In not a few instances have nuclear medicine physicians encountered persistent neck lesions in 131I whole body scintigraphy despite giving repeated radioactive iodine therapy. Interpreting these lesions as still thyroid remnants served as a dilemma. This is a case of a 37-year-old female with papillary thyroid cancer. 131I whole body scans done before and one year after radioactive iodine therapy showed persistent and unchanged neck lesions. Further imaging with SPECT/CT showed laryngeal skeleton involvement. Rarity of vascular and lymphatic spread to the larynx has led to a small number of reported cases. Neck lesions should not always be immediately diagnosed as thyroid remnants.
Human ; Female ; Adult ; WHOLE BODY IMAGING ; DIAGNOSIS ; DIAGNOSTIC TECHNIQUES AND PROCEDURES ; DIAGNOSTIC IMAGING

This is a case report of a 65-year-old female with lumbar vertebral lesions secondary to an unknown primary malignancy. 99mTc-methylene diphosphonate bone scintigraphy showed multiple bone metastases as well as focal extraosseous uptake in the area above the right supraclavicular area. Further imaging with SPECT/CT localized the calcified extraosseous uptake to the right thyroid bed. These findings narrowed down the primary malignancy to a thyroidal origin, which was eventually proven as such through immunohistologic studies of the lumbar lesions. Different pathophysiologic mechanisms of extraosseous uptake in bone scintigraphy and how SPECT/CT can increase the diagnostic value of a standard nuclear medicine procedure are highlighted in this paper.

Human ; Female ; Aged ; Thyroid Neoplasms ; Thyroid cancer, papillary ; Tomography, Emission-Computed, Single-Photon ; Low Back Pain

?Iodine-131 (I-131) whole body scan is a procedure routinely done after radioactive iodine therapy. It helps detect presence of functioning thyroid tissue remnants in the neck, as well as distant metastases. However, not all that take up I-131 are of thyroidal origin. Our patient is a 74-year-old woman with recurrent papillary thyroid carcinoma, who underwent a repeat radioactive iodine therapy (RAIT). Her post-RAIT whole body scan showed an unusual iodine-avid focus in the transverse colon which was later confirmed to be another primary malignancy of colonic origin through colonoscopy with biopsy, as well as post-surgical histopathology. This case report distinctively demonstrates uptake of I-131 in extra-thyroidal malignancy. It also emphasizes the importance of evaluating carefully any irregular-looking focal iodine uptake in areas with seemingly physiologic activity on a routine I-131 whole body-scan.

Human ; Female ; Aged ; Whole Body Imaging ; Thyroid cancer, papillary-Recurrence ; Carcinoma

Biliary atresia is a significant cause of neonatal jaundice that needs differentiation from neonatal hepatitis. Early identification of biliary atresia is important as surgical intervention is required. A hepatobiliary scan can help in the diagnosis of biliary atresia. Scintigraphic findings in a rare type of biliary atresia are described here to serve as a guide to other nuclear medicine physicians. Type 7 biliary atresia, which has an atretic common bile duct only, appears as persistent radiotracer activity in the gallbladder with no tracer activity in the intestines.

Human ; Female ; Infant ; Biliary Atresia ; Common Bile Duct ; Gallbladder ; Hepatitis ; Infant, Newborn ; Intestines ; Jaundice, Neonatal ; Nuclear Medicine ; Radionuclide Imaging

An established standard imaging modality for detecting bone metastases in patients with breast cancer is through the use of 99mTc-hydroxymethylene diphosphonate (99mTc-IIDP) bone scintigraphy. It is clearly documented that sensitivity is generally high while specificity is often lower because of tracer uptake in non-malignant processes. The aim of this study is to evaluate the diagnostic performance of whole body 2-deoxy-2-[18F]-D- glucose positron emission tomography (18 F-FDG PET) and bone scintigraphy in the detection of bone metastasis in patients with breast cancer.
METHODS: There were 232 consecutive patients who underwent FDG PET for breast cancer staging/restaging at our center during the study period. We included those who only had a bone scintigraphy within a month before or after the PET scan. The results of each image interpretation were compared retrospectively by an experienced nuclear medicine physician. Per-patient and per-lesion detection rates were collected. Bone metastasis slams was established on the basis of multimodality imaging and/or clinical follow-up for at least 6 months Weighted kappa was also calculated to determine agreement between the two modalities.
RESULTS: Forty-seven patients were included in the study with ages ranging from 28-86 years. For the patient-based data, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 90%, 92.6%, 90%, 92.6%, and 91.5%, respectively, for FDG PET, and 95%, 44.4%, 55.9%, 92.3% and 66%, respectively,for bone scintigraphy. For the lesion-based data, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 66.4%, 90%, 94.7%, 50%, and 72.8%, respectively, for FDG PET, and 74.5%, 27%, 752%, 26.3% and 62.6%, respectively, for bone scintigraphy Agreement between the two modalities was slight.
CONCLUSIONS: Overall, FDG PET shows to be as sensitive as bone scintigraphy in picking up bone metastases Furthermore, on both per patient and per lesion bases; PET was shown to be more confirmatory and more accurate with evidence of statistical significance. FDG PET and bone scintigraphy should play complementary roles in the detection of skeletal metastases.

