BJR
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
British Journal of Radiology (2003) 76, 690-695
© 2003 British Institute of Radiology
doi: 10.1259/bjr/31538331
This Article
Right arrow Abstract Freely available
Right arrow Figures Only
Right arrow Full Text (PDF)
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Khan, N
Right arrow Articles by Endo, K
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Khan, N
Right arrow Articles by Endo, K

Review article

PET in the follow-up of differentiated thyroid cancer

N Khan, MD, N Oriuchi, MD, T Higuchi, MD, H Zhang, DMSc and K Endo, MD

Department of Nuclear Medicine & Diagnostic Radiology, Gunma University, Faculty of Medicine, 3-39-22 Showamachi, Maebashi City, Gunma 371-8511, Japan


   Abstract
Top
 Abstract
Introduction
 Methods
 Clinical value of FDG...
 Can TSH influence on...
 Conclusion
 References
 
Fluorine-18-fluorodeoxyglucose (FDG) PET has become an increasingly important functional imaging modality in clinical oncology. This article will focus primarily on the role of FDG PET during treatment and follow-up of thyroid cancer. The major role of FDG PET is in patients with elevated thyroglobulin (Tg) levels where thyroid cancer tissue does not concentrate radioiodine rendering false-negative results on I-131 scanning. FDG PET imaging takes advantage of the increased uptake of FDG in cancer cells and is sensitive (60–94%) to the detection of recurrent or metastatic cancer in patients who have negative radioiodine scans. The specificity (25–90%) of PET imaging is relatively less than its sensitivity because some inflammatory processes avidly accumulate FDG. PET can fail to localize the tumour sites in some patients with well-differentiated thyroid cancer that retain good iodine ability. This can result the well recognized phenomenon of "flip-flop" depending on the differentiation of the thyroid cancer. Several studies have documented the higher accuracy of PET, compared with other imaging modalities in the evaluation of patients with recurrent or metastatic differentiated thyroid cancer. The value of thyroid stimulating hormone stimulation for FDG PET has recently been reported. Therefore, if available, this method should be considered in all patients of differentiated thyroid cancer with suspected recurrence and/or metastasis.


   Introduction
Top
 Abstract
 Introduction
Methods
 Clinical value of FDG...
 Can TSH influence on...
 Conclusion
 References
 
The four broad categories of primary thyroid cancer include (i) papillary carcinoma, (ii) follicular carcinoma, (iii) medullary carcinoma, and (iv) anaplastic thyroid carcinoma [1]. Each of these morphologic patterns has its own distinctive biology and clinical significance. The differentiated thyroid carcinoma (DTC) consists of papillary and follicular carcinomas deriving from follicular cells of the thyroid. These tumours, representing the most common type of thyroid cancers, can be cured with initial adequate surgical treatment and subsequent adjunctive therapy. However, tumour recurrence either involving the thyroid bed or the regional lymph nodes or both, can be associated with significant morbidity and even mortality [2]. The prognosis of patients with recurrent or metastatic disease depends on the size and extent of tumour when detected [3]. After primary treatment, patients are routinely followed-up using serum thyroglobulin (Tg) measurement and conventional I-131/123 scintigraphy [4]. An elevated serum Tg concentration is usually associated with abnormal I-131 scan findings in case of recurrent or metastatic disease [5]. On the other hand, a negative Tg measurement corresponds to a negative I-131 whole body scan in patients without disease. In general, when the above methods corresponds positively, patients are treated with large dose I-131 and when these tests become negative and clinically the patient shows no symptoms, no other measures are undertaken. However, some patients have true metastases or recurrence, causing a high Tg level, that do not concentrate I-131, even when it is given in therapeutic doses [6]. In addition, serum Tg can be occasionally detected in patients without disease [7], and undetectable Tg levels are also found in some patients with metastases [8]. In this setting further imaging is essential to localize the recurrence or metastases. Morphologic imaging techniques such as ultrasound, CT and MRI, have limited value as to their specificity, particularly in cases of altered anatomy after surgical treatment. Frequently it causes difficulties in the differentiation of scar tissue from local recurrence and of non-specific lymph node enlargement from lymph node metastases [9]. Other radionuclides used for this purpose include Tl-201, 99Tcm-sestamibi (99Tcm-MIBI), or 99Tcm-tetrofosmin or In-111-octreoscan. In the literature, there are several publications presenting sensitivities, specificities and accuracies of these tests [10–14]. However, all of these imaging techniques lack of sensitivity or specificity to some extent due to their limited resolution. Because the usefulness of positron-emission tomography using fluorine-18-fluorodeoxyglucose (FDG PET) has been substantiated for various cancers [15–18], and on account of significant glucose consumption of thyroid cancer cells, this new modality has also become valuable for detecting recurrent or metastatic thyroid cancer. This article will focus on PET imaging in patients with DTC during follow-up based on published data.


