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ABSTRACT: A 64-slice multidetector computed tomography (MDCT) is well known to be a useful noninvasive form of angiography for the general population, but not for certain patients with diabetes. The aim of this study was to investigate the diagnostic accuracy and usefulness of 64-slice MDCT coronary angiography for detecting coronary artery disease in Korean patients with type 2 diabetes mellitus (T2DM).
A total of 240 patients were included, 74 of whom had type 2 diabetes (M:F=40:33; 41.8±9.5 years). We compared significant coronary stenosis (>50% luminal narrowing) in MDCT with invasive coronary angiography (ICA) by segment, artery, and patient. We also evaluated the influence of obesity and coronary calcium score on MDCT accuracy.
Of the 4,064 coronary segments studied, 4,062 segments (T2DM=1,109) were assessed quantitatively by both MDCT and ICA, and 706 segments (T2DM=226) were detected as a significant lesion by ICA in all patients. Sensitivity, specificity, as well as positive and negative predictive values for the presence of significant stenosis in T2DM were: by segment, 89.4%, 96.4%, 85.8%, and 97.4%, respectively; by artery (n=222), 95.1%, 92.9%, 94.4%, and 93.8%, respectively; by patients (n=74), 98.4%, 100.0%, 98.4%, and 90.0%, respectively. Regardless of presence of diabetes, there was no significant difference in diagnostic accuracy. Obesity (≥25 kg/m(2)) and coronary calcium score did not also affect the diagnostic accuracy of MDCT.
The 64-slice MDCT coronary angiography was found to have similar diagnostic accuracy with ICA, regardless of diabetes. These results suggest MDCT may be helpful to reduce unnecessary invasive studies for patients with diabetes.
Diabetes & metabolism journal 02/2013; 37(1):54-62.
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ABSTRACT: Inflammatory pseudotumor is a rare benign lesion mimicking malignancy both clinically and radiologically. An accurate diagnosis
is still difficult and is based on the histological examination. Since inflammatory pseudotumor is exceptionally rare in the
colon, this unexpected lesion can be mistaken for malignancy. We report the first case of inflammatory pseudotumor in the
colon that showed 18F-fluorodeoxyglucose (FDG) uptake and acted as the lead point causing colocolic intussusception.
KeywordsPlasma cell granuloma–Colon–Intussusception–Positron-emission tomography
Annals of Nuclear Medicine 04/2012; 25(6):447-450. · 1.50 Impact Factor
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ABSTRACT: ObjectiveMost of the current clinical data on the role of 2-[18F]fluoro-2-deoxy-d-glucose positron emission tomography (18F-FDG-PET) in musculoskeletal tumors come from patients studied with PET and less frequently with hardware fusion PET/computed
tomography (CT). And the number of cases in each report is too small to clarify the exact clinical efficacy of PET or PET/CT.
This prompted us to analyze our experience with 18F-FDG-PET/CT in a relatively large group of patients with musculoskeletal tumors.
Methods
18F-FDG-PET/CT was performed on 91 patients from May 2004 to June 2007. The final diagnosis was obtained from surgical biopsy
in 83 patients (91%) and clinical follow-up in 8 (9%). We analyzed the characteristics and amount of 18F-FDG uptake in soft tissue and bone tumors, and investigated the ability of 18F-FDG-PET/CT to differentiate malignant from benign tumors. The cutoff maximum standardized uptake value (SUVmax) was calculated using the receiver-operation characteristic curve method. Sensitivity, specificity, and diagnostic accuracy
were calculated with cutoff SUVmax and the final diagnosis. Unpaired t test was used for the statistical analysis.
ResultsFinal diagnosis revealed 19 benign soft tissue tumors (mean SUVmax 4.7), 27 benign bone tumors (5.1), 25 malignant soft tissue tumors (8.8), and 20 malignant bone tumors (10.8). There was
a significant difference in SUVmax between benign and malignant musculoskeletal tumors in total (P < 0.002), soft tissue tumors (P < 0.05), and bone tumors (P < 0.02). Sensitivity, specificity, and diagnostic accuracy were 80%, 65.2%, and 73% in total with cutoff SUVmax 3.8, 80%, 68.4%, and 75% in the soft tissue tumors with cutoff SUVmax 3.8, and 80%, 63%, and 70% in the bone tumors with cutoff SUVmax 3.7.
