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J Nucl Med. 2006; 47 (Supplement 1):331P
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Poster Presentations - Physicians/Scientists/Pharmacists

General Clinical Specialties Track

Whole body scan post I-131 thyroid carcinoma ablation therapy: Overlap of findings between early and delayed imaging

Sherif Heiba2, Ivan Castellon1, Jenine Vecchio1, Philip Bukberg1, Vincent Yen1, Erkan Altinyay1, Barbara Raphael1, Hussein Abdel-Dayem1 and Iven Young1

1 Radiology, Division of Nuclear Medicine, St. Vincent's Hospital Manhattan, New York, New York 2 Nuclear Medicine Section, Mount Sinai Medical Center, New York, New York

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Objectives: Although the information obtained from early versus delayed whole body scanning (WBS) post I-131 thyroid cancer ablation therapy is generally similar, the findings on the two scans may not be identical. This study was undertaken to examine the variation between early and delayed post-therapy WBS, both on a lesion and patient basis.

Methods: Fifty-two consecutive patients (10 men, 42 women, mean age 47±14 years) with differentiated thyroid carcinoma (16 follicular, 36 papillary) had both early (mean 2±1 days) and delayed (mean 10±3 days) WBS after I-131 ablation therapy. Mean treatment activity given was 3.8±1.5 GBq (140±55 mCi). Both early and delayed post-therapy WBS were compared (2 observers) with the pre-therapy WBS that was performed 24 hours post ingestion of 135 MBq (5 mCi) I-123. Additionally, the focal uptake to background count ratio was obtained for every lesion in all scans.

Results: The number of residual neck foci, regional lymph nodes and distant metastatic foci in pre-therapy, early and delayed post-therapy WBS are shown in table 1. Patients were classified according to number of neck, regional lymph node, and metastatic foci in both early and delayed post-therapy WBS. There was good overall agreement between both post-therapy WBS for the patient’s foci number that was highest for metastatic (100% agreement, kappa 1.0, p < 0.001) and lowest for regional lymph nodes (57% agreement, kappa .31, p < 0.05). Four patients showed regional lymph node uptake in delayed WBS but not in early WBS, whereas regional lymph node uptake was only evident in early post-therapy WBS in 2 of the patients. The mean count ratio of all the lesions was not significantly different between early and delayed post-therapy WBS. However on a single lesion basis, there was no significant correlation between early and delayed post-therapy WBS count ratio for the neck and metastatic foci with only borderline significant correlation for regional lymph nodes (R2 = .41).

Conclusions: Although the findings in early and delayed post-therapy WBS were generally agreeable, some discordance was found in the number of the lesions and the uptake ratio. Therefore, the utilization of both early and delayed WBS is advisable for the optimal evaluation of thyroid cancer patients post I-131 therapy.


Figure 1







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