   Methods
Top
 Abstract
 Introduction
 Methods
Clinical value of FDG...
 Can TSH influence on...
 Conclusion
 References
 
PET radiopharmaceuticals
PET studies of tumour metabolism are usually performed with glucose derivatives and amino acids. Fluorine-18-fluorodeoxyglucose (18F-FDG), fluorine-18 sodium fluoride (18F), fluorine-18-dihydroxyphenylalanine (18F-DOPA) and iodine-124 (124I) are the positron-emitting radiopharmaceuticals used in patients with thyroid cancer. For practical reasons 18F-FDG is the principal radiotracer for clinical PET studies. 18F is produced in a cyclotron and then the radiopharmaceutical is usually synthesized locally by simple radiochemistry. Many PET centres have a cyclotron facility and camera in close proximity, ensuring a supply of 18F-FDG. Owing to the short half-life of 18F (110 min), its production at a distance from the PET camera can cause problems. FDG being trapped within the metabolically active tumour cells and provide the basis for functional imaging.

There are few studies in literature using 18F-PET and 18F-DOPA PET in the evaluation of patients with thyroid cancer [19, 20]. 124I is a positron-emitting radionuclide of iodine with a half-life of 4.02 days. Although its use in clinical oncology is limited, a potential use of 124I-PET in the management of patients with DTC can be expected in future. PET methodology with 124I for more accurate tumour localization with the added bonus of more accurate tumour dosimetry to predict dose delivery has been advocated by some investigators [21].

Instruments and imaging
PET imaging can be carried out with either a dedicated PET or a coincidence detection capable gamma camera [22]. Most of the published studies regarding patients with thyroid cancer have been performed with a dedicated PET camera. We perform PET studies with a dedicated PET scanner (SET 2400W, Shimadzu, Kyoto, Japan) with a 59.5 cm transaxial field of view and 20.0 cm axial field of view, which produces 63 image planes with a 3.125 mm interval between images. Transaxial resolution at the centre of the field of view is 4.2 mm full width half maximum. The ordered-subsets expectation maximization (OSEM) algorithm is used to produce the PET images.

FDG imaging is performed after 40–60 min of intravenous administration while patients are in a fasting state. Fasting is necessary to minimize competitive inhibition of FDG uptake by blood glucose [23]. At least 4 h fasting is recommended. Some institutes measure serum glucose before tracer injection and if it is higher than 200 mg dl-1 defer a PET scan until the patient is normoglycaemic. In patient with diabetes who require FDG PET, the blood sugar should be well controlled by either oral hypoglycaemic agents or insulin before scanning. The administered dose of FDG is 5–6 MBq kg-1 in our institute. In a standard protocol of thyroid cancer imaging, the patient should be relaxed prior to and after the injection of FDG. Tension of the neck muscles can result in focal uptake, which can be misinterpreted as nodal metastases [24]. Whole body scans are usually performed to evaluate patients with known malignancy, but metastasis is rarely seen in the legs. We routinely scan patients from the skull to the mid-thigh region. Emission scans typically take 40 min to cover 100 cm. Emission scans are corrected for signal attenuation by applying a correction derived from a 68Ga transmission scan of the same region. Transmission scans are typically acquired for 18 min. In our institute, we acquire an 8 min simultaneous emission–transmission scan for attenuation correction. Images are viewed in the transaxial, coronal and sagittal planes from a computer monitor screen which allows coregistration of all three orthogonal views.

The FDG images are usually interpreted qualitatively like other imaging studies, and an area of abnormality is identified by comparison with background activity. Using attenuation-corrected images, a semiquantitative parameter standardized uptake value (SUV) determination may be useful in characterizing lesions as benign or malignant [25]. SUV can be calculated from the equation Go


However, some authorities do not like to emphasize on SUV calculation as they observed no significant difference between visual assessment and semiquantitative assessment using SUV [26].


