Nuclear Medicine. Diagnosis of thyroid and parathyroid gland pa-thology
Abstract Introduction and objective: Nuclear Medicine has a relevant role in the study of thyroid and parathyroid gland pathology. The aim of this work is to review the imaging techniques available nowadays in Nuclear Medicine, to study this pathology. Synthesis: Thyroid scinthigraphy is, even today, a useful tool in the study of thyroid pathology, such us in the thyroid nodule or in congenital hypothyroidism. SPECT-CT, compared to whole body scintigraphy (WBS) with radioiodine, improve the diagnosis and change the therapeutic management in patients with differentiated thyroid cancer, at the same time that, added to the parathyroid scintigraphy, it helps planning the surgery, especially in ectopic adenomas. PET-CT with FDG and other tracers has a relevant role in several indications and histology types of thyroid cancer, although mainly in the suspicion of recurrence. In addition, Fluorocholine PET-CT is an excellent alternative, with high successful localization rate, in cases with primary hyperparathyroidism (pHPT) and negative conventional techniques. Conclusions: With technical advances in the area of Nuclear Medicine, and particularly with hybrid imaging, the study of thyroid pathology has improved, especially in thyroid cancer, as well as pre-surgical localization of pHPT.
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1. Díaz García C, De Haro Del Moral FJ. Visión de conjunto del diagnóstico médico por la Imagen. En: Técnicas de exploración en Medicina Nuclear. Barcelona: Masson; 2005. p. 1-21.
2. Diaz García C, De Haro Del Moral FJ. Tomografía por emisión de positrones. En: Técnicas de exploración en Medicina Nuclear. Barcelona: Masson; 2005. p. 329-42.
3. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133.
4. Soelberg KK, Bonnema SJ, Brix TH, Hegedüs L. Risk of Malignancy in Thyroid Incidentalomas Detected by 18 F-Fluorodeoxyglucose Positron Emission Tomography: A Systematic Review. Thyroid. 2012;22(9):918-25.
5. Gharib H, Papini E, Paschke R, Duick D, Valcavi R, Hegedüs L, et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract. 2010;16(Suppl 1):1-43.
6. ACR-SNM-SPR Practice Guideline for the performance of Thyroid scintigraphy and uptake measurements. [Fecha de última actualización: 2009; Fecha de nuestra consulta: 24 jun 2019] Disponible en: http://snmmi.files.cms-plus.com/docs/Thyroid_Scintigraphy_1382732120053_10.pdf.
7. Jacob H, Peters C. Screening, diagnosis and management of congenital hypothyroidism: European Society for Paediatric Endocrinology Consensus Guideline. Arch Dis Child Educ Pract Ed. 2015;100(5):260-3.
8. Léger J, Olivieri A, Donaldson M, Torresani T, Krude H, van Vliet G, et al. European Society for Paediatric Endocrinology Consensus Guidelines on Screening, Diagnosis, and Management of Congenital Hypothyroidism. J Clin Endocrinol Metab. 2014;99(2):363-84.
9. Xue YL, Qiu ZL, Song HJ, Luo QY. Value of 131I SPECT/CT for the evaluation of differentiated thyroid cancer: a systematic review of the literature. Eur J Nucl Med Mol Imaging. 2013;40(5):768-78.
10. Zilioli V, Peli A, Panarotto MB, Magri G, Alkraisheh A, Wiefels C, et al. Differentiated thyroid carcinoma: Incremental diagnostic value of 131I SPECT/CT over planar whole body scan after radioiodine therapy. Endocrine. 2017;56(3):551-9.
11. Muros de Fuentes MA, Mitjavila Casanovas M, Estorch Cabrera M, Lecumberri Santamaria B, Navarro González E. Utilidad de la 18F-FDG PET/TC en el cáncer de tiroides. Rev Esp Med Nucl Imagen Mol. 2016;35(3):186-92.
12. Feine U, Lietzenmayer R, Hanke JP, Wöhrle H and Müller-Schauenburg W. 18FDG whole body PET in differentiated thyroid carcinoma. Flip-flop in uptake patterns of 18FDG and 131I. Nuklearmedizin. 1995; 34(4):127-34.
13. Wan Q, Bai L, Zhao G, Zhang Y, Ma Q, Wang R, et al. Diagnostic performance of 18F-FDG-PET/CT in DTC patients with thyroglobulin elevation and negative iodine scintigraphy: a meta-analysis. Eur J Endocrinol. 2019; 181 (2): 93-102
14. Haddad RI, Bischoff L, Busaidy NL, Callender G, Dickson P, Duh QY et al. NCCN Clinical Practice guidelines in Oncology. Thyroid carcinoma. Version 1.2019. Disponible en: https://www.nccn.org/store/login/login.aspx?ReturnURL=https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf
15. Pacini F, Castagna MG, Brilli L, Pentheroudakis G. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23(suppl 7):vii110-9.
16. Smallridge RC, Ain KB, Asa SL, Bible KC, Brierley JD, Burman KD, et al. American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer. Thyroid. 2012;22(11):1104-39.
