Thyroid nodule other imaging findings: Difference between revisions
Jump to navigation
Jump to search
| (7 intermediate revisions by 2 users not shown) | |||
| Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
{{Thyroid nodule}} | {{Thyroid nodule}} | ||
| Line 7: | Line 5: | ||
==Overview== | ==Overview== | ||
Thyroid nodules may also be diagnosed via [[Radionuclide test|radionuclide thyroid scan]], whole-body [[Radioactive iodine uptake|radioactive iodine scan]], [[positron emission tomography]] ([[Positron emission tomography|PET]] scan) or [[iodine-131]] [[single photon emission computed tomography]] ([[Single photon emission computed tomography|SPECT]]). | |||
==Other Imaging Studies== | ==Other Imaging Studies== | ||
=== Radionuclide thyroid scan/scintigraphy === | === Radionuclide thyroid scan/scintigraphy === | ||
* Using either [[Pertechnetate|technetium 99 mTc pertechnetate]] or [[I-123 thyroid imaging|I123]] | |||
* [[Radionuclide|Radionuclide scan]] is contraindicated during [[pregnancy]] | |||
* [[Scintigraphy|Thyroid scintigraphy]] is useful to determine the functional status of a nodule. It is specifically indicated in patients with thyroid nodule and a low [[serum]] [[TSH]] to determine if the nodule has autonomous functioning. | |||
* In [[scintigraphy]], [[iodine]] [[radioisotopes]] (more commonly used; usually [[I-123 thyroid imaging|I-123]]) or [[Technetium-99m|technetium pertechnetate (99Tc)]], are injected and then the [[radioisotope]] uptake time by the [[thyroid gland]] is measured.<ref name="pmid16910877">{{cite journal |vauthors=Reschini E, Ferrari C, Castellani M, Matheoud R, Paracchi A, Marotta G, Gerundini P |title=The trapping-only nodules of the thyroid gland: prevalence study |journal=Thyroid |volume=16 |issue=8 |pages=757–62 |year=2006 |pmid=16910877 |doi=10.1089/thy.2006.16.757 |url=}}</ref><ref name="pmid4406304">{{cite journal |vauthors=Shambaugh GE, Quinn JL, Oyasu R, Freinkel N |title=Disparate thyroid imaging. Combined studies with sodium pertechnetate Tc 99m and radioactive iodine |journal=JAMA |volume=228 |issue=7 |pages=866–9 |year=1974 |pmid=4406304 |doi= |url=}}</ref> | |||
* High [[radioisotope]] uptake=Hot nodule: | |||
** Hyperfunctioning nodules | |||
* Low [[radioisotope]] uptake=Cold nodule: | |||
** Most [[benign]] nodules | |||
** Most [[malignant]] thyroid nodules | |||
* Post therapy whole-body [[iodine]] scanning is typically conducted approximately 1 week after [[RAIU|RAI]] therapy to visualize [[metastases]]. | |||
==== Diagnostic whole-body RAI scans ==== | |||
* Diagnostic whole body scanning (DxWBS), either following [[thyroid]] [[hormone]] withdrawal or recombinant hormone TSH (rhTSH), 6–12 months after remnant ablation may be of value in the follow-up of patients with high or intermediate risk of persistent disease, but should be done with [[I-123 thyroid imaging|I-123]] or low activity I-131.<ref name="pmid12534353">{{cite journal |vauthors=Torlontano M, Crocetti U, D'Aloiso L, Bonfitto N, Di Giorgio A, Modoni S, Valle G, Frusciante V, Bisceglia M, Filetti S, Schlumberger M, Trischitta V |title=Serum thyroglobulin and 131I whole body scan after recombinant human TSH stimulation in the follow-up of low-risk patients with differentiated thyroid cancer |journal=Eur. J. Endocrinol. |volume=148 |issue=1 |pages=19–24 |year=2003 |pmid=12534353 |doi= |url=}}</ref> | |||
=== FDG-PET scan === | === FDG-PET scan === | ||
* Improved diagnostic accuracy of indeterminate thyroid nodules | |||