   Clinical value of FDG PET
Top
 Abstract
 Introduction
 Methods
 Clinical value of FDG...
Can TSH influence on...
 Conclusion
 References
 
FDG PET imaging is now being used in the evaluation of DTC patients with negative I-131 scans and elevated Tg levels as well as undetectable Tg with suspicious recurrence or metastases. Following the first positive report of FDG PET on thyroid cancer [27], many investigators have studied the role of FDG PET in detecting recurrent or metastatic DTC [28–32]. In a prospective study of 41 patients, Feine et al found a sensitivity of 94% for FDG PET [28]. They observed the "flip-flop" phenomenon in this study. Flip-flop means the alternating uptake pattern of I-131 and FDG by the differentiated papillary or follicular thyroid carcinomas. The thyroid cancers and their metastases show either some iodine uptake combined with low FDG uptake, or no uptake of I-131 combined with high FDG uptake. These differences reflect tumour cell differentiation. Subsequently, in a review of 222 patients who had both FDG PET and I-131 scans, Feine calculated the sensitivity and specificity of 75% and 90% for FDG PET [29]. He also clarified that cancers with good differentiation were more successfully imaged with I-131, and those with poorer differentiation being better imaged on PET scan. Similar observations were made by Grunwald et al [30] who found FDG PET to be superior to I-131 scintigraphy in poorly differentiated carcinoma. In the view of Dietlein et al [31], the utility of FDG PET varied among different organs, being highest in the cervical lymph nodes and lowest in the small pulmonary metastases. Comparing the sensitivity of conventional bone scintigraphy using 99Tcm-methylene diphosphonate, the common method for searching bone metastases, with 18F-PET, Schirrmeister et al [33] found the latter to be more sensitive and recommended using it when possible.

A multicentre study in Germany [34], which included 222 patients of DTC, observed superiority of FDG PET compared with I-131 and Tl-201/99Tcm-MIBI scintigraphy. The overall sensitivity of FDG PET was 75%, it increased to 85% when only patients with negative I-131 scans were included. In agreement with these observations, Chung et al found that FDG PET was highly accurate in identifying recurrent or metastatic thyroid cancer in a study of 33 patients [35]. They found a sensitivity of 93.9% for FDG PET. In this study, 15 patients with metastatic disease had undetectable Tg level, and FDG PET could detect abnormality in 14 of 15 patients. This indicates that FDG PET is effective not only with elevated Tg patients but also in patients with undetectable Tg. Plotkin et al [36] calculated an overall sensitivity of 92% and a specificity of 80% from data analysis of a multicentre study for the detection of recurrent or metastatic Hurthle cell carcinoma.

Schluter et al [37] analyzed the data of 118 PET studies on 64 patients and found the sensitivity and specificity of 69.4% and 41.7%, respectively. In their study, treatment was directly changed in 19 of 34 patients with true-positive PET findings. Four patients who underwent further surgery on the basis of locoregional findings had no signs for recurrence (Figure 1Go) later on [37]. Conti et al studied 24 patients with either elevated Tg, a rising Tg or at the presence of Tg antibodies and negative I-131 scans [38]. PET identified locally recurrent or metastatic disease in all 24 patients. In contrast, Shiga et al observed a low positive predictive value (47%) for FDG PET, compared with I-131 scanning (70%) [39]. However, their comparison was between both iodine positive and negative cases. Wang et al analyzed PET scans of 37 patients with DTC who had negative whole body I-131 scans [40]. They found a sensitivity of 70% and a specificity of 76.5% for FDG PET. In an another study, they observed a relationship between prognosis and FDG uptake in patients with thyroid cancer [41]. They found reduced survival in patients with PET positivity, high rates of FDG uptake, and high volume of the FDG-avid tumour. This indicates that FDG PET can provide prognostic information in thyroid cancer patients.



View larger version (55K):
[in this window]
[in a new window]
  		Figure 1. (a) FDG-positive local recurrence (arrow) in a 49-year-old man who presented with negative I-131 scan after thyroidectomy and two courses of radioiodine treatment of papillary thyroid cancer initially staged as T2bN0M0. (b) No tumour remnants were seen after further operation and (c) during follow-up. Reprinted with permission of SNM from Schulter et al [37].

