title: Technetium-99m methoxyisobutylisonitrile scintigraphy in the assessment of cold thyroid nodules: is it time to change the approach to the management of cold thyroid nodules?
abstract: BACKGROUND
  Scanning with technetium-99m methoxyisobutylisonitrile (Tc-MIBI) is recommended for evaluating thyroid nodule metabolism. In addition, it may help differentiate between benign and malignant nodules; however, the efficacy of this technique has not been fully elucidated. Therefore, it is not currently performed for routine clinical application. This prospective study was conducted to investigate the clinical significance of Tc-MIBI scintigraphy in the assessment of patients with cold thyroid nodules.
  
  
  METHODS
  This prospective study was conducted on 104 patients with cold thyroid nodules greater than 1 cm in diameter as detected on Tc-pertechnetate scintigraphy. Uptake of MIBI in thyroid nodules was compared with that in the surrounding normal thyroid tissue for both early and delayed images, and a score of 0-3 was assigned to each nodule as follows: 0, cold; 1, decreased; 2, equal; 3, increased. The thyroid scan was performed 20 and 40 min after intravenous injection of 555 MBq of Tc-MIBI. The patients underwent fine-needle aspiration cytology (FNAC). Detailed statistical parameters were determined on a per-nodule basis for each qualitative and quantitative scan analysis, as defined by histology.
  
  
  RESULTS
  A total of 104 patients (93 women and 11 men; mean age 40.76±11.40 years, range 20-73) with a total number of 167 cold nodules were included in this study. When Tc-MIBI uptake was regarded as the criterion of malignancy in Tc-MIBI scintigraphy, the accuracy was between 69.46 and 92.21% on using seven different methods. In addition, FNAC findings indicated a sensitivity of 66.66%, a specificity of 100%, a negative predictive value of 95.72%, a positive predictive value of 100%, and an accuracy of 96.06%. Six malignant cold nodules were detected on a positive Tc-MIBI scan, which were determined as benign nodules on FNAC examinations.
  
  
  CONCLUSIONS
  The study demonstrated that Tc-MIBI scanning can be complementary to other diagnostic techniques in patients with cold thyroid nodules. In addition, because of its availability, rather low cost, simple protocol, and objective semiquantitative information, Tc-MIBI scanning seems to hold promise in routine imaging of cold thyroid nodules.
authors.affiliation: aDepartments of Surgery bInternal Medicine cPathology, Bushehr Medical University Hospital, Bushehr University of Medical Sciences dDepartment of Endocrinology, The Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences eThe Persian Gulf Nuclear Medicine Research Center, The Persian Gulf Biomedical Sciences Institute, Bushehr University of Medical Sciences, Bushehr fGolestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Riazi
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Kalantarhormozi
authors.forename: Iraj
authors.initials: I
authors.lastname: Nabipour
authors.forename: Seyed S
authors.initials: SS
authors.lastname: Eghbali
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Farzaneh
authors.forename: Hamid
authors.initials: H
authors.lastname: Javadi
authors.forename: Afshin
authors.initials: A
authors.lastname: Ostovar
authors.forename: Mohammad
authors.initials: M
authors.lastname: Seyedabadi
authors.forename: Majid
authors.initials: M
authors.lastname: Assadi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011877:Radionuclide Imaging; D017256:Technetium Tc 99m Sestamibi; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D055815:Young Adult
chemical_list: D017256:Technetium Tc 99m Sestamibi