DIFERANSIYE TIROID KANSERLERINDE RADYOAKTIF IYOT TEDAVISI SONRASI GORUNTULEME: SPECT-BT GORUNTULEMENIN PLANAR GORUNTULEMEYE KATKISI/POST-THERAPY IMAGING AFTER RADIOACTIVE IODINE THERAPY FOR DIFFERENTIATED THYROID CANCER: THE CONTRIBUTION OF SPECT-CT IMAGING TO PLANAR IMAGING

• Published in: İstanbul Tıp Fakültesi dergisi = Journal of the Istanbul Faculty of Medicine Vol. 81; no. 4; p. 106
• Main Authors: SImsek, Duygu Has, Sanli, Yasemin, Kuyumcu, Serkan, Yilmaz, Ebru, Özkan, Zeynep Gözde, Türkmen, Cüneyt, Adalet, Isik, Mudun, Ayse, Ünal, Seher Nilgün
• Format: Journal Article
• Language: English
• Published: AVES 01.12.2018
• Subjects: Cancer metastasis; Cancer treatment; Carcinoma; Care and treatment; CAT scans; Diagnostic imaging; Health aspects; Medical research; Physicians; Radiotherapy; Rutin; Single photon emission computed tomography; Thyroid cancer; Thyroid diseases
• ISSN: 1305-6433
• DOI: 10.26650/IUITFD.345626

Amaç: Bu çalismada differansiye papiller tiroid kanseri (DTK) olan hastalarda tedavi sonrasi görüntülemede SPECT-BT'nin planar görüntülemeye katkisini arastirdik. Gereç ve Yöntem: DTK tanisi ile opere olan ve radyoaktif iyot tedavisi (100-200mCi) uygulanan toplam 325 hastaya tedavi sonrasi görüntüleme yapildi (254 kadin, 71 erkek; yas araligi: 15-81). Tüm hastalarin tüm vücut planar ile boyun-toraks bölgesinden planar + SPECT-BT görüntüleri alindi. Ek olarak planar görüntülerde süpheli tutulum saptanan alanlardan SPECT-BT görüntüleme yapildi. Planar görüntülemede benign, süpheli ve malign olarak siniflandirilan iyot pozitif alanlar iki nükleer tip uzmani tarafindan SPECT-BT görüntüleri ile yeniden degerlendirildi. Nihai tani histoloji, diger görüntüleme yöntemleri, klinik-serolojik takipler ile dogrulandi. Bulgular: Hasta bazli sonuçlara göre SPECT-BT planar görüntülemeye ek olarak 21 (21/50) hastada metastatik lenf nodlari, 2 (2/10) hastada akciger metastazlari, 2 (2/12) hastada kemik metastazlari tespit ederek; 83 hastada benign, 48 hastada malign olmak üzere süpheli tutulumlari açikliga kavusturarak planar görüntüleme yorumunu degistirdi. Duyarlilik, özgüllük, pozitif prediktif deger, negatif prediktif deger ve dogruluk planar görüntüleme için sirasiyla %63,4, %92,7, %67,7, %91,3, %87 iken SPECT-BT için sirasiyla % 96,8, % 100, %100, %99,2 ve %99,3 olarak hesaplandi. SPECT-BT toplamda 76 hastanin (%23,3) tedavi yönetimini etkiledi. Sonuç: SPECT-BT görüntüleme, DTC hastalarinda tedavi sonrasi taramada planar görüntülemenin yanlis negatif/pozitif sonuçlarini azaltarak tanisal dogrulugu artirmaktadir. Sonuçlarimiz DTC'nin en sik metastaz yaptigi boyun ve toraks bölgesinin degerlendirilmesinde SPECT-BT görüntülemenin rutin görüntüleme protokolüne alinmasini önermektedir. Anahtar Kelimeler: Iyot, Radyoaktif, SPECT-BT Objective: The aim of this study was to investigate the contribution of SPECT-CT to planar imaging in patients with differentiated thyroid carcinoma (DTC) following radioiodine therapy. Materials and Methods: Post-therapy scan was performed on 325 patients (254 women, 71 men; age range 15-81 years) who were operated on for DTC and treated with radioactive iodine (100-200 mCi) therapy. Whole-body planar imaging and neck-chest planar + SPECT-CT imaging were performed on all patients. Additional SPECT-CT scans were performed in other areas where suspicious findings were observed on the planar images. The iodine-positive areas on the planar images were classified as benign, equivocal, or malignant and were also reevaluated by two nuclear medicine physicians using SPECT-CT images. The final diagnosis was verified by histology, other imaging modalities, and clinical-serological follow-up. Results: Based on patient-based analysis, SPECT/CT altered the interpretation of the planar scans by detecting the following findings: additional metastatic lymph nodes in 21 (21/50) patients, lung metastases in 2 (2/10) patients, and bone metastases in 2 (2/12) patients. Furthermore, SPECT/CT confirmed that equivocal focal uptakes were benign in 83 patients and malign in 48 patients. The sensivity, specificity, positive predictive value, negative predictive value, and accuracy were 63.4%, 92.7%, 67.7%, 91.3%, and 87%, respectively, for the planar imaging and 96.8%, 100%, 100%, 99.2%, and 99.3%, respectively, for the SPECT-CT imaging. Overall, SPECT-CT affected therapy management in 76 patients (23.3%). Conclusion: SPECT-CT imaging improves diagnostic accuracy by reducing false-negative or -positive results in planar imaging in the post-therapy scan in patients with DTC. Our findings suggest that neck-thorax SPECT-CT imaging should be incorporated into the routine imaging protocol for detecting the most metastatic sites of DTC. Keywords: Iodine, Radioactive, SPECT-CT