Conclusions
18F-FDG-PET/CT reliably differentiated malignant soft tissue and bone tumors from benign ones, although there were many false-positive
and falsenegative lesions. Further studies with all kinds of musculoskeletal tumors in large numbers are needed to improve
the diagnostic accuracy of 18F-FDG-PET/CT.
Annals of Nuclear Medicine 04/2012; 22(7):603-609. · 1.50 Impact Factor
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ABSTRACT: Background
18F-fluorodeoxyglucose (18F-FDG) positron emission tomography ((PET) safely predicts axillary status in patients with breast cancer, but is not sufficiently
accurate in early breast cancer patients. This study analyzed the value of 18F-FDG PET/computed tomography (CT) with contrast enhancement in detecting axillary lymph node involvement in T1 breast cancer
patients.
MethodsContrast-enhanced 18F-FDG PET/CT was performed within 20days of surgery in 143 breast cancer patients with tumors ≤2cm in size. The patients
underwent either axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB), and histopathology reports were
used to provide the definitive diagnosis against which the contrast-enhanced 18F-FDG PET/CT study results were compared.
ResultsThe sensitivity, specificity, and negative and positive predictive values of contrast-enhanced 18F-FDG PET/CT in detecting axillary involvement were 70.0%, 92.2%, 88.8%, and 77.8%, respectively, in the entire series of
143 patients, with eight false-positive and 12 false negative results. The false-negative results were associated with the
number of metastatic lymph nodes and the rate of FDG uptake.
ConclusionContrast-enhanced 18F-FDG PET/CT cannot replace histologic staging using SLNB in patients with breast cancer, but 18F-FDG PET/CT increases the sensitivity for predicting axillary node metastasis, and allows for a selective approach to either
ALND or SLNB, even in patients with T1 breast cancer.
KeywordsBreast cancer-Axillary lymph node-FDG-PET/CT
04/2012; 44(3):170-176.
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ABSTRACT: Inflammatory pseudotumor is a rare benign lesion mimicking malignancy both clinically and radiologically. An accurate diagnosis is still difficult and is based on the histological examination. Since inflammatory pseudotumor is exceptionally rare in the colon, this unexpected lesion can be mistaken for malignancy. We report the first case of inflammatory pseudotumor in the colon that showed (18)F-fluorodeoxyglucose (FDG) uptake and acted as the lead point causing colocolic intussusception.
Annals of Nuclear Medicine 04/2011; 25(6):447-50. · 1.50 Impact Factor
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ABSTRACT: This study was designed to assess the value of a combinatorial protocol, namely, stress only myocardial perfusion SPECT (MPS), 64-slice coronary computed tomographic angiography (CTA), and SPECT/CTA 3-dimensional (3D) fusion imaging for the evaluation of coronary artery disease.
A total of 142 patients were retrospectively reviewed. All underwent stress only MPS and 64-slice CTA before invasive coronary angiography (ICA). The SPECT/CTA 3D fusion images were generated. We compared the results of the combinatorial protocol with ICA.
Seventy nine (76.0%) subjects were found to have ≥50% stenoses, by ICA. The sensitivity of the combinatorial examination was 100% and its specificity 80.8%. Its positive and negative predictive values were 94.0 and 100%, respectively. The number of lesion for abnormal MPS with matching significant stenoses on CTA is 94 [43 in left anterior descending (LAD); 19 in left circumflex (LCX); 32 in right coronary artery (RCA)], the number of lesion for equivocal perfusion defect with matching stenoses on CTA is 24 (14 in LAD; 7 in LCX; 3 in RCA). The number of coronary arterial stenoses without MPS abnormality is 10, 4 stenoses were detected in left main lesion and the other stenoses were comparatively mild lesion in multi-vessel disease.
Stress only MPS/CTA 3D fusion imaging could provide the potential for improved diagnostic accuracy and additional information of hemodynamically relevant coronary arterial stenoses.
