of older patients. Preablation scans with SPECT/CT contribute to staging of thyroid cancer. Identification of regional and distant metastases prior to radioiodine therapy has significant potential to alter patient management.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/secondary
- Adenocarcinoma, Follicular/surgery
- Adenoma, Oxyphilic
- Adolescent
- Adult
- Age Factors
- Aged
- Aged, 80 and over
- Carcinoma/diagnosis
- Carcinoma/secondary
- Carcinoma/surgery
- Carcinoma, Papillary
- Child
- Female
- Humans
- Iodine Radioisotopes
- Lymphatic Metastasis/diagnostic imaging
- Male
- Middle Aged
- Neoplasm Staging
- Postoperative Complications/diagnostic imaging
- Postoperative Period
- Predictive Value of Tests
- Prospective Studies
- Thyroid Cancer, Papillary
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/secondary
- Thyroid Neoplasms/surgery
- Tomography, Emission-Computed, Single-Photon/methods
- Tomography, X-Ray Computed/methods
- Young Adult
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Affiliation(s)
- Anca M Avram
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109-5028, USA.
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Singer K, Menon RK, Lesperance MM, McHugh JB, Gebarski SS, Avram AM. Residual thyroid tissue after thyroidectomy in a patient with TSH receptor-activating mutation presenting as a neck mass. J Clin Endocrinol Metab 2013; 98:448-52. [PMID: 23271753 DOI: 10.1210/jc.2012-3146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Activating mutations of the TSH receptor (TSHR) are rare, with few reported cases of long-term follow-up. CASE We present a follow-up report on a patient with neonatal thyrotoxicosis known to have a rare activating mutation of the TSHR, a heterozygous substitution in exon 10 (p.Ile568Thr). Initial treatment included total thyroidectomy at age 2 ½ years, resulting in iatrogenic hypothyroidism and hypoparathyroidism. The patient was treated with levothyroxine replacement to maintain TSH levels within normal range, as well as calcitriol and calcium carbonate to treat postsurgical hypoparathyroidism. However, 4 years later, while euthyroid, he developed a palpable 1-cm midline neck mass. METHODS AND RESULTS Functional imaging with 123-I thyroid scan demonstrated active thyroid tissue within the thyroglossal duct remnant and in the tracheoesophageal groove. Surgical removal of the neck mass revealed cytologically bland thyroid follicular cells. CONCLUSION These findings suggest that even after total thyroidectomy, patients with TSHR-activating mutations are at risk to develop significant quantities of functional thyroid tissue related to the hypertrophy of residual foci in the thyroid bed and in the thyroglossal duct remnant. These residual foci may enlarge and secrete thyroid hormones autonomously, decreasing the patient's levothyroxine requirement. Surveillance with serial physical examination and biochemical monitoring is recommended; suspicious findings can be further evaluated with functional thyroid imaging (99-m technetium or radioiodine 123-I thyroid scans) to adequately identify residual foci of thyroid tissue, which may require further treatment with surgical excision or radioablation.
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Affiliation(s)
- Kanakadurga Singer
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Abstract
Staging and risk stratification predicate the postoperative management of thyroid cancer patients, determining not only the need for (131)I therapy or alternative options (conservative management without ablation, surgical reintervention, or external-beam radiation therapy) but also the long-term follow-up strategy. This paper presents the progress made in the field of thyroid cancer imaging by application of SPECT/CT technology to radioiodine scintigraphy in both diagnostic and post-therapy settings and reviews the impact of fusion radioiodine imaging on staging, risk stratification, and clinical management of patients with thyroid cancer. In addition, this paper addresses the role of preablation radioiodine imaging and provides nuclear medicine physicians with the background knowledge required for integrating information from fusion imaging into the clinical and histopathologic risk stratification for developing an individualized treatment plan for patients with thyroid cancer.
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Affiliation(s)
- Anca M Avram
- Division of Nuclear Medicine/Radiology, University of Michigan Medical Center, Ann Arbor, Michigan 48109-5028, USA.
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Abstract
BACKGROUND Three endocrine neoplasms-bilateral pheochromocytomas, somatotrophic pituitary adenoma inducing acromegaly, and papillary carcinoma of the thyroid-occurred concurrently in a patient. A genetic mutation was hypothesized. Possible previously described genetic mutations were explored. METHODS Clinical assessments, laboratory data, images of tumors, histopathology, and immunohistochemistry of excised tissues documented the three neoplasms. Clinical assessment of the patient, family history, and a review of the literature sought a familial basis for the disorders. RESULTS The methods confirmed the presence of three endocrine neoplasms. Each neoplasm was surgically excised and histologically verified. Surgical and (131)I treatments reduced the papillary carcinoma, but eventually this tumor progressed to a lethal degree. History, including that of nine siblings, uncovered no familial neoplasms. No similar case was found in the literature, but possible associations with germline mutations were considered. CONCLUSIONS The concurrent development of pheochromocytomas, pituitary somatotrophic adenoma, and papillary thyroid carcinoma appears to be unique. Nevertheless, such tumors, particularly bilateral pheochromocytomas, strongly suggest a de novo germline mutation in a gene not previously associated with multiple endocrine neoplasia syndromes.
