S P E C I A L I m a g e
i n
F E A T U R E
E n d o c r i n o l o g y
SPECT/CT and I131 Therapy of Brain Metastases From Follicular Variant Papillary Thyroid Carcinoma (FVPTC) Andrew C. Olson, Bryan R. Haugen, Jacob Walter, Jennifer J. Kwak, Brian M. Bagrosky, and Phillip J. Koo Department of Radiology, Division of Nuclear Medicine and Molecular Imaging (A.C.O., J.W., J.J.K., B.M.B., P.J.K.), and Department of Medicine, Division of Endocrinology and Metabolism (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045
he patient was diagnosed at age 9 years with stage II follicular variant papillary thyroid carcinoma, with metastases to lymph nodes, lung, and bone, and was treated with thyroidectomy, regional node dissection, and I131 (85 mCi). She presented at age 15 for follow-up and was asymptomatic. She underwent an I123 whole-body scan (WBS), and her stimulated thyroglobulin was 10.8 ng/mL. Planar images demonstrated new activity in the head, and SPECT/CT was then performed to localize the activity (Figure 1). Magnetic resonance imaging (MRI) was performed the same day and demonstrated two parietal lobe lesions (Figure 2A). The patient was treated with 154 mCi of I131. The lesions resolved on an MRI 4 months later (Figure 2B), at which time her thyroglobulin had decreased to 1.3 ng/mL. Metastases from papillary thyroid carcinoma are most common in regional lymph nodes, with distant metastases occurring in 1–7% of patients, most often to
T
Figure 2. MRI. A, Postcontrast T1 image demonstrates two enhancing lesions (arrows) that correlate to the areas of uptake on the I123 WBS. B, Postcontrast T1 FLAIR image 4 months after I131 therapy demonstrates resolution of the lesions.
lung and bone (1). Brain metastases are rare and have been associated with high mortality rate (2). Risk factors for brain metastases have not been reported, and standard treatment protocols have not been developed. SPECT/CT allows for improved localization of radioiodine activity seen on planar scans. Diagnostic value of SPECT/CT for lesions outside of the neck is high, but it is of little value in patients without abnormal findings on planar imaging (3). A recent meta-analysis demonstrated that SPECT/CT improved the diagnosis in 47.6 – 88% of cases and modified therapeutic strategies in 23.5–25% of patients (4). SPECT/CT may be useful for localization of activity identified in the head on I123 planar scans.
Acknowledgments Figure 1. A, Planar images from an I123 WBS demonstrate two foci of uptake in the head. B, I123 SPECT/CT localized the activity to the brain and not the skull. The lesions were not apparent on noncontrast CT. ISSN Print 0021-972X ISSN Online 1945-7197 Printed in U.S.A. Copyright © 2014 by the Endocrine Society Received March 27, 2014. Accepted July 2, 2014. First Published Online July 24, 2014
doi: 10.1210/jc.2014-1875
Address all correspondence and requests for reprints to: Phillip J. Koo, MD, Department of Radiology, Mail Stop L954, 12401 Abbreviations: MRI, magnetic resonance imaging; WBS, whole-body scan.
J Clin Endocrinol Metab, October 2014, 99(10):3511–3512
jcem.endojournals.org
The Endocrine Society. Downloaded from press.endocrine.org by [${individualUser.displayName}] on 31 January 2015. at 16:52 For personal use only. No other uses without permission. . All rights reserved.
3511
3512
Olson et al
SPECT/CT of Thyroid Carcinoma Brain Metastases
East 17th Avenue, Room 1512, Aurora, CO 80045. E-mail: [email protected]. Disclosure Summary: The authors have nothing to disclose.
References 1. Hay ID, Thompson GB, Grant CS, et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940 –1999): tem-
J Clin Endocrinol Metab, October 2014, 99(10):3511–3512
poral trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg. 2002;26(8):879 – 885. 2. Henriques de Figueiredo B, Godbert Y, Soubeyran I, et al. Brain metastases from thyroid carcinoma: a retrospective study of 21 patients. Thyroid. 2014;24(2):270 –276. 3. Menges M, Uder M, Kuwert T, Schmidt D. 131I SPECT/CT in the follow-up of patients with differentiated thyroid carcinoma. Clin Nucl Med. 2012;37:555–560. 4. Xue YL, Qiu ZL, Song HJ, Luo QY. Value of 131I SPECT/CT for the evaluation of differentiated thyroid cancer: a systematic review of the literature. Eur J Nucl Med Mol Imaging. 2013;40(5): 768 –778.