 
Muros et al studied 10 patients of DTC with negative radioiodine scans and elevated Tg levels [42]. They determined a sensitivity of 60% for FDG PET in detecting recurrent and metastatic thyroid cancer. In another study of 22 patients with papillary thyroid cancer studied by FDG PET imaging in case of negative I-131 scanning, a sensitivity and specificity of 80% and 83% were found [43]. Frilling et al reported a sensitivity of 84.6% in a study including 13 patients with negative I-131 scans and elevated Tg level [44]. Subsequently, in an another study on 24 patients by FDG PET they determined a sensitivity of 94.6% [45]. In this study, unexpected distant metastases were detected in 37.5% of patients by PET, leading to alterations in the initial surgical plans. Figure 2Go shows an example of a true-positive patient with histologically proven locoregional and distant metastases [45].



View larger version (87K):
[in this window]
[in a new window]
  		Figure 2. (a) A 70-year-old woman with follicular thyroid carcinoma. Cervical ultrasound indicated regional lymph node metastases. To confirm this finding and to determine whether there were additional lesions, FDG PET was performed which showed hot spots in the neck, upper mediastinum, the sternum and 12th thoracic vertebra (arrow). (b) Coronal slice in a 81-year-old woman showing lymph node metastases in the neck as well as mediastinum.

 
Alnafisi et al reported that FDG PET was effective under thyroid stimulating hormone (TSH) suppression [46]. They studied 11 patients except one continuing with levothyroxine (LT4) therapy. In this study, FDG PET identified lesions in 7 of 11 patients. Helal et al [47] studied 37 patients of DTC with negative I-131 scans after initial therapy on whom FDG PET was performed during LT4 therapy. All patients had recurrent or persistent disease, documented by elevated Tg levels or conventional imaging. FDG PET demonstrated positive findings in 28 of 37 patients (76%) and accurately localized tumour sites in 89% of them. In this study, PET was effective in both low and high stage tumours. FDG data led to a change in the clinical management of 29 of 37 patients. Table 1Go shows the sensitivity and specificity of FDG PET for detecting recurrence or metastases of DTC with negative I-131 scans from some of the published reports. The median sensitivity and specificity are 77% and 78.3%, respectively.


View this table:
[in this window]
[in a new window]
  		Table 1. Results of FDG PET for detecting I-131 negative recurrent and metastatic differentiated thyroid cancer: summary of literature

 

   Can TSH influence on FDG PET imaging in DTC?
Top
 Abstract
 Introduction
 Methods
 Clinical value of FDG...
 Can TSH influence on...
Conclusion
 References
 
TSH stimulated I-131 whole body scanning either by withdrawal of thyroxine or exogenous thyrotropin administration is the preferred method in routine follow-up of DTC, because an elevated TSH level is essential for effective radioiodine scintigraphy [48]. Iodide trapping of thyroid tissue is largely the result of TSH. On the other hand, glucose uptake is most likely related to the growth of the cells, which in the case of a cancerous cell might be independent of TSH. However, there is experimental evidence that TSH can modulate glucose transport and thus FDG uptake in thyroid carcinoma. In cultured thyroid cells, TSH increases Glut1 expression and glucose transport [49, 50]. Despite these experimental results, there has been debate as to whether the sensitivity of FDG PET could be further improved by TSH stimulation. This proposition is clinically supported by a small number of initial studies [51, 52]. Sisson et al first reported higher FDG uptake in one patient with euthyroid and then hypothyroid [51]. But this was in contrast to the conclusion of Feine [28] and Wang et al [40], who did not find a clinically significant difference in four patients who had PET scans in both euthyroid and hypothyroid states. Grunwald et al also did not find an increase in FDG uptake with an elevated TSH [53]. But in their study, scan outcome was compared group wise and no sequential FDG PET scans were performed in the same patients. Recently, Moog et al [54] reported from a sequential study that FDG uptake in recurrent and metastatic DTC was dependent on the TSH level and this might influence the sensitivity of lesion detection. FDG PET demonstrated 15 of 17 lesions under TSH stimulation and 12 of 17 lesions under TSH suppression in 10 patients. In agreement with this report, Van Tol et al [55] also observed better yield of FDG PET for the detection of recurrent or metastatic DTC under TSH stimulation in a study of eight patients. PET detected abnormal lesions in five patients during TSH stimulation and in four patients during TSH suppression. In two of the five patients, more lesions were found on FDG imaging during TSH stimulation compared with TSH suppression. In all PET positive patients, lesion-contrast was better during TSH stimulation. More recently, there is a publication by Petrich et al [56] using recombinant human thyroid stimulating hormone (rhTSH) in FDG PET scanning on 30 patients. They determined the sensitivity of 87% under rhTSH stimulation and 53% under rhTSH suppression. This new method is clinically applicable, as rhTSH is increasingly administered in the follow-up of differentiated thyroid cancer patients, and since induction of hypothyroidism is not required. Table 2Go compares the results of sequential FDG PET scans intraindividually under TSH stimulation and TSH suppression from the published reports.


