Abstract
Purpose
Using 123I for diagnostic purposes avoids the risk of stunning for subsequent radioiodine treatment and affords an excellent image quality. In this study we assessed the role of 123I in comparison with 131I post-treatment imaging in patients with thyroid cancer.
Methods
We compared a total of 292 123I scans with their corresponding post-treatment 131I images. Patients received a therapeutic dose of 131I following diagnostic scanning with 50–111 MBq of 123I. All patients were in a hypothyroid state (>30 μIU/l) before radioiodine administration for either diagnostic or therapeutic purposes.
Results
In 228 out of 263 patients with a positive diagnostic scan, 123I whole-body scan findings were concordant with those of corresponding post-treatment 131I images (concordance rate 87%). However, there were 44 additional foci of abnormal uptake on post-treatment 131I scans in 22 discordant cases with no impact on therapeutic management of the patients. In 13 patients, there was at least one new site on post-treatment images that had been missed on pretreatment 123I images. Twenty-nine patients with a negative diagnostic scan were treated with 131I owing to a high serum thyroglobulin level (range 11.3–480 ng/ml). Radioiodine uptake sites were seen in eight post-treatment scans. In 21 pairs of whole-body scans, both the pre- and the post-treatment scan were negative (concordance rate 72.4%).
Conclusion
123I scanning is comparable to high-dose 131I post-treatment imaging in thyroid carcinoma patients, and 123I offers excellent image quality as a diagnostic agent. It avoids disadvantages such as stunning before treatment and delivery of a high radiation dose to patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Tsang RW, Brierly JD, Simpson WJ, Panzarella T, Gospodarowicz MK, Sutchliffe SB. The effects of surgery, radioiodine and external radiation therapy on the clinical outcome of patients with differentiated thyroid carcinoma. Cancer 1998;82:375–88.
Coburn M, Teates D, Wanebo HJ. Recurrent thyroid cancer. Role of surgery vs. radioactive iodine. Ann Surg 1994;219:587–95.
Park HM. The stunning effect in radioiodine therapy of thyroid cancer. In: Freeman L, editors. Nuclear medicine annals. Philadelphia, PA: Lippincott Williams & Wilkins; 2001. p 49–67.
Leger FA, Izembart M, Dagousset F, Barritault L, Baillet G, Chevalier A, et al. Decreased uptake of therapeutic doses of I-131 after 185 MBq I-131 diagostic imaging for thyroid remnants in differentiated thyroid carcinoma. Eur J Nucl Med 1998;25:242–6.
Mandel SJ, Shankar LK, Benard F, Yamamoto A, Alavi A. Superiority of I-123 compared with I-131 scanning for thyroid remnants in patients with differentiated thyroid cancer. Clin Nucl Med 2001;26 1:6–9.
Yaakob W, Gordon L, Spicer KM, Nitke SJ. The usefulness of I-123 whole-body scans in evaluating thyroid carcinoma and metastases. J Nucl Med Technol 1999;27:279–81.
Shankar LK, Yamamoto AJ, Alavi A, Mandel SJ. Comparison of I-123 scintigraphy at 5 and 24 hours in patients with differentiated thyroid cancer. J Nucl Med 2002;43:72–6.
Gerard SK, Cavalieri RR. I-123 diagnostic thyroid tumor whole-body scanning with imaging at 6, 24 and 48 hours. Clin Nucl Med 2001;27:1–8.
Alzahrani AS, Bakheet S, Al Mandil M, Al-Hajjaj A, Almahfouz A, Al Haj A. I-123 isotope as a diagnostic agent in the follow-up of patients with differentiated thyroid cancer: a comparison with post I-131 therapy whole-body scanning. J Clin Endocrin Metab 2001;86:5294–300.
Sherman SI, Tielens ET, Sostre S, Wharam MD Jr, Ladenson PW. Clinical utility of post-treatment radioiodine scans in the management of patients with thyroid carcinoma. J Clin Endocrinol Metab 1994;78:629–34.
Schlumberger M, Tubiana M, De Vathaire F, Hill C, Gardet P, Travagli JP, et al. Long-term results of treatment of 283 patients with lung and bone metastases from differentiated thyroid carcinoma. J Clin Endocrin Metab 1986;63:960–7.
Sisson JC, Giordano TJ, Jamadar DA, Kazerooni EA, Shapiro B, Gross MD, et al. I-131 treatment of micronodular pulmonary metastases from papillary thyroid carcinoma. Cancer 1996;78:2184–92.
Samuel AM, Rajashekharrao B, Shah DH. Pulmonary metastases in children and adolescents with well-differentiated thyroid cancer. J Nucl Med 1998;39:1531–6.
Hilditch TE, Dempsey MF, Bolster AA, McMenemin RM, Reed NS. Self-stunning in thyroid ablation: evidence from comparative studies of diagnostic I-131 and I-123. Eur J Nucl Med Mol Imaging 2002;29:783–8.
Pacini F, Lippi F, Formica N, Elisei R, Anelli S, Ceccarelli C, et al. Therapeutic doses of I-131 reveal undiagnosed metastases in thyroid cancer patients with detectable serum thyroglobulin levels. J Nucl Med 1987;28:1888–91.
Pineda JD, Lee T, Ain K, Reynolds JC, Robbins J. Iodine-131 therapy for thyroid cancer patients with elevated thyroglobulin and negative diagnostic scan. J Clin Endocrinol Metab 1995;80:1488–92.
Schlumberger M, Arcangioli O, Piekarski JD, Tubiana M, Parmentier C. Detection and treatment of lung metastases of differentiated thyroid carcinoma in patients with normal chest X-rays. J Nucl Med 1988;29:1790–4.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Urhan, M., Dadparvar, S., Mavi, A. et al. Iodine-123 as a diagnostic imaging agent in differentiated thyroid carcinoma: a comparison with iodine-131 post-treatment scanning and serum thyroglobulin measurement. Eur J Nucl Med Mol Imaging 34, 1012–1017 (2007). https://doi.org/10.1007/s00259-006-0341-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00259-006-0341-x