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Impact of combined FDG-PET/CT and MRI on the detection of local recurrence and nodal metastases in thyroid cancer.
Cancer Imaging. 2016 Nov 03; 16(1):37.CI

Abstract

BACKGROUND

Suspected recurrence of thyroid carcinoma is a diagnostic challenge when findings of both a radio iodine whole body scan and ultrasound are negative. PET/CT and MRI have shown to be feasible for detection of recurrent disease. However, the added value of a consensus reading by the radiologist and the nuclear medicine physician, which has been deemed to be helpful in clinical routines, has not been investigated. This study aimed to investigate the impact of combined FDG-PET/ldCT and MRI on detection of locally recurrent TC and nodal metastases in high-risk patients with special focus on the value of the multidisciplinary consensus reading.

MATERIALS AND METHODS

Forty-six patients with suspected locally recurrent thyroid cancer or nodal metastases after thyroidectomy and radio-iodine therapy were retrospectively selected for analysis. Inclusion criteria comprised elevated thyroglobulin blood levels, a negative ultrasound, negative iodine whole body scan, as well as combined FDG-PET/ldCT and MRI examinations. Neck compartments in FDG-PET/ldCT and MRI examinations were independently analyzed by two blinded observers for local recurrence and nodal metastases of thyroid cancer. Consecutively, the scans were read in consensus. To explore a possible synergistic effect, FDG-PET/ldCT and MRI results were combined. Histopathology or long-term follow-up served as a gold standard. For method comparison, sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were calculated.

RESULTS

FDG-PET/ldCT was substantially more sensitive and more specific than MRI in detection of both local recurrence and nodal metastases. Inter-observer agreement was substantial both for local recurrence (κ = 0.71) and nodal metastasis (κ = 0.63) detection in FDG-PET/ldCT. For MRI, inter-observer agreement was substantial for local recurrence (κ = 0.69) and moderate for nodal metastasis (κ = 0.55) detection. In contrast, FDG-PET/ldCT and MRI showed only slight agreement (κ = 0.21). However, both imaging modalities identified different true positive results. Thus, the combination created a synergistic effect. The multidisciplinary consensus reading further increased sensitivity, specificity, and diagnostic accuracy.

CONCLUSIONS

FDG-PET/ldCT and MRI are complementary imaging modalities and should be combined to improve detection of local recurrence and nodal metastases of thyroid cancer in high-risk patients. The multidisciplinary consensus reading is a key element in the diagnostic approach.

Authors+Show Affiliations

Department of Radiology, Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, D-72076, Tübingen, Germany. johann-martin.hempel@uni-tuebingen.de. Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany. johann-martin.hempel@uni-tuebingen.de.Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany.Department of Nuclear Medicine, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany.Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany.Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany.Department of Otolaryngology and Head and Neck Surgery, AMEOS Hospital Haldensleben, Kiefholzstr. 4 & 27, D-39340, Haldensleben, Germany.Department of Radiology, Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, D-72076, Tübingen, Germany. Department of Neuroradiology, National Hospital of Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom.Department of Endocrinology and Metabolism, I. Medical Clinic, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany.Department of Endocrinology and Metabolism, I. Medical Clinic, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany.Clinic of General, Visceral- and Transplantation Surgery, Endocrine Surgery Section, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany.Department of Nuclear Medicine, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany.Department of Nuclear Medicine, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27809936