Annals of Nuclear Medicine 03/2011; 25(6):387-95. · 1.50 Impact Factor
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Shin Young Jeong,
Sang-Woo Lee,
Hui Joong Lee,
Sungmin Kang,
Ji-Hyoung Seo,
Kyung Ah Chun, Ihn Ho Cho,
Kyung Sook Won,
Seok Kil Zeon,
Byeong-Cheol Ahn,
Jaetae Lee
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ABSTRACT: The purpose of this study was to determine the incidence of incidental pituitary uptake on whole-body 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and to investigate its clinical significance.
The files of 40,967 patients who underwent whole-body FDG PET/CT were retrospectively reviewed. Quantification of pituitary metabolic activity was obtained by using the maximum standardized uptake value (SUVmax). Hormone assays and pituitary MRIs were performed to assess pituitary lesions.
Focally increased pituitary FDG uptake on PET/CT was found in 30 of 40,967 patients, accounting for an incidence of 0.073%. The mean SUVmax of 30 patients was 8.9±6.6 (range: 3.2-32.6). Histological diagnosis was obtained in three patients and included two growth hormone-secreting adenomas and one non-functioning adenoma. Hormone assays were performed on serum samples from 11 patients, 2 of whom were shown to have hypersecretion of pituitary hormone. MRI was performed on 19 patients. Abnormal MRI findings suggesting a pituitary mass were found in 18 of 19 cases (94.7%). The mean SUV(max) calculated without correction for partial volume effect for macroadenomas was significantly higher than the SUVmax for microadenomas (11.5±8.4 vs 4.8±1.3; p<0.05). There were no cases diagnosed with metastasis to the pituitary gland during clinical follow-up.
Incidental pituitary FDG uptake was a very rare finding. Cases with incidental pituitary FDG uptake were diagnosed primarily with clinically non-functioning adenomas, and there were also a few functioning adenomas. Further evaluations, including hormone assays and pituitary MRI, are warranted when pituitary uptake is found on FDG PET/CT.
European Journal of Nuclear Medicine 12/2010; 37(12):2334-43. · 4.53 Impact Factor
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ABSTRACT: Stent fracture (SF) has been found in peripheral and coronary vasculatures, and in the latter mostly after implantation of sirolimus- or paclitaxel-eluting stents. We report a patient with a fractured stent associated with restenosis after zotarolimus-eluting stent (ZES) implantation which was confirmed by fluoroscopy, intravascular ultrasound and computerized tomography. To our knowledge, this is the first published report of SF after ZES implantation.
International journal of cardiology 03/2009; 147(2):e29-31. · 7.08 Impact Factor
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ABSTRACT: Most of the current clinical data on the role of 2-[(18)F]fluoro-2-deoxy-D -glucose positron emission tomography ((18)F-FDG-PET) in musculoskeletal tumors come from patients studied with PET and less frequently with hardware fusion PET/computed tomography (CT). And the number of cases in each report is too small to clarify the exact clinical efficacy of PET or PET/CT. This prompted us to analyze our experience with (18)F-FDG-PET/CT in a relatively large group of patients with musculoskeletal tumors.
(18)F-FDG-PET/CT was performed on 91 patients from May 2004 to June 2007. The final diagnosis was obtained from surgical biopsy in 83 patients (91%) and clinical follow-up in 8 (9%). We analyzed the characteristics and amount of (18)F-FDG uptake in soft tissue and bone tumors, and investigated the ability of (18)F-FDG-PET/CT to differentiate malignant from benign tumors. The cutoff maximum standardized uptake value (SUV(max)) was calculated using the receiver-operation characteristic curve method. Sensitivity, specificity, and diagnostic accuracy were calculated with cutoff SUV(max) and the final diagnosis. Unpaired t test was used for the statistical analysis.
Final diagnosis revealed 19 benign soft tissue tumors (mean SUV(max) 4.7), 27 benign bone tumors (5.1), 25 malignant soft tissue tumors (8.8), and 20 malignant bone tumors (10.8). There was a significant difference in SUV(max) between benign and malignant musculoskeletal tumors in total (P < 0.002), soft tissue tumors (P < 0.05), and bone tumors (P < 0.02). Sensitivity, specificity, and diagnostic accuracy were 80%, 65.2%, and 73% in total with cutoff SUV(max) 3.8, 80%, 68.4%, and 75% in the soft tissue tumors with cutoff SUV(max) 3.8, and 80%, 63%, and 70% in the bone tumors with cutoff SUV(max) 3.7.