View this table:
[in this window]
[in a new window]
  		Table 2. Results of FDG PET during thyroid stimulating hormone (TSH) stimulation and TSH suppression

 

   Conclusion
Top
 Abstract
 Introduction
 Methods
 Clinical value of FDG...
 Can TSH influence on...
 Conclusion
References
 
Based on the results of published data FDG PET appears to be effective for detecting recurrent or metastatic DTC with high sensitivity and specificity, particularly in patients with negative radioiodine scans and elevated Tg levels. Patient management is improved because when localized tumour is diagnosed correctly, surgery or focused radiotherapy could be used to eradicate the tumour. Therefore, the technique should be used in the follow-up of DTC if it is available. PET imaging under rhTSH stimulation may increase its sensitivity. However, it needs more studies to establish this clinical proposition.

Received for publication October 14, 2002. Revision received May 27, 2003. Accepted for publication June 21, 2003.


   References
Top
 Abstract
 Introduction
 Methods
 Clinical value of FDG...
 Can TSH influence on...
 Conclusion
 References
 

  1. Hedinger C, Williams ED, Sobin LH. The WHO histological classification of thyroid tumors: A commentary on the second edition. Cancer 1989;63:908.[CrossRef][Medline]
  2. Sanders LE, Cady B. Differentiated thyroid cancer: reexamination of risk groups and outcome of treatment. Arch Surg 1998;133:419–25.[Abstract/Free Full Text]
  3. Schlumberger MJ. Diagnostic follow-up of well-differentitated thyroid carcinoma: historical prospective and current status. J Endocrinol Invest 1999;22(11 Suppl):3–7.[Medline]
  4. Schlumberger MJ. Papillary and follicular carcinoma. N Engl J Med 1998;338:297–306.[Free Full Text]
  5. Lin JD, Chao TC, Huang MJ, Weng HF, Tzen KY. Use of radioactive iodine for thyroid remnant ablation in well differentiated thyroid carcinoma to replace the thyroid reoperation. Am J Clin Oncol 1998;21:77–81.[CrossRef][Medline]
  6. Schlumberger M, Arcangioli O, Piekarski JD, Tubiana M, Parmentier C. Detection and treatment of lung metastases of differentiated thyroid carcinoma in patients with normal chest x-rays. J Nucl Med 1988;29:1790–4.[Abstract/Free Full Text]
  7. Black EG, Cassoni A, Gimlette TM, Harmer CL, et al. Serum thyroglobulin in thyroid cancer. Lancet 1981;2:443–5.[Medline]
  8. Grant S, Luttrell B, Reeve T, et al. Thyroglobulin may be undetectable in the serum of patients with metastatic disease secondary to differentiated thyroid carcinoma. Follow-up of differentiated thyroid carcinoma. Cancer 1984;54:1625–8.[CrossRef][Medline]
  9. Galloway RJ, Smallridge RC. Imaging in thyroid cancer. Endocrinol Metab Clin North Am 1996;25:93–113.[CrossRef][Medline]
  10. Nakada K, Katoh C, Kanegae E, et al. Thallium-201 scintigraphy to predict therapeutic outcome of iodine-131 therapy of metastatic thyroid carcinoma. J Nucl Med 1998;39:807–10.[Abstract/Free Full Text]
  11. Yen T-C, Lin H-D, Lee C-H, Chang S-L, Yeh S-H. The role of technetium-99m sestamibi whole-body scans in diagnosing metastatic Hurthle cell carcinoma of the thyroid gland after total thyroidectomy: a comparsion with iodine-131 and thallium-201. Eur J Nucl Med 1994;21:980–3.[Medline]
  12. Lind P, Gallowitsch HJ, Langsteger W, et al. Technetium-99m-tetrofosmin whole body scintigraphy in the follow-up of differentiated thyroid carcinoma. J Nucl Med 1997;38:348–52.[Abstract/Free Full Text]
  13. Tenenbaum F, Lumbroso J, Schlumberger M, Caillou B, Fragu P, Parmentier C. Radiolabeled somatostatin analog scintigraphy in differentiated thyroid carcinoma. J Nucl Med 1995;36:807–10.[Abstract/Free Full Text]
  14. Baudin E, Schlumberger M, Lumbroso J, Travagli JP, Caillou B, Parmentier C. Octreotide scintigraphy in patients with differentiated thyroid carcinoma; contribution for patients with negative radioiodine scans. J Clin Endocrinol Metab 1996;81:2541–4.[Abstract]
  15. Strauss LG, Conti PS. The applications of PET in clinical oncology. J Nucl Med 1991;32:623–48.[Abstract/Free Full Text]
  16. Gambhir SS, Hoh CK, Phelps ME, Madar I, Maddahi J. Decision tree sensitivity analysis for cost-effectiveness of FDG PET in the staging and management of non-small cell lung carcinoma. J Nucl Med 1996;37:1428–36.[Abstract/Free Full Text]
