Usefulness of [99mTC]MIBI and [18F]fluorodeoxyglucose for imaging recurrent medullary thyroid cancer and hyperparathyroidism in MEN 2a syndrome.
We report the case of a MEN 2a patient with a history of medullary thyroid cancer (MTC) treated by total thyroidectomy, who presented an increasing calcitonin level, suggesting tumor recurrence. Conventional radiographic and radionuclide imaging failed to localize the responsible lesions. A planar and tomographic (SPECT) [99mTc]MIBI scan, performed in order to investigate a recent hyperparathyroidism localized a parathyroid adenoma and revealed an abnormal uptake in the left lateral neck region, corresponding to apparently banal lymph nodes on MRI. This abnormal uptake was also observed on a [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) study and was proven to be an uptake in MTC lymph nodes metastases as confirmed by histopathologic analysis. We conclude that, using an adequate acquisition protocol (i.e. SPECT), [99mTc]MIBI scan is potentially able to localize both parathyroid adenoma and recurrent MTC at one and the same time, particularly in case of non-diagnostic conventional imaging techniques. In this setting, the potential usefulness of FDG-PET is also discussed.
Roelants
V
V
Department of Nuclear Medicine, University Hospital of Mont-Godinne, Université Catholique de Louvain, Yvoir and Brussels, Belgium.
Michel
L
L
Lonneux
M
M
Lacrosse
M
M
Delgrange
E
E
Donckier
J E
JE
D000328:Adult; D018276:Carcinoma, Medullary / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D018813:Multiple Endocrine Neoplasia Type 2a / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011868:Radioisotopes; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D013964:Thyroid Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery
D011868:Radioisotopes; D019788:Fluorodeoxyglucose F18; D017256:Technetium Tc 99m Sestamibi