* In patients with thyroid PET [[incidentaloma]], the incidence of primary [[thyroid malignancy]] is very high <ref name="pmid24902804">{{cite journal |vauthors=Gavriel H, Tang A, Eviatar E, Chan SW |title=Unfolding the role of PET FDG scan in the management of thyroid incidentaloma in cancer patients |journal=Eur Arch Otorhinolaryngol |volume=272 |issue=7 |pages=1763–8 |year=2015 |pmid=24902804 |doi=10.1007/s00405-014-3120-5 |url=}}</ref> | |||
In patients | * There is insuffiecient evidence to recommend to or against routine clinical use | ||
* Usage indications: | |||
** Simple disease localization in [[thyroglobulin]] (Tg) positive, [[RAIU|RAI]] scan–negative patients | |||
** Initial staging and follow-up of high-risk patients with poorly differentiated [[thyroid cancers]] unlikely to concentrate [[RAIU|RAI]] in order to identify sites of disease that may be missed with [[RAIU|RAI]] scanning and conventional imaging. | |||
** Initial staging and follow-up of invasive or [[metastatic]] [[Hurthle cell carcinoma]]. | |||
** As a powerful prognostic tool for identifying which patients with known distant [[metastases]] are at highest risk for disease-specific [[mortality]]. | |||
** As a selection tool to identify those patients unlikely to respond to additional [[RAIU|RAI]] therapy. | |||
** As a measurement of post treatment response following external beam irradiation, surgical resection, [[embolization]], or systemic therapy. | |||
Larson SM, Robbins R 2002 Positron emission tomography in thyroid cancer management. Semin Roentgenol 37:169–174. 316. | |||
<ref name="pmid19158200">{{cite journal |vauthors=Leboulleux S, Schroeder PR, Busaidy NL, Auperin A, Corone C, Jacene HA, Ewertz ME, Bournaud C, Wahl RL, Sherman SI, Ladenson PW, Schlumberger M |title=Assessment of the incremental value of recombinant thyrotropin stimulation before 2-[18F]-Fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography imaging to localize residual differentiated thyroid cancer |journal=J. Clin. Endocrinol. Metab. |volume=94 |issue=4 |pages=1310–6 |year=2009 |pmid=19158200 |doi=10.1210/jc.2008-1747 |url=}}</ref> | |||
False-positive 18FDG-PET findings can be due to: | |||
* Inflammatory [[lymph nodes]] | |||
* Suture [[granulomas]] | |||
* Increased [[muscle]] activity | |||
Therefore, cytologic or histologic confirmation is required before one can be certain that an 18FDG-positive lesion represents metastatic disease. | |||
==== Iodine 131 single photon emission computed tomography (SPECT)=CT fusion imaging ==== | |||
* May provide superior lesion localization after remnant ablation, but it is still a relatively new imaging modality | |||
==References== | ==References== | ||
| Line 39: | Line 55: | ||
[[Category:Needs content]] | [[Category:Needs content]] | ||
<references /> | |||
Latest revision as of 15:09, 3 November 2017
|
Thyroid nodule Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Thyroid nodule other imaging findings On the Web |
|
American Roentgen Ray Society Images of Thyroid nodule other imaging findings |
|
Risk calculators and risk factors for Thyroid nodule other imaging findings |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Thyroid nodules may also be diagnosed via radionuclide thyroid scan, whole-body radioactive iodine scan, positron emission tomography (PET scan) or iodine-131 single photon emission computed tomography (SPECT).
Other Imaging Studies
Radionuclide thyroid scan/scintigraphy
- Using either technetium 99 mTc pertechnetate or I123
- Radionuclide scan is contraindicated during pregnancy
- Thyroid scintigraphy is useful to determine the functional status of a nodule. It is specifically indicated in patients with thyroid nodule and a low serum TSH to determine if the nodule has autonomous functioning.