(18)F-FDG-PET/CT reliably differentiated malignant soft tissue and bone tumors from benign ones, although there were many false-positive and false negative lesions. Further studies with all kinds of musculoskeletal tumors in large numbers are needed to improve the diagnostic accuracy of (18)F-FDG-PET/CT.
Annals of Nuclear Medicine 09/2008; 22(7):603-9. · 1.50 Impact Factor
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ABSTRACT: Stent fracture (SF) is emerging as one of the leading causes of late cardiac events after sirolimus-eluting stent (SES) implantation. A 44-year old man was admitted with ST-segment elevated myocardial infarction 22 months after treatment with SES. SF was confirmed by fluoroscopy, intravascular ultrasound study (IVUS) and computerized tomographic study. IVUS demonstrated a soft, ruptured plaque at the site of the SF where the plaque was not covered by the stent strut. This case suggests that rupture of vulnerable plaque because of SF led to thrombosis and acute myocardial infarction.
International journal of cardiology 04/2008; 134(2):e79-81. · 7.08 Impact Factor
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ABSTRACT: We report a case of giant cell arteritis involving the aorta and several large arteries identified by integrated positron emission tomography (PET)/computed tomography (CT) obtained in a patient with a high erythrocyte sedimentation rate (ESR). A 63-year-old man with anemia and a high ESR noted on a regular medical examination was transferred to our department. The patient complained of only a low-grade general weakness for several months; there were no specific symptoms or signs. A PET was recommended. The image showed strong (18)F-fluorodeoxyglucose ((18)F-FDG) uptake at the ascending aorta, aortic arch, descending aorta, thoraco-lumbar aorta, brachial artery, and the carotid artery wall, bilaterally. Suspicious for large-vessel vasculitis, a temporal artery biopsy was performed, which confirmed giant cell arteritis. After treatment with prednisolone, the high ESR and anemia resolved, and (18)F-FDG uptake decreased on follow-up integrated PET/CT.
Clinical Rheumatology 12/2007; 26(11):1959-62. · 2.00 Impact Factor
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ABSTRACT: Ectopic thyroid is a rare entity and can occur at any location in the midline position. A role for the ectopic thyroid in the pathogenesis of hypothyroidism and nongoitrous cretinism has been emphasized.
To assess the clinical characteristics of an ectopic thyroid by analyzing 49 cases reported in Korea.
This study was a retrospective review of 19 cases who were diagnosed by thyroid scan at our institutions together with 30 cases reported in the Korean medical literature, found using KoreaMed.
Most cases of ectopic thyroid were diagnosed in patients aged between 1 and 29 years; it was more common in females (43 patients). A lingual thyroid was found in 23 patients, a sublingual thyroid in 17 patients, combined type in 7 patients, a prelaryngeal thyroid in 1 patient, and an intratracheal thyroid in 1 patient. Only four cases had the thyroid gland in the normal position. The chief complaints at presentation were palpable mass in 20 patients, growth retardation in 10 patients, and a lump sensation in the throat in 6 patients. Twenty-six of 42 patients (61.9%) had hypothyroidism, and 16 patients (38.1%) had euthyroidism. As for the treatment modalities, 18 of 26 patients with hypothyroidism and 4 of 16 patients with normal thyroid function received thyroid hormone medication; 3 of 26 patients with hypothyroidism and 8 of 16 patients with euthyroidism underwent resection of the ectopic thyroid.
Our study suggests that radionuclide thyroid scanning and function testing may be useful not only for the diagnosis of an ectopic thyroid but also before deciding on the therapeutic modality; patients should be followed up to detect changes in thyroid function and malignant transformation.
Thyroid 12/2007; 17(11):1117-21. · 4.79 Impact Factor
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ABSTRACT: A 29-year old male was transferred to our hospital with an abnormal chest X-ray finding diagnosed as hypertrophic cardiomyopathy with apical necrosis and aneurysm formation. Four years after the initial hospitalization, we confirmed the aneurysm and necrosis using both integrated positron emission tomography (PET) and computed tomography (CT) scanning. The F-18 2-fluoro-2-deoxy-D-glucose (FDG) PET/CT enabled precise localization of the aneurysm, which was found to be composed of semi-lunar calcification of non-metabolic myocardium. A contrast-enhanced CT angiography showed an hour-glass appearance of the left ventricular cavity. The integrated PET/CT fusion scanner is a novel multimodality technology that allows for a comprehensive analysis of the anatomical and functional status of complex heart disease. Based on these findings, long standing mechanical and physiologic abnormalities may have led to chronic ischemia in the hypertrophied myocardium, induced necrosis and calcification at the cardiac apex.
