Skip to main content

Main menu

  • Home
  • Content
    • Current
      • JNMT Supplement
    • Ahead of print
    • Past Issues
    • SNMMI Annual Meeting Abstracts
  • Subscriptions
    • Subscribers
    • Rates
    • Journal Claims
    • Institutional and Non-member
  • Authors
    • Submit to JNMT
    • Information for Authors
    • Assignment of Copyright
    • AQARA Requirements
  • Info
    • Permissions
    • Continuing Education
    • Advertisers
    • Corporate & Special Sales
  • About
    • About Us
    • Editorial Board
    • Editorial Contact
  • More
    • Alerts
    • Feedback
    • Help
    • SNMMI Journals
  • SNMMI
    • JNMT
    • JNM
    • SNMMI Journals
    • SNMMI

User menu

  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
Journal of Nuclear Medicine Technology
  • SNMMI
    • JNMT
    • JNM
    • SNMMI Journals
    • SNMMI
  • Subscribe
  • My alerts
  • Log in
  • My Cart
Journal of Nuclear Medicine Technology

Advanced Search

  • Home
  • Content
    • Current
    • Ahead of print
    • Past Issues
    • SNMMI Annual Meeting Abstracts
  • Subscriptions
    • Subscribers
    • Rates
    • Journal Claims
    • Institutional and Non-member
  • Authors
    • Submit to JNMT
    • Information for Authors
    • Assignment of Copyright
    • AQARA Requirements
  • Info
    • Permissions
    • Continuing Education
    • Advertisers
    • Corporate & Special Sales
  • About
    • About Us
    • Editorial Board
    • Editorial Contact
  • More
    • Alerts
    • Feedback
    • Help
    • SNMMI Journals
  • Follow SNMMI on Twitter
  • Visit SNMMI on Facebook
  • Join SNMMI on LinkedIn
  • Subscribe to JNMT RSS feeds
OtherIMAGING

The Helmet Sign: Physiologic Radioactive Accumulation After 131I Therapy—A Case Report

Lorraine Ash, Bohdan Bybel, Donald Neumann and Wendy Beebe
Journal of Nuclear Medicine Technology September 2004, 32 (3) 164-165;
Lorraine Ash
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Bohdan Bybel
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Donald Neumann
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Wendy Beebe
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Abstract

After 131I radioablative treatment, a 51-y-old woman underwent whole-body 131I scanning, which revealed intense uptake along the periphery of the skull. The patient disclosed that she had not washed her hair because she had obtained a new hairstyle between the 131I treatment and the scan. The intense uptake along the periphery of the skull represented radioactive physiologic accumulation at the patient’s scalp.

  • thyroid cancer
  • radionuclide imaging
  • contamination artifact
  • physiologic variant

The specificity of 131I whole-body scans for detecting residual or recurrent local and metastatic disease is generally reported to be greater than 90% (1). However, in failing to recognize physiologic accumulation from perspiration, as in the following case, and other potential contamination artifacts and physiologic variants, the specificity is further compromised and often leads to unwarranted examinations and additional radiation exposure.

CASE REPORT

A 51-y-old African-American woman with a history of metastatic papillary thyroid cancer had undergone surgical resection of the tumor, external-beam radiation therapy for residual local disease, and treatment with 2 radioablative doses of 131I. The patient had been doing well, and her thyroglobulin levels had been stable. Because of a recent thyroglobulin increase, a whole-body 131I scan was ordered to identify any residual disease. Tracer uptake in the neck suggested local recurrence (Fig. 1). Subsequently, radioablative treatment with 5.55 GBq of 131I was given.

FIGURE 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
FIGURE 1.

Anterior view of skull from whole-body 131I scan. Uptake is present in the region of the thyroid bed.

Ten days after treatment, the patient returned for a whole-body scan to better identify any other recurrences or metastatic disease. In addition to uptake at the thyroid bed, increased uptake along the periphery of the skull was present (Fig. 2). Upon questioning, the patient revealed that between the 131I treatment and the scan, she had not washed her hair because she wished to preserve the hair extensions she had placed. The patient stated that rather than washing her hair, which would disturb the hair extensions weaved into her own hair, she applied a petroleum-based jelly to the scalp to prevent drying. Presumably, this application caused perspiration to collect along her scalp within the hairline and produced the intense uptake of tracer seen along the periphery of the skull.

FIGURE 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
FIGURE 2.

Anterior view of skull after 131I treatment. Diffuse uptake is present along the periphery of the skull.

DISCUSSION

The scope of false-positive findings after radioiodine treatment has been well documented (1–12). Such findings are primarily physiologic, being secondary to uptake in tissues that can concentrate 131I but do not retain it in organic form (11). Diffuse hepatic uptake due to the metabolism of radioiodinated thyroid hormones in the liver, as well as salivary and intestinal activity, is commonly seen (11). Contamination of the patient’s personal items, such as perspiration on jewelry or nasal secretions on a handkerchief, is reported less often but represents a very real pitfall for accurate interpretation of whole-body 131I images (1,3–12). In our case, the patient history, the knowledge of 131I artifacts, and the atypical location and distribution of the uptake all served to identify the abnormal tracer uptake as a physiologic variant.