  17. Delbeke D. Oncological applications of FDG PET imaging. J Nucl Med 1999;40:1706–15.[Free Full Text]
  18. Bailet JW, Abemayor E, Jabour BA, Hawkins RA, Ho C, Ward PH. Positron emission tomography: a new, precise imaging modality for detection of primary head and neck tumors and assessment of cervical adenopathy. Laryngoscope 1992;102:281–8.[Medline]
  19. Schirrmeister H, Buck A, Guhlmann A, Reske SN. Anatomical distribution and sclerotic activity of bone metastases from thyroid cancer assessed with F-18 sodium fluoride positrom emission tomography. Thyroid 2001;11:677–83.[CrossRef][Medline]
  20. Hoegerle S, Altehoefer C, Ghanem N, Brink I, Moser E, Nitzsche E. 18F-DOPA positron emission tomography for tumor detection in patients with medullary thyroid carcinoma and elevated calcitonin levels. Eur J Nucl Med 2001;28:64–71.[CrossRef][Medline]
  21. Erdi YE, Macapinlac HA, Larson SM, et al. Radiation dose assessment for I-131 therapy of thyroid cancer using I-124 PET imaging. Clin Pos Imaging 1999;2:41–6.[CrossRef][Medline]
  22. Patton JA, Turkington TG. Coincidence imaging with a dual-head scintillation camera. J Nucl Med 1999;40:432–41.[Free Full Text]
  23. Lindholm P, Minn H, Leskinen-Kallio S, Bergman J, Ruotsalainen U, Joensuu H. Influence of the blood glucose concentration on FDG uptake in cancer: a PET study. J Nucl Med 1993;34:1–6.[Abstract/Free Full Text]
  24. Cook GJR, Maisy MN, Fogelman I. Normal variants, artefacts and interpretative pitfalls in PET with 18-fluoro-2-deoxyglucose and carbon-11 methionine. Eur J Nucl Med 1999;26:1363–78.[CrossRef][Medline]
  25. Lowe VJ, Fletcher JW, Gobar L, et al. Prospective investigation of positron emission tomography in lung nodules. J Clin Oncol 1998;16:1075–84.[Abstract]
  26. Yun M, Kim W, Alnafisi N, Lacorte L, Jang S, Alavi A. 18F-FDG PET in characeterizing adrenal lesions detected on CT or MRI. J Nucl Med 2001;42:1795–9.[Abstract/Free Full Text]
  27. Joensuu H, Ahonen A. Imaging of metastases of thyroid carcinoma with fluorine-18 fluorodeoxyglucose. J Nucl Med 1987;28:910–4.[Abstract/Free Full Text]
  28. Feine U, Leitzenmayer R, Hanke JP, Held J, Wohrle H, Muller-Schuenburg W. Fluorine-18-FDG and Iodine-131-iodide uptake in thyroid cancer. J Nucl Med 1996;37:1468–72.[Abstract/Free Full Text]
  29. Feine U. Fluoro-18-deoxyglucose positron emission tomography in differentiated thyroid carcinoma. Eur J Endocrinol 1998;138:492–6.[CrossRef][Medline]
  30. Grunwald F, Schomburg A, Bender H, et al. Fluorine-18-fluorodeoxyglucose positron emission tomography in the follow-up of differentiated thyroid cancer. Eur J Nucl Med 1996;23:312–9.[CrossRef][Medline]
  31. Dietlein M, Scheidhauer K, Voth E, Theissen P, Schicha H. Fluorine-18 fluorodeoxyglucose positron emission tomography and iodine-131 whole-body scintigraphy in the follow-up of differentiated thyroid cancer. Eur J Nucl Med 1997;24:1342–8.[CrossRef][Medline]
  32. Altenvoerde G, Lerch H, Kuwert T, Matheja P, Schafers M, Schober O. Positron emission tomography with F-18-deoxyglucose in patients with differentiated thyroid carcinoma, elevated thyroglobulin levels, and negative iodine scans. Langenbecks Arch Surg 1998;383:160–3.[Medline]
  33. Schirrmeister H, Guhlmann A, Elsner K, et al. Sensitivity in detecting osseous lesions depends on anatomic localization: planar bone scintigraphy versus 18F PET. J Nucl Med 1999;40:1623–9.[Abstract/Free Full Text]
  34. Grunwald F, Kalicke T, Feine U, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography in thyroid cancer: results of a multicentre study. Eur J Nucl Med 1999;26:1547–52.[CrossRef][Medline]
  35. Chung JK, So Y, Lee JS, et al. Value of FDG PET in papillary thyroid carcinoma with negative 131I whole-body scan. J Nucl Med 1999;40:986–92.[Abstract/Free Full Text]
  36. Plotkin M, Hautzel H, Krause BJ, et al. Implication of 2-18fluoro-2-deoxyglucose positron emission tomography in the follow-up of Hurthle cell thyroid cancer. Thyroid 2002;12:155–61.[CrossRef][Medline]
  37. Schluter B, Bohuslavizki KH, Beyer W, Plotkin M, Buchert R, Clausen M. Impact of FDG PET on patients with differentiated thyroid cancer who present with elevated thyroglobulin and negative I-131 scan. J Nucl Med 2001;42:71–6.[Abstract/Free Full Text]
