ABSTRACT
Purpose: It has been reported that high image quality and high sensitivity can be achieved by the I-131 post therapy scan. We aim to demonstrate through our clinical experience the efficacy of I-131 therapeutic whole body scans [WBSs] compared to diagnostic scans in detecting lesions and to appraise whether the differentiated thyroid carcinoma patient has to undergo postoperative radioiodine therapy based on the diagnostic scan and/or thyroglobulin level
Method: 263 patients [193 females, 70 males, 19-67 years old] with well differentiated thyroid carcinoma [208 papillary, 55 follicular] underwent postoperative diagnostic radioiodine scan. All patients [263] were imaged 48 hours after receiving a diagnostic I-131 dose of 111-185 MBq [3-5 mCi]. Two hundred seven [207] with a postoperative thyroid ablation and I-131 uptake above 2% received an 1110-4440 MBq [30-120 mCi] therapeutic I-131 dose and were imaged 72 hours thereafter. Images from both scans, diagnostic and therapeutic, were compared for the presence and the intensity of thyroid cancer lesions [recurrences and metastases] and correlated to the serum thyroglobulin level
Results : Compared to negative diagnostic WBSs [25 patients] and those with high serum thyroglobulin level [110 patients], therapeutic scans revealed positive lesions in 19/25 patients [76%]. Almost all lesions [104/ 110] were detected and more clearly defined in the therapeutic scan than the diagnostic scan. Sensitivity was calculated to be 96% for therapeutic WBS and 88% for diagnostic WBS, respectively. Only 7/207 patients [3.4%] who received a high therapeutic dose [4440 MBq] showed a greater lesion uptake in the diagnostic scan than the therapeutic scan
Conclusion: The findings indicate that therapeutic scans are more effective than diagnostic scans for follow-up studies in differentiated thyroid carcinoma patients undergoing postoperative radioiodine treatment. Despite recording a negative diagnostic scan, postoperative radioiodine therapy still had to be performed for those patients with high serum thyroglobulin levels
ABSTRACT
To evaluate the efficacy of somatostatin analog scintigraphy with indium-111-pentetreotide and its overall impact on management in patients with gastroenteropancreatic neuroendocrine tumors [GEP-NET]. Twenty-two consecutive patients with a proven or clinically suspected GEP-NET with or without proven metastases were imaged at 24 and 48 h after injection of [111] In-pentetreotide. The scintigraphic findings were compared with results from conventional imaging methods. The final diagnosis was based on histopathological and surgical findings and complementary radiology. Somatostatin receptor-positive lesions were found in 20 of the patients, whereas conventional methods were positive in 18 patients. Additionally, 13 new tumor sites were discovered by somatostatin receptor scintigraphy in 5 patients [liver: 6; chest: 2; bone: 1; abdomen: 4]. The surgical therapeutic strategy was changed in 7 patients [32%]. Our data reinforced that scintigraphy with [111]In-pentetreotide represents the imaging modality of choice in the initial evaluation of GEP-NET. It is highly accurate and can identify clinically unsuspected lesions and optimize the overall staging. It also guides optimal therapy choice and most importantly identifies patients with inoperable or metastatic disease who might be candidates for high-dose targeted therapy
ABSTRACT
To evaluate the efficacy and usefulness of [99m]Tc- sestambi sccintigraphy and gamma probe localization of parathyroid glands in patients with primary hyperparathyroidism and establish radio-guided minimally invasive parathyroidectomy at Hussain Makki Al Jumma Center for Specialized Surgery, Kuwait. Twelve patients with primary hyperparathyroidism [mean age: 48 +/- 14 years; median age: 46 years; age range-29-68 years] were evaluated. The diagnosis of hyperparathyroidism was established by elevated serum calcium and parathyroid hormone levels. All patients had a well-defined parathyroid lesion on previous standard [99m]Tc-sestambi scintigraphy with or without ultrasound study. All had a normal thyroid gland, no history of familial hyperparathyroidism or multiple endocrine neoplasia nor any history of previous neck irradiation. On the day of surgery, patients were injected with 740 MBq [20mCi] of [99m]Tc-sestamibi followed by a half-hour-delayed single standard pinhole view of the neck. A skin marker was placed on the basis of maximum count intensity during gamma probe localization. Patients were then sent for radio-guided minimally invasive parathyroidectomy. The preoperative localization of the affected gland was successful in all cases using a gamma probe and [99m]Tc-sestamibi scintigraphy. The pathological parathyroid tissue was localized and successfully removed with the gamma probe. The histopathological diagnosis was parathyroid adenoma in 11 cases and hyperplasia in the remaining one. All patients remained disease and symptom free at 12-month follow-up. Our initial experience with intraoperative use of a gamma probe to carry out minimally invasive parathyroidectomy was a useful, easy and safe procedure for treating patients with primary hyperparathyroidism