open access

Vol 57, No 4 (2006)
Case report
Published online: 2006-07-07
Submitted: 2013-02-15
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Positron emission tomography (18FDG-PET) in the detection of medullary thyroid carcinoma metastases

Sławomir A. Mucha, Jolanta Kunert-Radek, Lech Pomorski
Endokrynologia Polska 2006;57(4):452-457.

open access

Vol 57, No 4 (2006)
Case report
Published online: 2006-07-07
Submitted: 2013-02-15

Abstract

Introduction: Medullary thyroid carcinoma (MTC) is usually more advanced at presentation than differentiated thyroid cancers and often has distant metastases. The primary treatment of MTC is total thyroidectomy and regional lymph node dissection. The efficacy of these procedures has been limited by the aggressiveness of the disease and metastatic spread at the time of surgery. Persistently elevated levels of calcitonin (CT) and carcinoembryonic antigen (CEA) or their increase postoperatively are indicative for residual or recurrent disease. Conventional imaging methods such as ultrasonography, computed tomography, magnetic resonance imaging and MIBI scintigraphy usually fail to find the source of calcitonin. Better imaging properties have been shown by DMSA scintigraphy, somatostatin receptor scintigraphy or by positron emission tomography (PET). The aim of the study was to evaluate the diagnostic accuracy of PET for the localisation of occult MTC in patients after surgery with increased concentrations of CT, in whom conventional imaging procedures have not been successful.
Material and methods: The PET investigation using 18F-fluoro- 2-deoxy-D-glucose combined with computed tomography (18 2000 ng/l (normal < 10 ng/l) no tumour lesions were found using other imaging methods.
Results: In four of five cases, responsible lesions with a higher metabolism of FDG, indicating MTC tissue (remnants or metastases), were localised. In one patient no focus of FDG accumulation was found despite high CT concentration. PET detected tumour manifestations in the neck and the mediastinum in two patients, in the lung and the left adrenal gland in one case and in the neck and the liver in another patient. As a result of surgery for the removal of a residual tumour or metastases the accuracy of diagnosis was confirmed by histopathology in all four cases and a decrease in CT and CEA levels was observed in 3/4 cases. The metabolic imaging findings by PET/CT ensured that the surgery on these patients was successful.
Conclusions: For the detection of occult residual or metastatic MTC lesions, 18FDG-PET is a valuable procedure in imaging diagnostics.

Abstract

Introduction: Medullary thyroid carcinoma (MTC) is usually more advanced at presentation than differentiated thyroid cancers and often has distant metastases. The primary treatment of MTC is total thyroidectomy and regional lymph node dissection. The efficacy of these procedures has been limited by the aggressiveness of the disease and metastatic spread at the time of surgery. Persistently elevated levels of calcitonin (CT) and carcinoembryonic antigen (CEA) or their increase postoperatively are indicative for residual or recurrent disease. Conventional imaging methods such as ultrasonography, computed tomography, magnetic resonance imaging and MIBI scintigraphy usually fail to find the source of calcitonin. Better imaging properties have been shown by DMSA scintigraphy, somatostatin receptor scintigraphy or by positron emission tomography (PET). The aim of the study was to evaluate the diagnostic accuracy of PET for the localisation of occult MTC in patients after surgery with increased concentrations of CT, in whom conventional imaging procedures have not been successful.
Material and methods: The PET investigation using 18F-fluoro- 2-deoxy-D-glucose combined with computed tomography (18 2000 ng/l (normal < 10 ng/l) no tumour lesions were found using other imaging methods.
Results: In four of five cases, responsible lesions with a higher metabolism of FDG, indicating MTC tissue (remnants or metastases), were localised. In one patient no focus of FDG accumulation was found despite high CT concentration. PET detected tumour manifestations in the neck and the mediastinum in two patients, in the lung and the left adrenal gland in one case and in the neck and the liver in another patient. As a result of surgery for the removal of a residual tumour or metastases the accuracy of diagnosis was confirmed by histopathology in all four cases and a decrease in CT and CEA levels was observed in 3/4 cases. The metabolic imaging findings by PET/CT ensured that the surgery on these patients was successful.
Conclusions: For the detection of occult residual or metastatic MTC lesions, 18FDG-PET is a valuable procedure in imaging diagnostics.
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Keywords

medullary thyroid carcinoma; positron emission tomography; metastases

About this article
Title

Positron emission tomography (18FDG-PET) in the detection of medullary thyroid carcinoma metastases

Journal

Endokrynologia Polska

Issue

Vol 57, No 4 (2006)

Pages

452-457

Published online

2006-07-07

Bibliographic record

Endokrynologia Polska 2006;57(4):452-457.

Keywords

medullary thyroid carcinoma
positron emission tomography
metastases

Authors

Sławomir A. Mucha
Jolanta Kunert-Radek
Lech Pomorski

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