Hybrid SPECT/CT Imaging in the Management of Differentiated Thyroid Carcinoma

Document Type: Systematic Review and Meta-analysis

Authors

1 Department of Radiology and Nuclear Medicine, Hull and East Yorkshire Hospitals NHS Trust, Hull, United Kingdom.

2 Department of Nuclear Medicine, Fujairah Hospital, Fujairah, United Arab Emirates.

3 Hull York Medical School, Hull, United Kingdom.

4 Department of Nuclear Medicine, Kuwait Cancer Control Centre, Kuwait.

Abstract

Differentiated thyroid cancer (DTC) has a good prognosis overall; however, lifelong follow-up is required for
many cases. Radioiodine planar imaging with iodine-123 (123I) or radioiodine-131 (131I) remains the standard in
the follow-up after initial surgery and ablation of residual thyroid tissue using 131I therapy. Radioiodine imaging is
also used in risk-stratifying and for staging of thyroid cancer, and in long-term follow-up. Unfortunately, the lack
of anatomical detail on planar gamma camera imaging and superimposition of areas presenting with increased radioiodine
uptake can make accurate diagnosis and localization of radioiodine-avid metastatic disease challenging, leading to false
positive results and potentially to over-treatment of patients. Hybrid SPECT/CT allows precise anatomical localization
and superior characterization of foci of increased tracer uptake when compared to planar imaging. This, in turn, allows
the differentiation pathological and physiological uptake, increasing the accuracy of image interpretation and ultimately
improving the accuracy of DTC staging and subsequent patient management. In this review, we look at the unique and
emerging role that SPECT/CT plays in the management of DTC, illustrated by examples from our own clinical practice.

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