The Korean Journal of Internal Medicine 04/2007; 22(1):28-31.
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Jeoung-Hee Ha,
Jae-Tae Lee, Ihn-ho Cho,
Kyung-Ah Chun,
Gi-Eun Park,
Hyung-Chul Choi,
Kwang-Youn Lee,
Sang-Hyun Kim,
Kyoungho Suk,
In-Kyeom Kim,
Maan-Gee Lee
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ABSTRACT: To investigate the putative mediation of peripheral benzodiazepine receptor (PBR) in the cytotoxicity of flavonoids, in this study, modulatory effects of several flavonoids on the lipid peroxide (LPO) production and PBR mRNA expression of human neuroblastoma cells were observed. Elevated levels of peroxidated products in cancer cells may activate pro-apoptotic and anti-proliferative signaling pathways. Treatment of 10(-6) M 4'-chlorodiazepam and PK 11195 ligands of the PBR for 6 days enhanced the generation of LPO of the human neuroblastoma cells. Several flavonoids, well-known cytotoxic substances, potentiated the enhancement of LPO production by PBR ligands. Treatment of 10(-6) M flavonoids for 6 days elevated the expression of PBR mRNA in cells. These findings indicate that the potential of flavonoids to induce apoptosis in cancer cells is strongly associated with their PBR-inducing properties, thereby providing a new mechanism by which polyphenolic compounds may exert their cancer-preventive and anti-neoplastic effects.
Phytomedicine 03/2007; 14(2-3):232-5. · 3.27 Impact Factor
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ABSTRACT: Adenosine 5'-triphosphate (ATP), a potent and inexpensive coronary vasodilator, was introduced as a pharmacologic stress agent for thallium 201 single photon emission computed tomography (SPECT). However, there has been no direct comparison of ATP and adenosine as myocardial stressors in the same subjects.
Thirty-six patients underwent consecutive Tl-201 SPECT imaging with adenosine and ATP in a randomly assigned order. There were no changes in clinical status and no invasive procedures were performed between the two tests. The hemodynamic response and side effects were monitored, and myocardial tracer uptake was assessed by use of a visual grading system and quantitative analysis via a CEqual map. The hemodynamic changes and adverse effects did not differ significantly between the two groups. There were no changes in the detection of any perfusion defect on a per-subject basis, except in one. The exact agreement rate for the visual grading of the myocardial tracer uptake was 84.8%. However, the average extent of the perfusion defect and the severity score were higher with adenosine.
The hemodynamic changes and the degree of myocardial uptake were similar between the adenosine and ATP infusion. However, quantitative analysis by use of a CEqual map revealed smaller perfusion defects and lower severity scores in subjects undergoing Tl-201 SPECT with ATP.
Journal of Nuclear Cardiology 10/2006; 13(5):621-8. · 2.67 Impact Factor
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ABSTRACT: Heme oxygenase-1 (HO-1) has been described as an inducible protein that is capable of cytoprotection via radical scavenging and the prevention of apoptosis. Chronic exposure to hyperglycemia can lead to cellular dysfunction that may become irreversible over time, and this process has been termed glucose toxicity. Yet little is known about the relation between glucose toxicity and HO-1 in the islets. The purposes of the present study were to determine whether prolonged exposure of pancreatic islets to a supraphysiologic glucose concentration disrupts the intracellular balance between reactive oxygen species (ROS) and HO-1, and so this causes defective insulin secretion; we also wanted to evaluate a protective role for HO-1 in pancreatic islets against high glucose levels. The intracellular peroxide levels of the pancreatic islets (INS-1 cell, rat islet) were increased in the high glucose media (30 mM glucose or 50 mM ribose). The HO-1 expression was induced in the INS-1 cells by the high glucose levels. Both the HO-1 expression and glucose stimulated insulin secretion (GSIS) was decreased simultaneously in the islets by treatment of the HO-1 antisense. The HO-1 was upregulated in the INS-1 cells by hemin, an inducer of HO-1. And, HO-1 upregulation induced by hemin reversed the GSIS in the islets at a high glucose condition. These results suggest HO-1 seems to mediate the protective response of pancreatic islets against the oxidative stress that is due to high glucose conditions.
