ABSTRACT
PURPOSE: This study evaluated the potential of Tc-99m sestamibi whole-body scan (WBMIBI) as an alternative to whole-body I-131 scan (WBI) for the follow-up of patients with differentiated thyroid carcinoma. MATERIALS AND METHODS: We evaluated 99 consecutive patients with differentiated thyroid carcinoma who had total or nearly total thyroidectomy followed by an ablative dose of I-131 (86 women, 13 men; mean age, 44 +/- 12 years). WBMIBI was performed and serum thyroglobulin (TG) levels were obtained at least 6 months after I-131 treatment. All persons were receiving levothyroxine therapy. RESULTS: From the total of 110 studies performed, WBMIBI and TG were in agreement in 96% and discordant in 4%. From the 27 crossed studies (WBMIBI x TG) with at least one abnormal result, 16 were compared with WBI. In four cases, the WBI did not reveal functioning thyroid tissue when both TG and WBMIBI indicated tumoral activity. In one case of pulmonary metastasis confirmed by chest radiographs, with a normal TG value, the results of both WBMIBI and WBI were positive. CONCLUSIONS: WBMIBI should be considered as a scintigraphic method in the follow-up of differentiated thyroid carcinoma. This technique can show the sites of tumoral activity with optimal image resolution, particularly in those with abnormal TG and negative WBI results, and it is a potentially valuable tool in patients with anti-TG antibodies. The WBI in patients having ablation should be reserved only for therapy planning.
Subject(s)
Carcinoma/surgery , Radiopharmaceuticals , Technetium Tc 99m Sestamibi , Thyroid Neoplasms/surgery , Thyroidectomy , Whole-Body Irradiation , Adenocarcinoma, Follicular/diagnostic imaging , Adenocarcinoma, Follicular/secondary , Adult , Biomarkers, Tumor/blood , Carcinoma/diagnostic imaging , Carcinoma/radiotherapy , Carcinoma/secondary , Carcinoma, Papillary/diagnostic imaging , Carcinoma, Papillary/secondary , Female , Follow-Up Studies , Humans , Iodine Radioisotopes/therapeutic use , Lung Neoplasms/secondary , Lymphatic Metastasis/diagnostic imaging , Male , Neoplasm Recurrence, Local/diagnostic imaging , Radionuclide Imaging , Radiopharmaceuticals/therapeutic use , Thyroglobulin/blood , Thyroid Neoplasms/radiotherapy , Thyroxine/therapeutic useABSTRACT
Decreased oxygen supply rather than increased demand may be the primary pathogenic mechanism of myocardial ischemia in patients with unstable angina. Coronary artery spasm and in vivo platelet aggregation may play an important role in the mechanism by which the magnitude of fixed obstruction secondary to coronary atherosclerosis is transiently exacerbated. In this case report, we describe a patient who developed chest pain accompanied by ischemic ECG changes during coronary arteriography, due to a transient thrombotic aggravation of a fixed, significant coronary stenosis. Percutaneous transluminal coronary angioplasty was performed with relief of the coronary stenosis and of the symptoms.