- In scintigraphy, iodine radioisotopes (more commonly used; usually I-123) or technetium pertechnetate (99Tc), are injected and then the radioisotope uptake time by the thyroid gland is measured.[1][2]
- High radioisotope uptake=Hot nodule:
- Hyperfunctioning nodules
- Low radioisotope uptake=Cold nodule:
- Post therapy whole-body iodine scanning is typically conducted approximately 1 week after RAI therapy to visualize metastases.
Diagnostic whole-body RAI scans
- Diagnostic whole body scanning (DxWBS), either following thyroid hormone withdrawal or recombinant hormone TSH (rhTSH), 6–12 months after remnant ablation may be of value in the follow-up of patients with high or intermediate risk of persistent disease, but should be done with I-123 or low activity I-131.[3]
FDG-PET scan
- Improved diagnostic accuracy of indeterminate thyroid nodules
- In patients with thyroid PET incidentaloma, the incidence of primary thyroid malignancy is very high [4]
- There is insuffiecient evidence to recommend to or against routine clinical use
- Usage indications:
- Simple disease localization in thyroglobulin (Tg) positive, RAI scan–negative patients
- Initial staging and follow-up of high-risk patients with poorly differentiated thyroid cancers unlikely to concentrate RAI in order to identify sites of disease that may be missed with RAI scanning and conventional imaging.
- Initial staging and follow-up of invasive or metastatic Hurthle cell carcinoma.
- As a powerful prognostic tool for identifying which patients with known distant metastases are at highest risk for disease-specific mortality.
- As a selection tool to identify those patients unlikely to respond to additional RAI therapy.
- As a measurement of post treatment response following external beam irradiation, surgical resection, embolization, or systemic therapy.
Larson SM, Robbins R 2002 Positron emission tomography in thyroid cancer management. Semin Roentgenol 37:169–174. 316. [5]
False-positive 18FDG-PET findings can be due to:
- Inflammatory lymph nodes
- Suture granulomas
- Increased muscle activity
Therefore, cytologic or histologic confirmation is required before one can be certain that an 18FDG-positive lesion represents metastatic disease.
Iodine 131 single photon emission computed tomography (SPECT)=CT fusion imaging
- May provide superior lesion localization after remnant ablation, but it is still a relatively new imaging modality
References
- ↑ Reschini E, Ferrari C, Castellani M, Matheoud R, Paracchi A, Marotta G, Gerundini P (2006). "The trapping-only nodules of the thyroid gland: prevalence study". Thyroid. 16 (8): 757–62. doi:10.1089/thy.2006.16.757. PMID 16910877.
- ↑ Shambaugh GE, Quinn JL, Oyasu R, Freinkel N (1974). "Disparate thyroid imaging. Combined studies with sodium pertechnetate Tc 99m and radioactive iodine". JAMA. 228 (7): 866–9. PMID 4406304.
- ↑ Torlontano M, Crocetti U, D'Aloiso L, Bonfitto N, Di Giorgio A, Modoni S, Valle G, Frusciante V, Bisceglia M, Filetti S, Schlumberger M, Trischitta V (2003). "Serum thyroglobulin and 131I whole body scan after recombinant human TSH stimulation in the follow-up of low-risk patients with differentiated thyroid cancer". Eur. J. Endocrinol. 148 (1): 19–24. PMID 12534353.
- ↑ Gavriel H, Tang A, Eviatar E, Chan SW (2015). "Unfolding the role of PET FDG scan in the management of thyroid incidentaloma in cancer patients". Eur Arch Otorhinolaryngol. 272 (7): 1763–8. doi:10.1007/s00405-014-3120-5. PMID 24902804.
- ↑ Leboulleux S, Schroeder PR, Busaidy NL, Auperin A, Corone C, Jacene HA, Ewertz ME, Bournaud C, Wahl RL, Sherman SI, Ladenson PW, Schlumberger M (2009). "Assessment of the incremental value of recombinant thyrotropin stimulation before 2-[18F]-Fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography imaging to localize residual differentiated thyroid cancer". J. Clin. Endocrinol. Metab. 94 (4): 1310–6. doi:10.1210/jc.2008-1747. PMID 19158200.