Thyroid nodule other imaging findings: Difference between revisions

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{{Thyroid nodule}}
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==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 technetium 99 mTc pertechnetate or 123I
* 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>


radionuclide scan is contraindicated during pregnancy
* High [[radioisotope]] uptake=Hot nodule:
 
** Hyperfunctioning nodules
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 is autonomously functioning.
* Low [[radioisotope]] uptake=Cold nodule:
** Most [[benign]] nodules
** Most [[malignant]] thyroid nodules


In scintigraphy, iodine radioisotopes (more commonly used; usually 123I) or technetium pertechnetate (99Tc), are injected to the patient and then the radioisotope uptake time by the thyroid gland is measured.4406304 16910877
* Post therapy whole-body [[iodine]] scanning is typically conducted approximately 1 week after [[RAIU|RAI]] therapy to visualize [[metastases]].
* High radioisotopes uptake=Hot nodule:
** Hyperfunctioning nodules
* Low radioisotopes uptake=Cold nodule:
** Most benign nodules
** Most malignant thyroid nodules


==== 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 ===
improve diagnostic accuracy of indeterminate thyroid nodules
* 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 with thyroid PET incidentaloma, the incidence of primary thyroid malignancy is very high 
* 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>


24902804
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.


There is insuffiecient evidence to recommend to or against routine clinical use
==== 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==
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<references />

Latest revision as of 15:09, 3 November 2017


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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

  • 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:

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

Template:WH Template:WS

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.