Can I-124 PET/CT Predict Pathological Uptake of Therapeutic Dosages of Radioiodine (I-131) in Differentiated Thyroid Carcinoma?

Gauke K. Lammers, Jan Paul Esser, Pieternel C. M. Pasker, Marina E. Sanson-van Praag, John M. H. de Klerk

Department of Epidemiology and Research, Meander Medical Centre, Amersfoort, The Netherlands.
Department of Internal Medicine, Meander Medical Centre, Amersfoort, The Netherlands.
Department of Nuclear Medicine, Meander Medical Centre, Amersfoort, The Netherlands.

DOI: 10.4236/ami.2014.43004                

Abstract

Introduction: The aim of the study was to assess the role of I-124 PET/CT in the prediction of uptake of a therapeutic dosage I-131 during follow-up of patients with differentiated thyroid cancer (DTC). Methods: The results of 34 I-124 PET/CT scans performed in our hospital between 2007 and 2012 were retrospectively evaluated. All scans were made in patients under follow up, replacing the diagnostic I-131 or I-123 scintigraphy. In all cases thyroglobulin (Tg) was stimulated (by recombinant thyroid stimulating hormone (rhTSH) or thyroid hormone withdrawal). A dosage of 40 MBq I-124 was used, with scans at 24 hours and 96 hours after administration. Results were compared to subsequent I-131 post-treatment scans (6 cases) and a combination of follow up, stimulated Tg and other imaging tools results available to assess presence of recurrence. Results: Recurrence of DTC was found in 14/34 cases. I-124 PET/CT correctly detected recurrence in 2 cases, with false negative results in 12 cases. In 1 case a false positive I-124 PET/CT result was recorded. 19 true negative results were found. For I-124 PET/CT this meant a sensitivity of 14% and a specificity of 95%. Positive predictive value was 67%, negative predictive value 61%. Post-treatment I-131 uptake (6 cases) was correctly predicted in 1 case, with false negative results in 4 cases and 1 true negative result. Conclusions: In this study I-124 PET/CT did not reliably detect recurrent differentiated thyroid carcinoma. More importantly it failed to predict I-131 uptake on post-treatment scintigraphy in a significant number of cases, which would lead to under-treatment.

Keywords

I-124, PET, I-131, Thyroid, Carcinoma

Conflicts of Interest

The authors declare no conflicts of interest.

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