Human ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Glucose ; Neoplasm Staging ; Fluorodeoxyglucose F18 ; Positron-emission Tomography ; Bone Neoplasms ; Breast Neoplasms ; Diphosphonates

An established standard imaging modality for detecting bone metastases in patients with breast cancer is through the use of 99mTc-hydroxymethylene diphosphonate (99mTc-IIDP) bone scintigraphy. It is clearly documented that sensitivity is generally high while specificity is often lower because of tracer uptake in non-malignant processes. The aim of this study is to evaluate the diagnostic performance of whole body 2-deoxy-2-[18F]-D- glucose positron emission tomography (18 F-FDG PET) and bone scintigraphy in the detection of bone metastasis in patients with breast cancer.
METHODS: There were 232 consecutive patients who underwent FDG PET for breast cancer staging/restaging at our center during the study period. We included those who only had a bone scintigraphy within a month before or after the PET scan. The results of each image interpretation were compared retrospectively by an experienced nuclear medicine physician. Per-patient and per-lesion detection rates were collected. Bone metastasis slams was established on the basis of multimodality imaging and/or clinical follow-up for at least 6 months Weighted kappa was also calculated to determine agreement between the two modalities.
RESULTS: Forty-seven patients were included in the study with ages ranging from 28-86 years. For the patient-based data, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 90%, 92.6%, 90%, 92.6%, and 91.5%, respectively, for FDG PET, and 95%, 44.4%, 55.9%, 92.3% and 66%, respectively,for bone scintigraphy. For the lesion-based data, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 66.4%, 90%, 94.7%, 50%, and 72.8%, respectively, for FDG PET, and 74.5%, 27%, 752%, 26.3% and 62.6%, respectively, for bone scintigraphy Agreement between the two modalities was slight.
CONCLUSIONS: Overall, FDG PET shows to be as sensitive as bone scintigraphy in picking up bone metastases Furthermore, on both per patient and per lesion bases; PET was shown to be more confirmatory and more accurate with evidence of statistical significance. FDG PET and bone scintigraphy should play complementary roles in the detection of skeletal metastases.

Human ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Glucose ; Neoplasm Staging ; Fluorodeoxyglucose F18 ; Positron-emission Tomography ; Bone Neoplasms ; Breast Neoplasms ; Diphosphonates

Background/Objective: Papillary thyroid carcinoma is the most common type of thyroid cancer. Treatment includes surgery and remnant ablation with radioactive iodine theraphy while follow-up monitoring includes I- 131 whole body scans land thyroglobulin monitoring. Lymphovascular invasion (LVI) has been used as a predictor of metastasis in different cancers. Therefore, it might be useful in predicting metastasis in patients with papillary thyroid carcinoma since metastasis in this type of carcinoma travels via the lymphatic route. The purpose of this study was to determine the association of LVI with metastasis among patients with papillary thyroid carcinoma Methodology: Records of patients with papillary thyroid carcinoma (histopathologic reports, thyroglobulin levevls and I-131 whole body scans) were reviewed. Univariate and multivariate anlyses were performed. Results: A total of 108 subjects were recruited for this study, 47 (43.5%) of which had LVI. There was no association found between LVI and metastasis on baseline (p=0.72) and follow-up scans (p=0.07). However, there was an association between metastasis resolution on follow-up scans and high-dose radioactive treatment (p=0.02) regarless of presence or absence of LVI. Conclusion There was a significant association of the presence of LVI with elevated thyroglobulin levels (p-value<0.0001). A significant association was also seen with LVI and dose of activity with resolution of thyroid remnant, locoregional lymph node and distant metastasis (p=0.02). Even though no association jwas seen between LVI and metastasis, a robust percentage of patients with LVI were positive for metastasis on whole body scans.
Thyroid Cancer, Papillary