The Endocrine Society. Downloaded from press.endocrine.org by [${individualUser.displayName}] on 31 January 2015. at 16:52 For personal use only. No other uses without permission. . All rights reserved.
i n
F E A T U R E
E n d o c r i n o l o g y
SPECT/CT and I131 Therapy of Brain Metastases From Follicular Variant Papillary Thyroid Carcinoma (FVPTC) Andrew C. Olson, Bryan R. Haugen, Jacob Walter, Jennifer J. Kwak, Brian M. Bagrosky, and Phillip J. Koo Department of Radiology, Division of Nuclear Medicine and Molecular Imaging (A.C.O., J.W., J.J.K., B.M.B., P.J.K.), and Department of Medicine, Division of Endocrinology and Metabolism (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045
he patient was diagnosed at age 9 years with stage II follicular variant papillary thyroid carcinoma, with metastases to lymph nodes, lung, and bone, and was treated with thyroidectomy, regional node dissection, and I131 (85 mCi). She presented at age 15 for follow-up and was asymptomatic. She underwent an I123 whole-body scan (WBS), and her stimulated thyroglobulin was 10.8 ng/mL. Planar images demonstrated new activity in the head, and SPECT/CT was then performed to localize the activity (Figure 1). Magnetic resonance imaging (MRI) was performed the same day and demonstrated two parietal lobe lesions (Figure 2A). The patient was treated with 154 mCi of I131. The lesions resolved on an MRI 4 months later (Figure 2B), at which time her thyroglobulin had decreased to 1.3 ng/mL. Metastases from papillary thyroid carcinoma are most common in regional lymph nodes, with distant metastases occurring in 1–7% of patients, most often to
T
Figure 2. MRI. A, Postcontrast T1 image demonstrates two enhancing lesions (arrows) that correlate to the areas of uptake on the I123 WBS. B, Postcontrast T1 FLAIR image 4 months after I131 therapy demonstrates resolution of the lesions.
lung and bone (1). Brain metastases are rare and have been associated with high mortality rate (2). Risk factors for brain metastases have not been reported, and standard treatment protocols have not been developed. SPECT/CT allows for improved localization of radioiodine activity seen on planar scans. Diagnostic value of SPECT/CT for lesions outside of the neck is high, but it is of little value in patients without abnormal findings on planar imaging (3). A recent meta-analysis demonstrated that SPECT/CT improved the diagnosis in 47.6 – 88% of cases and modified therapeutic strategies in 23.5–25% of patients (4). SPECT/CT may be useful for localization of activity identified in the head on I123 planar scans.
Acknowledgments Figure 1. A, Planar images from an I123 WBS demonstrate two foci of uptake in the head. B, I123 SPECT/CT localized the activity to the brain and not the skull. The lesions were not apparent on noncontrast CT. ISSN Print 0021-972X ISSN Online 1945-7197 Printed in U.S.A. Copyright © 2014 by the Endocrine Society Received March 27, 2014. Accepted July 2, 2014. First Published Online July 24, 2014
doi: 10.1210/jc.2014-1875
Address all correspondence and requests for reprints to: Phillip J. Koo, MD, Department of Radiology, Mail Stop L954, 12401 Abbreviations: MRI, magnetic resonance imaging; WBS, whole-body scan.
J Clin Endocrinol Metab, October 2014, 99(10):3511–3512
jcem.endojournals.org
The Endocrine Society. Downloaded from press.endocrine.org by [${individualUser.displayName}] on 31 January 2015. at 16:52 For personal use only. No other uses without permission. . All rights reserved.
3511
3512
Olson et al
SPECT/CT of Thyroid Carcinoma Brain Metastases
East 17th Avenue, Room 1512, Aurora, CO 80045. E-mail: [email protected]. Disclosure Summary: The authors have nothing to disclose.
References 1. Hay ID, Thompson GB, Grant CS, et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940 –1999): tem-
J Clin Endocrinol Metab, October 2014, 99(10):3511–3512
poral trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg. 2002;26(8):879 – 885. 2. Henriques de Figueiredo B, Godbert Y, Soubeyran I, et al. Brain metastases from thyroid carcinoma: a retrospective study of 21 patients. Thyroid. 2014;24(2):270 –276. 3. Menges M, Uder M, Kuwert T, Schmidt D. 131I SPECT/CT in the follow-up of patients with differentiated thyroid carcinoma. Clin Nucl Med. 2012;37:555–560. 4. Xue YL, Qiu ZL, Song HJ, Luo QY. Value of 131I SPECT/CT for the evaluation of differentiated thyroid cancer: a systematic review of the literature. Eur J Nucl Med Mol Imaging. 2013;40(5): 768 –778.
The Endocrine Society. Downloaded from press.endocrine.org by [${individualUser.displayName}] on 31 January 2015. at 16:52 For personal use only. No other uses without permission. . All rights reserved.