17. Wilhelm SM, Wang TS, Ruan DT, Lee JA, Asa SL, Duh QY, et al. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. JAMA Surgery. 2016;151(10):959-68.
18. Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, et al. Guidelines for the Management of Asymptomatic Primary Hyperparathyroidism: Summary Statement from the Fourth International Workshop. J Clin Endocrinol Metab. 2014;99(10):3561-9.
19. Khan AA, Hanley DA, Rizzoli R, Bollerslev J, Young JEM, Rejnmark L, et al. Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int. 2017;28(1):1-19.
20. Greenspan BS, Dillehay G, Intenzo C, Lavely WC, O’Doherty M, Palestro CJ, et al. SNM Practice Guideline for Parathyroid Scintigraphy 4.0. J Nucl Med Technol. 2012;40(2):111-8.
21. Hindié E, Ugur Ö, Fuster D, ODoherty M, Grassetto G, Ureña P, et al. 2009 EANM parathyroid guidelines. Eur J Nucl Med Mol Imaging. 2009;36(7):1201-16.
22. García-Talavera P, Díaz-Soto G, Montes AA, Villanueva JG, Cobo A, Gamazo C, et al. Contribution of early SPECT/CT to 99mTc-MIBI double phase scintigraphy in primary hyperparathyroidism: Diagnostic value and correlation between uptake and biological parameters. Rev Esp Med Nucl Imagen Mol. 2016;35(6):351-7.
23. Prats E, Razola P, Tardín L, Andrés A, García López F, Abós MD, et al. Parathyroid scintigraphy and radioguided surgery in primary hyperparathyroidism. Rev Esp Med Nucl. 2007;26(5):310-28.
24. Wei WJ, Shen CT, Song HJ, Qiu ZL, and Luo QY. Comparison of SPET/CT, SPET and planar imaging using 99mTc-MIBI as independent techniques to support minimally invasive parathyroidectomy in primary hyperparathyroidism: A meta-analysis. Hell J Nucl Med. 2015; 18 (2):127-35.
25. Caldarella C, Treglia G, Isgrò MA, Giordano A. Diagnostic performance of positron emission tomography using 11C-methionine in patients with suspected parathyroid adenoma: a meta-analysis. Endocrine. 2013;43(1):78-83.
26. Treglia G, Piccardo A, Imperiale A, Strobel K, Kaufmann PA, Prior JO, et al. Diagnostic performance of choline PET for detection of hyperfunctioning parathyroid glands in hyperparathyroidism: a systematic review and meta-analysis. European Journal of Nuclear Medicine and Molecular Imaging. 2019;46(3):751-65.
27. Garcia-Talavera P, García-Talavera JR. Radio-Guided Surgery and Intraoperative iPTH Determination in the Treatment of Primary Hyperparathyroidism. En: Diaz Soto G, editor. Hyperparathyroidism [Internet]. Rijeka (Croatia): InTech; 2012 [citado 6 de julio de 2019]. Disponible en: http://www.intechopen.com/books/hyperparathyroidism/radio-guided-surgery-and-intraoperative-ipth-determination-in-the-treatment-of-primary-hyperparathyr
2. Diaz García C, De Haro Del Moral FJ. Tomografía por emisión de positrones. En: Técnicas de exploración en Medicina Nuclear. Barcelona: Masson; 2005. p. 329-42.
3. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133.
4. Soelberg KK, Bonnema SJ, Brix TH, Hegedüs L. Risk of Malignancy in Thyroid Incidentalomas Detected by 18 F-Fluorodeoxyglucose Positron Emission Tomography: A Systematic Review. Thyroid. 2012;22(9):918-25.
5. Gharib H, Papini E, Paschke R, Duick D, Valcavi R, Hegedüs L, et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract. 2010;16(Suppl 1):1-43.
6. ACR-SNM-SPR Practice Guideline for the performance of Thyroid scintigraphy and uptake measurements. [Fecha de última actualización: 2009; Fecha de nuestra consulta: 24 jun 2019] Disponible en: http://snmmi.files.cms-plus.com/docs/Thyroid_Scintigraphy_1382732120053_10.pdf.
7. Jacob H, Peters C. Screening, diagnosis and management of congenital hypothyroidism: European Society for Paediatric Endocrinology Consensus Guideline. Arch Dis Child Educ Pract Ed. 2015;100(5):260-3.
8. Léger J, Olivieri A, Donaldson M, Torresani T, Krude H, van Vliet G, et al. European Society for Paediatric Endocrinology Consensus Guidelines on Screening, Diagnosis, and Management of Congenital Hypothyroidism. J Clin Endocrinol Metab. 2014;99(2):363-84.
9. Xue YL, Qiu ZL, Song HJ, Luo QY. Value of 131I SPECT/CT for the evaluation of differentiated thyroid cancer: a systematic review of the literature. Eur J Nucl Med Mol Imaging. 2013;40(5):768-78.
10. Zilioli V, Peli A, Panarotto MB, Magri G, Alkraisheh A, Wiefels C, et al. Differentiated thyroid carcinoma: Incremental diagnostic value of 131I SPECT/CT over planar whole body scan after radioiodine therapy. Endocrine. 2017;56(3):551-9.