  38. Conti PS, Durski JM, Bacqai F, Grafton ST, Singer PA. Imaging of locally recurrent and metastatic thyroid cancer with positron emission tomography. Thyroid 1999;9:797–804.[Medline]
  39. Shiga T, Tsukamoto E, Nakada K, et al. Comparison of 18F-FDG, 131I-Na and 201Tl in diagnosis of recurrent or metastatic thyroid carcinoma. J Nucl Med 2001;42:414–9.[Abstract/Free Full Text]
  40. Wang W, Macapinlac H, Finn RD, et al. PET scanning with [18F] 2-fluoro-2-D-glucose (FDG) can localize residual differentiated thyroid cancer in patients with negative [131I]- iodine whole-body scans. J Clin Endocrinol Metab 1999;84:2291–302.[Abstract/Free Full Text]
  41. Wang W, Larson SM, Fazzari M, et al. Prognostic value of [18F] fluorodeoxyglucose positron emission tomographic scanning in patients with thyroid cancer. J Clin Endocrinol Metab 2000;85:1107–13.[Abstract/Free Full Text]
  42. Muros MA, Llamas-Elvire JM, Ramirez-Navarro A, et al. Utility of fluorine-18-fluorodeoxyglucose positron emission tomography in differentiated thyroid carcinoma with negative radioiodine scans and elevated serum thyroglobulun levels. Am J Surg 2000;179:457–61.[CrossRef][Medline]
  43. Yeo JS, Chung JK, So Y, et al. F-18-fluorodeoxyglucose positron emission tomography as presurgical evaluation modality for I-131 scan-negative thyroid carcinoma patients with local recurrence in cervical lymph nodes. Head Neck 2001;23:94–103.[CrossRef][Medline]
  44. Frilling A, Gorges R, Tecklenborg K, et al. Value of preoperative diagnostic modalities in patients with recurrent thyroid carcinoma. Surgery 2000;128:1067–74.[CrossRef][Medline]
  45. Frilling A, Teckenborg K, Gorges R, et al. Preoperative diagnostic value of [18F] fluorodeoxyglucose positron emission tomography in patients with radioiodine negative recurrent well differentiated thyroid carcinoma. Ann Surg 2001;234:804–11.[CrossRef][Medline]
  46. Alnafisi NS, Driedger AA, Coates G, Moote DG, Raphael SJ. FDG PET of recurrent or metastatic I-131 negative papillary thyroid carcinoma. J Nucl Med 2000;41:1010–5.[Abstract/Free Full Text]
  47. Helal BO, Merlet P, Toubert M-E, et al. Clinical impact of 18F-FDG PET in thyroid carcinoma patients with elevated thyroglobulin levels and negative 131I scanning results after therapy. J Nucl Med 2001;42:1464–9.[Abstract/Free Full Text]
  48. Ladenson PW, Braverman LE, Mazzaferri EL, et al. Comparison of administration of recombinant human thyrotropin with withdrwal of thyroid hormone for radioactive iodine scanning in patients with thyroid carcinoma. N Engl J Med 1997;337:888–96.[Abstract/Free Full Text]
  49. Filetti S, Damante G, Foti D. Thyrotropin stimulates glucose transport in cultured rat thyroid cells. Endocrinol 1987;120:2576–81.[Abstract]
  50. Hosaka Y, Tawata M, Kurihara A, Endo T, Onaya T. The regulation of two distinct glucose transporter (GLUT1 and GLUT 4) gene expressions in cultured rat thyroid cells by thyrotropin. Endocrinol 1992;131:159–65.[Abstract]
  51. Sisson JC, Ackerman RJ, Meyer MA, Wahl RL. Uptake of 18-fluoro-2-deoxy-D-glucose by thyroid cancer: implications for diagnosis and therapy. J Clin Endocrinol Metab 1993;77:1090–4.[Abstract]
  52. Moog F, Linke R, Tiling R, et al. The influence of TSH levels on the uptake of F-18-FDG in metastatic thyroid cancer [abstract]. Eur J Nucl Med 1999;26(Suppl):1014p.
  53. Grunwald F, Menzel C, Bender H, et al. Comparison of FDG PET, I-131 and 99mTc-sestamibi scintigraphy in differentiated thyroid cancer. Thyroid 1997;7:327–35.[Medline]
  54. Moog F, Linke R, Manthey N, et al. Influence of thyroid-stimulating hormone levels on uptake of FDG in recurrent and metastatic differentiated thyroid carcinoma. J Nucl Med 2000;41:1989–95.[Abstract/Free Full Text]
  55. Van Tol KM, Jager PL, Piers DA, et al. Better yield of 18Fluorodeoxyglucose-positron emission tomography in patients with metastatic differentiated thyroid carcinoma during thyrotropin stimulation. Thyroid 2002;12:381–7.[CrossRef][Medline]
  56. Petrich T, Borner AR, Otto D, Hofmann M, Knapp WH. Influence of rhTSH on [(18)] fluorodeoxyglucose uptake by differentiated thyroid carcinoma. Eur J Nucl Med 2002;29:641–7.