Footnotes

  • For correspondence or reprints contact: Bohdan Bybel, MD, Department of Molecular and Functional Imaging, Cleveland Clinic Foundation, 9500 Euclid Gb3, Cleveland, OH 44195

    E-mail: bybelb{at}ccf.org

REFERENCES

  1. ↵
    McDougall IR. Whole-body scintigraphy with radioioidine-131: a comprehensive list of false-positives with some examples. Clin Nucl Med. 1995;20:869–875.
    OpenUrlCrossRefPubMed
  2. Bakheet SM, Hammami MM. False-positive thyroid cancer metastasis on whole-body radioiodine scanning due to retained radioactivity in the oesophagus. Eur J Nucl Med. 1993;20:415–419.
    OpenUrlPubMed
  3. ↵
    Bakheet SM, Hammami MM. Spurious thyroid cancer bone metastases on radioiodine scan due to external contamination. Eur J Radiol. 1993;16:239–242.
    OpenUrlPubMed
  4. Boxen I, Zong MZ. Nasal secretion of iodine-131. Clin Nucl Med. 1990;15:610–611.
    OpenUrlCrossRefPubMed
  5. Bybel B, Beebe W, Kim BY, et al. Contamination of a bracelet following iodine-131 therapy: a case report. J Nucl Med Technol. 2000;28:257–258.
    OpenUrlAbstract/FREE Full Text
  6. Dick C, Mudun A, Alazraki NP. False-positive I-131 images mimicking thyroid cancer metastasis: the nose ring sign. Clin Nucl Med. 1995;20:876–877.
    OpenUrlCrossRefPubMed
  7. Greenler DP, Klein HA. The scope of false-positive iodine-131 images for thyroid carcinoma. Clin Nucl Med. 1989;14:111–117.
    OpenUrlCrossRefPubMed
  8. Grigsby P. Cost minimization analysis and utility of pretreatment and posttreatment total body iodine-131 scan in patients with thyroid carcinoma. Cancer. 1998;82:931–935.
    OpenUrlPubMed
  9. Park HM, Tarver RD, Schauwecker DS, et al. Spurious thyroid cancer metastasis: saliva contamination artifact in high dose iodine-131 metastases survey. J Nucl Med. 1986;27:634–636.
    OpenUrlAbstract/FREE Full Text
  10. Pochis WT, Krasnow AZ, Isitman AT, et al. The radioactive handkerchief sign: a contamination artifact in I-131 imaging for metastatic thyroid carcinoma. Clin Nucl Med. 1990;15:491–494.
    OpenUrlPubMed
  11. ↵
    Shapiro B, Rufini V, Jarwan A, et al. Artifacts, anatomic and physiological variants, and unrelated diseases that might cause false-positive whole-body I-131 scan in patients with thyroid cancer. Semin Nucl Med. 2000;30:115–132.
    OpenUrlCrossRefPubMed
  12. ↵
    Sutter CW, Masilungan BG, Stadalnik RC. False-positive results of I-131 whole-body scan in patients with thyroid cancer. Semin Nucl Med. 1995;25:279–282.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Journal of Nuclear Medicine Technology: 32 (3)
Journal of Nuclear Medicine Technology
Vol. 32, Issue 3
September 1, 2004
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Journal of Nuclear Medicine Technology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
The Helmet Sign: Physiologic Radioactive Accumulation After 131I Therapy—A Case Report
(Your Name) has sent you a message from Journal of Nuclear Medicine Technology
(Your Name) thought you would like to see the Journal of Nuclear Medicine Technology web site.
Citation Tools
The Helmet Sign: Physiologic Radioactive Accumulation After 131I Therapy—A Case Report
Lorraine Ash, Bohdan Bybel, Donald Neumann, Wendy Beebe
Journal of Nuclear Medicine Technology Sep 2004, 32 (3) 164-165;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
The Helmet Sign: Physiologic Radioactive Accumulation After 131I Therapy—A Case Report
Lorraine Ash, Bohdan Bybel, Donald Neumann, Wendy Beebe
Journal of Nuclear Medicine Technology Sep 2004, 32 (3) 164-165;
Twitter logo Facebook logo LinkedIn logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Bookmark this article

Jump to section

  • Article
    • Abstract
    • CASE REPORT
    • DISCUSSION
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • False-Positive Scalp Activity in 131I Imaging Associated with Hair Coloring
  • Iodine 131 Uptake Related to Hair Dyeing
  • Google Scholar

More in this TOC Section

  • Improving 90Y PET Scan Image Quality Through Optimized Reconstruction Algorithms
  • Evaluation of Data-Driven Respiration Gating in Continuous Bed Motion in Lung Lesions
  • Optimization of the Attenuation Coefficient for Chang Attenuation Correction in 123I Brain Perfusion SPECT
Show more Imaging

Similar Articles

SNMMI

© 2023 Journal of Nuclear Medicine Technology

Powered by HighWire