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Affiliation(s)
- James C Sisson
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan 48109, USA.
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Sisson JC, Freitas J, McDougall IR, Dauer LT, Hurley JR, Brierley JD, Edinboro CH, Rosenthal D, Thomas MJ, Wexler JA, Asamoah E, Avram AM, Milas M, Greenlee C. Radiation safety in the treatment of patients with thyroid diseases by radioiodine 131I : practice recommendations of the American Thyroid Association. Thyroid 2011; 21:335-46. [PMID: 21417738 DOI: 10.1089/thy.2010.0403] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Radiation safety is an essential component in the treatment of patients with thyroid diseases by ¹³¹I. The American Thyroid Association created a task force to develop recommendations that would inform medical professionals about attainment of radiation safety for patients, family members, and the public. The task force was constituted so as to obtain advice, experience, and methods from relevant medical specialties and disciplines. METHODS Reviews of Nuclear Regulatory Commission regulations and International Commission on Radiological Protection [corrected] recommendations formed the basic structure of the recommendations. Members of the task force contributed both ideas and methods that are used at their respective institutions to aid groups responsible for treatments and that instruct patients and caregivers in the attainment of radiation safety. There are insufficient data on long-term outcomes to create evidence-based guidelines. RESULTS The information was used to compile delineations of radiation safety. Factors and situations that govern implementation of safety practices are cited and discussed. Examples of the development of tables to ascertain the number of hours or days (24-hour cycles) of radiation precaution appropriate for individual patients treated with ¹³¹I for hyperthyroidism and thyroid cancer have been provided. Reminders in the form of a checklist are presented to assist in assessing patients while taking into account individual circumstances that would bear on radiation safety. Information is presented to supplement the treating physician's advice to patients and caregivers on precautions to be adopted within and outside the home. CONCLUSION Recommendations, complying with Nuclear Regulatory Commission regulations and consistent with guidelines promulgated by the National Council on Radiation Protection and Measurement (NCRP-155), can help physicians and patients maintain radiation safety after treatment with ¹³¹I of patients with thyroid diseases. Both treating physicians and patients must be informed if radiation safety, an integral part of therapy with ¹³¹I, is to be attained. Based on current regulations and understanding of radiation exposures, recommendations have been made to guide physicians and patients in safe practices after treatment with radioactive iodine.
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Roberson PL, Amro H, Wilderman SJ, Avram AM, Kaminski MS, Schipper MJ, Dewaraja YK. Bio-effect model applied to 131I radioimmunotherapy of refractory non-Hodgkin's lymphoma. Eur J Nucl Med Mol Imaging 2010; 38:874-83. [PMID: 21174088 DOI: 10.1007/s00259-010-1699-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Improved data collection methods have improved absorbed dose estimation by tracking activity distributions and tumor extent at multiple time points, allowing individualized absorbed dose estimation. Treatment with tositumomab and (131)I-tositumomab anti-CD20 radioimmunotherapy (BEXXAR) yields a cold antibody antitumor response (cold protein effect) and a radiation response. Biologically effective contributions, including the cold protein effect, are included in an equivalent biological effect model that was fit to patient data. METHODS Fifty-seven tumors in 19 patients were followed using 6 single proton emission computed tomography (SPECT)/CT studies, 3 each post tracer (5 mCi) and therapy (∼100 mCi) injections with tositumomab and (131)I-tositumomab. Both injections used identical antibody mass, a flood dose of 450 mg plus 35 mg of (131)I tagged antibody. The SPECT/CT data were used to calculate absorbed dose rate distributions and tumor and whole-body time-activity curves, yielding a space-time dependent absorbed dose rate description for each tumor. Tumor volume outlines on CT were used to derive the time dependence of tumor size for tracer and therapy time points. A combination of an equivalent biological effect model and an inactivated cell clearance model was used to fit absorbed dose sensitivity and cold effect sensitivity parameters to tumor shrinkage data, from which equivalent therapy values were calculated. RESULTS Patient responses were categorized into three groups: standard radiation sensitivity with no cold effect (7 patients), standard radiation sensitivity with cold effect (11 patients), and high radiation sensitivity with cold effect (1 patient). CONCLUSION Fit parameters can be used to categorize patient response, implying a potential predictive capability.
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Affiliation(s)
- Peter L Roberson
- Department of Radiation Oncology, University of Michigan, 519 W. William St, Argus I, Ann Arbor, MI 48103-4943, USA.
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