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Clinical Relevance of Single-Photon Emission Computed Tomography/Computed Tomography of the Neck and Thorax in Postablation ¹³¹I Scintigraphy for Thyroid Cancer

Departments of Nuclear Medicine and Thyroid Unit (N.A., S.B.), Head and Neck Surgery (J.-P.R.), Radiophysics (C.L.), and Clinical Research and Biostatistics (M.H.-A.), Centre François Baclesse, F-14076 Caen, France; GRECAN EA-1772 (N.H., M.H.-A.), Université de Caen-Basse Normandie, F-14000 Caen, France; and Department of Endocrinology (E.R.), Centre Hospitalo-Universitaire, F-14033 Caen, France

Address all correspondence and requests for reprints to: Dr. Stéphane Bardet, Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, 3 Avenue Général Harris, BP 5026, F-14076 Caen Cedex 05, France. E-mail: s.bardet{at}baclesse.fr.

Context: In patients with differentiated thyroid carcinoma, postablation ¹³¹I scintigraphy aims to detect residual neck disease and distant metastases, usually found in lungs and bones. New hybrid single-photon emission computed tomography/computed tomography (SPECT-CT) cameras that permit functional and anatomical image fusion may improve its clinical relevance.

Objective: Our objective was to test the added value of neck and thorax SPECT-spiral CT to whole-body scan (WBS) in postablation ¹³¹I scintigraphy.

Design and Setting: This was a single-referral-center prospective study with a median follow-up of 21 months.

Patients and Methods: Postablation ¹³¹I WBS and neck and thorax SPECT-CT were performed in 55 consecutive patients treated in 2006. WBS and SPECT-CT data were blindly reviewed, scored negative (benign), positive (malignant), or indeterminate and were correlated to the patient outcome.

Results: At patient level, WBS and SPECT-CT were negative in 67 and 78% of patients, positive in 4 and 15%, and indeterminate in 29 and 7%, respectively. Overall, nine patients (16%) presented treatment failure (persistent or recurrent disease) 1–16 months after radioiodine ablation. In the 16 patients with indeterminate WBS, negative SPECT-CT ruled out suspicion of disease in nine of nine patients, and positive SPECT-CT confirmed malignant lesions in four of five patients. Positive SPECT-CT predicted treatment failure better than positive WBS (McNemar’s test, P = 0.03).

Conclusions: This study demonstrates the complementary role of neck and thorax SPECT-CT to WBS in postablation ¹³¹I scintigraphy. Because SPECT-CT allows one to confirm or to rule out residual disease in most cases where WBS remains indeterminate, we recommend its use when available.