Citation

Hempel, Johann-Martin, et al. "Impact of Combined FDG-PET/CT and MRI On the Detection of Local Recurrence and Nodal Metastases in Thyroid Cancer." Cancer Imaging : the Official Publication of the International Cancer Imaging Society, vol. 16, no. 1, 2016, p. 37.
Hempel JM, Kloeckner R, Krick S, et al. Impact of combined FDG-PET/CT and MRI on the detection of local recurrence and nodal metastases in thyroid cancer. Cancer Imaging. 2016;16(1):37.
Hempel, J. M., Kloeckner, R., Krick, S., Pinto Dos Santos, D., Schadmand-Fischer, S., Boeβert, P., Bisdas, S., Weber, M. M., Fottner, C., Musholt, T. J., Schreckenberger, M., & Miederer, M. (2016). Impact of combined FDG-PET/CT and MRI on the detection of local recurrence and nodal metastases in thyroid cancer. Cancer Imaging : the Official Publication of the International Cancer Imaging Society, 16(1), 37.
Hempel JM, et al. Impact of Combined FDG-PET/CT and MRI On the Detection of Local Recurrence and Nodal Metastases in Thyroid Cancer. Cancer Imaging. 2016 Nov 3;16(1):37. PubMed PMID: 27809936.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of combined FDG-PET/CT and MRI on the detection of local recurrence and nodal metastases in thyroid cancer. AU - Hempel,Johann-Martin, AU - Kloeckner,Roman, AU - Krick,Sandra, AU - Pinto Dos Santos,Daniel, AU - Schadmand-Fischer,Simin, AU - Boeβert,Patrick, AU - Bisdas,Sotirios, AU - Weber,Matthias M, AU - Fottner,Christian, AU - Musholt,Thomas J, AU - Schreckenberger,Mathias, AU - Miederer,Matthias, Y1 - 2016/11/03/ PY - 2016/04/30/received PY - 2016/10/25/accepted PY - 2016/11/5/pubmed PY - 2016/12/16/medline PY - 2016/11/5/entrez KW - Consensus reading KW - Iodine-negative KW - Lymph node metastases KW - MRI KW - Negative ultrasound KW - Nodal metastases KW - PET/CT KW - Recurrent thyroid cancer KW - Recurrent thyroid carcinoma KW - Thyroid cancer SP - 37 EP - 37 JF - Cancer imaging : the official publication of the International Cancer Imaging Society JO - Cancer Imaging VL - 16 IS - 1 N2 - BACKGROUND: Suspected recurrence of thyroid carcinoma is a diagnostic challenge when findings of both a radio iodine whole body scan and ultrasound are negative. PET/CT and MRI have shown to be feasible for detection of recurrent disease. However, the added value of a consensus reading by the radiologist and the nuclear medicine physician, which has been deemed to be helpful in clinical routines, has not been investigated. This study aimed to investigate the impact of combined FDG-PET/ldCT and MRI on detection of locally recurrent TC and nodal metastases in high-risk patients with special focus on the value of the multidisciplinary consensus reading. MATERIALS AND METHODS: Forty-six patients with suspected locally recurrent thyroid cancer or nodal metastases after thyroidectomy and radio-iodine therapy were retrospectively selected for analysis. Inclusion criteria comprised elevated thyroglobulin blood levels, a negative ultrasound, negative iodine whole body scan, as well as combined FDG-PET/ldCT and MRI examinations. Neck compartments in FDG-PET/ldCT and MRI examinations were independently analyzed by two blinded observers for local recurrence and nodal metastases of thyroid cancer. Consecutively, the scans were read in consensus. To explore a possible synergistic effect, FDG-PET/ldCT and MRI results were combined. Histopathology or long-term follow-up served as a gold standard. For method comparison, sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were calculated. RESULTS: FDG-PET/ldCT was substantially more sensitive and more specific than MRI in detection of both local recurrence and nodal metastases. Inter-observer agreement was substantial both for local recurrence (κ = 0.71) and nodal metastasis (κ = 0.63) detection in FDG-PET/ldCT. For MRI, inter-observer agreement was substantial for local recurrence (κ = 0.69) and moderate for nodal metastasis (κ = 0.55) detection. In contrast, FDG-PET/ldCT and MRI showed only slight agreement (κ = 0.21). However, both imaging modalities identified different true positive results. Thus, the combination created a synergistic effect. The multidisciplinary consensus reading further increased sensitivity, specificity, and diagnostic accuracy. CONCLUSIONS: FDG-PET/ldCT and MRI are complementary imaging modalities and should be combined to improve detection of local recurrence and nodal metastases of thyroid cancer in high-risk patients. The multidisciplinary consensus reading is a key element in the diagnostic approach. SN - 1470-7330 UR - https://www.unboundmedicine.com/medline/citation/27809936/Impact_of_combined_FDG_PET/CT_and_MRI_on_the_detection_of_local_recurrence_and_nodal_metastases_in_thyroid_cancer_ L2 - https://cancerimagingjournal.biomedcentral.com/articles/10.1186/s40644-016-0096-y DB - PRIME DP - Unbound Medicine ER -