Journal of Korean Medical Science 07/2006; 21(3):418-24. · 0.99 Impact Factor
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ABSTRACT: This study was performed to determine the after-effects of pharmacologic stress (adenosine) on left ventricular (LV) function-end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (LVEF)-with Tl-201 and Tc-99m MIBI SPECT.
A total of 263 patients were grouped according to the time interval between isotope injection and imaging. Group A: within 1 hour (n = 99; men, n = 48; women, n = 51; mean age: 63.2 years), subgrouped as patients with no perfusion defect (NPD; n = 61), reversible defect (RD; n = 33), and fixed defect (FD; n = 5). Group B: 1 to 2 hours (n = 110; men, n = 66; woman, n = 44; mean age, 63 years), NPD (n = 64), RD (n = 26), and FD (n = 20). 3) Group C: 2 to 3 hours (n = 54; men, n = 30; women, n = 24; mean age, 62 years); NPD (n = 22), RD (n = 17), and FD (n = 15). All patients were in sinus rhythm during the study and had no prior history of myocardial infarction.
In group A, in the patients with RD, poststress LVEF was significantly depressed after adenosine infusion (53.1 +/- 9.5% vs 58.3 +/- 10.2%, P < 0.001) and showed a wall motion abnormality, which was worse after stress than during rest. The mean difference in LVEF (DeltaLVEF) between rest and stress was 5.2%. The DeltaLVEF in those patients with RD was significantly higher than that in the NPD (0.9%, P < 0.01) or FD (2.1%, P < 0.05) subgroups. Twenty of the 33 patients (60.6%) with RD showed an increase in LVEF > or = 5% from poststress to rest, and the poststress ESV (43.3 +/- 19.0 mL) was significantly higher than the ESV (38.5 +/- 18.4 mL, P < 0.01) at rest, but there was no significant difference in the EDV (90.5 +/- 26.4 vs 89.7 +/- 26.2 mL). In group B, DeltaLVEF was 1.5%, 4.4%, and 1.2% in patients with NPD, RD, and FD respectively. In group C, DeltaLVEF was 2.5%, 3.2%, and 0.9% in patients with NPD, RD, and FD respectively, and there was no significant difference in DeltaLVEF among patients. In group C, 4 of 17 patients (23.5%) with RD showed an increase in LVEF > or = 5% from poststress to rest.
These results showed that adenosine stress-induced postischemic LV dysfunction is well noted on early quantitative gated SPECT in patients with RD and can also be observed on delayed gated SPECT, even though the incidence of LV dysfunction is less than that in early gated SPECT.
Clinical Nuclear Medicine 02/2005; 30(1):18-22. · 3.67 Impact Factor
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ABSTRACT: A 27-year-old female patient was admitted to our hospital with a history of leg pain and mass. She had a benign osteoblastoma in right tibia. Resection of the tumor without treatment by vitamin D antagonist resulted in rapid cure of the osteomalacia. Bone scintigraphy with Tc-99m MDP revealed multiple hot uptakes in initial scan, and follow up scan showed a clear resolution of the lesions.
Annals of Nuclear Medicine 08/2003; 17(5):411-4. · 1.50 Impact Factor
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ABSTRACT: The authors report abnormal Tc-99m sestamibi (MIBI) and Tl-201 uptake in a 62-year-old patient with histologically and biochemically proved myeloma. Tl-201 imaging was undertaken for tumor evaluation, and 3 days later a Tc-99m MIBI study showed diffuse and focal marrow uptake with focal skull lesions, whereas Tl-201 did not show skull lesions. After treatment, follow-up Tc-99m MIBI whole-body imaging was performed and the marrow uptake was decreased.