11. Muros de Fuentes MA, Mitjavila Casanovas M, Estorch Cabrera M, Lecumberri Santamaria B, Navarro González E. Utilidad de la 18F-FDG PET/TC en el cáncer de tiroides. Rev Esp Med Nucl Imagen Mol. 2016;35(3):186-92.
12. Feine U, Lietzenmayer R, Hanke JP, Wöhrle H and Müller-Schauenburg W. 18FDG whole body PET in differentiated thyroid carcinoma. Flip-flop in uptake patterns of 18FDG and 131I. Nuklearmedizin. 1995; 34(4):127-34.
13. Wan Q, Bai L, Zhao G, Zhang Y, Ma Q, Wang R, et al. Diagnostic performance of 18F-FDG-PET/CT in DTC patients with thyroglobulin elevation and negative iodine scintigraphy: a meta-analysis. Eur J Endocrinol. 2019; 181 (2): 93-102
14. Haddad RI, Bischoff L, Busaidy NL, Callender G, Dickson P, Duh QY et al. NCCN Clinical Practice guidelines in Oncology. Thyroid carcinoma. Version 1.2019. Disponible en: https://www.nccn.org/store/login/login.aspx?ReturnURL=https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf
15. Pacini F, Castagna MG, Brilli L, Pentheroudakis G. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23(suppl 7):vii110-9.
16. Smallridge RC, Ain KB, Asa SL, Bible KC, Brierley JD, Burman KD, et al. American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer. Thyroid. 2012;22(11):1104-39.
17. Wilhelm SM, Wang TS, Ruan DT, Lee JA, Asa SL, Duh QY, et al. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. JAMA Surgery. 2016;151(10):959-68.
18. Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, et al. Guidelines for the Management of Asymptomatic Primary Hyperparathyroidism: Summary Statement from the Fourth International Workshop. J Clin Endocrinol Metab. 2014;99(10):3561-9.
19. Khan AA, Hanley DA, Rizzoli R, Bollerslev J, Young JEM, Rejnmark L, et al. Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int. 2017;28(1):1-19.
20. Greenspan BS, Dillehay G, Intenzo C, Lavely WC, O’Doherty M, Palestro CJ, et al. SNM Practice Guideline for Parathyroid Scintigraphy 4.0. J Nucl Med Technol. 2012;40(2):111-8.
21. Hindié E, Ugur Ö, Fuster D, ODoherty M, Grassetto G, Ureña P, et al. 2009 EANM parathyroid guidelines. Eur J Nucl Med Mol Imaging. 2009;36(7):1201-16.
22. García-Talavera P, Díaz-Soto G, Montes AA, Villanueva JG, Cobo A, Gamazo C, et al. Contribution of early SPECT/CT to 99mTc-MIBI double phase scintigraphy in primary hyperparathyroidism: Diagnostic value and correlation between uptake and biological parameters. Rev Esp Med Nucl Imagen Mol. 2016;35(6):351-7.
23. Prats E, Razola P, Tardín L, Andrés A, García López F, Abós MD, et al. Parathyroid scintigraphy and radioguided surgery in primary hyperparathyroidism. Rev Esp Med Nucl. 2007;26(5):310-28.
24. Wei WJ, Shen CT, Song HJ, Qiu ZL, and Luo QY. Comparison of SPET/CT, SPET and planar imaging using 99mTc-MIBI as independent techniques to support minimally invasive parathyroidectomy in primary hyperparathyroidism: A meta-analysis. Hell J Nucl Med. 2015; 18 (2):127-35.
25. Caldarella C, Treglia G, Isgrò MA, Giordano A. Diagnostic performance of positron emission tomography using 11C-methionine in patients with suspected parathyroid adenoma: a meta-analysis. Endocrine. 2013;43(1):78-83.
26. Treglia G, Piccardo A, Imperiale A, Strobel K, Kaufmann PA, Prior JO, et al. Diagnostic performance of choline PET for detection of hyperfunctioning parathyroid glands in hyperparathyroidism: a systematic review and meta-analysis. European Journal of Nuclear Medicine and Molecular Imaging. 2019;46(3):751-65.
27. Garcia-Talavera P, García-Talavera JR. Radio-Guided Surgery and Intraoperative iPTH Determination in the Treatment of Primary Hyperparathyroidism. En: Diaz Soto G, editor. Hyperparathyroidism [Internet]. Rijeka (Croatia): InTech; 2012 [citado 6 de julio de 2019]. Disponible en: http://www.intechopen.com/books/hyperparathyroidism/radio-guided-surgery-and-intraoperative-ipth-determination-in-the-treatment-of-primary-hyperparathyr
García-Talavera, P., Diaz-González, L. G., Martín-Gómez, E., Peñaherrera-Cepeda, A. C., López-Puche, S., & Tamayo-Alonso, P. (2019). Nuclear Medicine. Diagnosis of thyroid and parathyroid gland pa-thology. Revista ORL, 11(3), 283–295. https://doi.org/10.14201/orl.21496
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