CLINICAL UTILITY OF TC-99M METHOXISOBUTYLISONITRILE IMAGING IN DIFFERENTIATED THYROID-CARCINOMA - COMPARISON WITH THALLIUM-2O1 AND I-131 NASCINTIGRAPHY, AND SERUM THYROGLOBULIN QUANTITATION
S. Dadparvar et al., CLINICAL UTILITY OF TC-99M METHOXISOBUTYLISONITRILE IMAGING IN DIFFERENTIATED THYROID-CARCINOMA - COMPARISON WITH THALLIUM-2O1 AND I-131 NASCINTIGRAPHY, AND SERUM THYROGLOBULIN QUANTITATION, European journal of nuclear medicine, 22(11), 1995, pp. 1330-1338
Recently, technetium-99m methoxyisobutyl-isonitrile (Tc-99m-MIBI) has
been used to image thyroid carcinoma, A prospective study was performe
d to compare the efficacy of Tc-99m-MIBI to thallium-201 (Tl-201) scin
tigraphy in patients with differentiated thyroid carcinoma. The clinic
al utility of all radionuclide imaging modalities, i.e., Tc-99m-MIBI,
Tl-201 and iodine-131 Na (I-131-Na), as well as serum thyroglobulin es
timation, was evaluated. Thirty-four post-thyroidectomy patients (age
range: 26-76 years) underwent 45 studies. Histopathologies studied inc
luded fourteen papillary, eight papillary-follicular, ten follicular,
one Hurthle cell, and one medullary carcinoma of the thyroid. Followin
g optimal stimulation of endogenous thyroid stimulating hormone (i.e,
TSH greater than or equal to 50 mU/ml), the patients underwent Tl-201
and Tc-99m-MIBI scintigraphy. Concomitant I-131-Na scintigraphy was pe
rformed and serum thyroglobulin levels were measured. Sixteen scan set
s were performed prior to I-131-Na ablation therapy. Twenty-nine scan
sets were performed following I-131-Na ablation therapy. The presence
or absence of thyroid cancer was established by clinical, biochemical,
radiologic, and/or biopsy findings. There was no significant differen
ce in sensitivity and specificity of Tl-201 scintigraphy versus Tc-99m
-MIBI scintigraphy in pre- and postablation studies. I-131-Na scintigr
aphy with determination of thyroglobulin level was sufficient in preab
lation studies. Among postablation patients, the addition of Tc-99m-MI
BI or Tl-201 offered a higher diagnostic yield. Between the Tl-201 and
Tc-99m-MIBI studies, there was a concordance of 69% in preablation an
d 97% among postablation patients (P=0.027). It is concluded that Tc-9
9m-MIBI is a suitable alternative to Tl-201 scintigraphy in thyroid ca
rcinoma, especially following thyroidectomy and I-131-Na therapy. I-13
1-Na scintigraphy with serum thyroglobulin is adequate in both pre- an
d postablation patients, Among the post-I-131-Na ablation patients, Tc
-99m-MIBI or Tl-201 is extremely valuable for tumor localization, espe
cially when the I-131-Na whole-body scan is negative. The combination
of Tc-99m-MIBI or Tl-201 scintigraphy with I-131-Na and serum thyroglo
bulin offers the highest diagnostic yield.