Clinical Nuclear Medicine 02/2001; 26(3):212-215. · 3.67 Impact Factor
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ABSTRACT: High doses of iodine-131 ((131)I) are commonly used in patients with differentiated thyroid cancer (DTC) after total or subtotal thyroidectomy, in order to ablate the remaining cancer or normal thyroid tissue. Whole body scan performed after about 5 days can visualize possible metastatic lesions and may also show the stomach, salivary glands, the breasts expressing sodium iodide symporter (NIS), the liver due to metabolism of radioiodinated thyroglobulin and the urinary tract due to urinary excretion of the administered (131)I. A 65 years old female underwent a near total thyroidectomy for a 0.9cm DTC of the papillary type on the right lobe. Histopathology revealed extrathyroid extension of the cancer with multifocal metastases in both lobes, and in one pretracheal lymph node. After surgery, the patient underwent (131)I ablation with 5.55GBq of (131)I and whole body scan was obtained after 5 days. The scan demonstrated usual (131)I accumulation in the thyroid remnant, the salivary glands and the liver. Increased (131)I uptake at the area of the right kidney was also noted. The patient had a 5 years history of an asymptomatic large simple cyst in the right kidney. Computed tomography (CT) scan of the abdomen showed only the known cyst (7x6cm) involving the middle portion of the right kidney. Serum laboratory tests performed at the time of ablation revealed of thyrotropin: >81μIU/mL (reference range: 0.3-4.0μIU/mL), 3.2ng/mL thyroglobulin (reference range: 0-50.0μIU/mL), and 115.5U/mL antithyroglobulin antibody (reference range 0-35.0U/mL). The patient was followed-up with thyroid hormone replacement and serum thyroglobulin measurements every year. The thyroglobulin levels for the follow-up period remained undetectable (detection limit 0.2ng/mL). Three years after ablation, the patient underwent diagnostic whole body scan using 185MBq of (123)I. Thyroid function tests 4 weeks after thyroid hormone withdrawal were: thyrotropin >81μIU/mL, thyroglobulin was undetectable, antithyroglobulin antibody was 74.0U/mL, and the scan demonstrated no tracer uptake in the thyroid bed. No tracer uptake was apparent at the right kidney area where the cyst had been previously seen. The origin of simple renal cysts is not clear, but enlargement of a renal tubule and the eventual loss of its connection to the parent tubule has been suggested. The epithelium of the renal cyst may still be excreting as the renal tubular epithelium and might express NIS. Thus, activity of NIS of renal tissue of the renal cyst might be the mechanism for the radioiodine uptake of the renal cyst on the post-ablation (131)I whole body scan. Renal pelvis and ureter are not usually visualized due to the rapid transit time of the radioiodine through the kidneys. Uncomplicated renal cysts do not usually accumulate radioiodine, although several cases have been identified with this tracer indicating either communication between the cyst and the renal collecting system or diffusion of radioiodine from renal sinus lymphatics, and/or NIS activity of the renal cyst tissue. Renal metastases of DTC in the renal cyst, although very rare, have been reported and may also show radioiodine uptake. In the current case, the possibility of renal cyst metastases from the DTC was clinically ruled out by the typical finding of a well-defined cystic lesion in the right kidney on the CT scan and by the low serum thyroglobulin levels tested before both whole body scans. A possible reason for non-visualization of the renal cyst on the follow-up diagnostic (123)I whole body scan might be the ablation by the high (131)I dose, of the cystic epithelial cells having NIS expression and excreting radioiodine into the cyst. Both (131)I and (123)I, which emit gamma rays, can be used to detect hidden thyroid cancer lesions in thyroid cancer patients. In the present case, (123)I was used for the diagnostic whole body scan to reduce radiation burden to the patient. With the same administered activity, (123)I is known to deliver an absorbed radiation dose that is approximately one-fifth of that of (131)I to NIS-expressing tissues. The diagnostic (123)I whole body scan uses about 30 times a lower dose than the post-ablation (131)I scan, and offers a shorter time interval between its administration and image acquisition (1 day versus 5 days). These differences may eliminate image quality give lower target-to-background ratio and poorer spatial resolution, if the diagnostic (123)I whole body scan is applied. In conclusion, a renal cyst after a high dose whole body (131)I scan may be well identified as a false positive finding and may not reappear on a low dose diagnostic (123)I whole body scan performed after 3 years, possibly due to either ablation of NIS expressing cells or to the low dose of (123)I in the diagnostic scan.
Hellenic journal of nuclear medicine 15(3):258-9. · 0.81 Impact Factor