This article has been cited by other articles:


Home page
 J. Clin. Endocrinol. Metab.Home page
R. T. Kloos
Approach to the Patient with a Positive Serum Thyroglobulin and a Negative Radioiodine Scan after Initial Therapy for Differentiated Thyroid Cancer
J. Clin. Endocrinol. Metab., May 1, 2008; 93(5): 1519 - 1525.
[Abstract] [Full Text] [PDF]

Home page
 Br Med BullHome page
J. D. Berry and G. J. R. Cook
Positron emission tomography in oncology
Br. Med. Bull., December 14, 2006; (2006) ldl013v1.
[Abstract] [Full Text] [PDF]

Home page
 RadioGraphicsHome page
M. B. Fukui, T. M. Blodgett, C. H. Snyderman, J. J. Johnson, E. N. Myers, D. W. Townsend, and C. C. Meltzer
Combined PET-CT in the Head and Neck: Part 2. Diagnostic Uses and Pitfalls of Oncologic Imaging
RadioGraphics, July 1, 2005; 25(4): 913 - 930.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Figures Only
Right arrow Full Text (PDF)
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Khan, N
Right arrow Articles by Endo, K
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Khan, N
Right arrow Articles by Endo, K

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
BJR DMFR IMAGING  ALL BIR JOURNALS