18F-choline PET/CT incidental thyroid uptake in patients studied for prostate cancer
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ORIGINAL ARTICLE
18F-choline PET/CT incidental thyroid uptake in patients studied for prostate cancer Domenico Albano
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Rexhep Durmo1 Francesco Bertagna2 Raffaele Giubbini2 ●
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Received: 24 November 2018 / Accepted: 21 December 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Purpose Thyroid incidental uptake is defined as a thyroid uptake incidentally detected by imaging examinations performed for non-thyroid disease. The aim of this study was to establish the prevalence and the pathological nature of focal thyroid incidental uptake (FTIU) among patients studied with 18F-choline-PET/CT. Materials and methods We retrospectively evaluated 368 patients who performed 18F-choline-PET/CT between June 2016 and August 2018. The PET images were analyzed visually and semi-quantitatively by measuring the maximum standardized uptake value (SUVmax) and the mean SUV (SUVmean) of the thyroid gland and of the FTIU; every focal thyroid uptake deviating from physiological distribution and background was considered FTIU. Final diagnosis of FTIU was obtained by cytological or histological examination after surgery. Results The average SUVmax and SUVmean of thyroid gland in population were 3 and 1.8. Among 368 patients, FTIU was identified in nine cases (2.4%) and eight underwent further investigations to determine the nature. Two FTIU were classified as malignant (thyroid carcinoma), whereas five were benign (three nodular hyperplasia, one follicular adenoma, one Hurtle cell adenoma) and one indeterminate at cytological examination. In malignant lesions, average SUVmax was 9.6 and 4.5, respectively, while average SUVmean was 5.3 and 2.9, respectively. Average SUVmax and SUVmean of benign lesions were 4.9 and 3.2 and of the indeterminate lesion 5 and 3, respectively. Conclusions 18F-choline-PET/CT FTIU may be a relevant diagnostic reality, which requires further investigations and affects management, especially considering that, despite being mainly benign, also malignancy is possible. Keywords Incidentaloma PET/CT 18F-choline Thyroid ●
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Introduction Thyroid incidental uptake is defined as a thyroid uptake newly and incidentally detected by imaging techniques performed for an unrelated purpose and in particular for non-thyroid diseases [1, 2]. Focal thyroid incidental uptake (FTIU) has been previously described, especially for 18-fluorodeoxyglucose positron emission tomography/computed tomography (18FFDG PET/CT); often it causes a management dilemma for
* Domenico Albano [email protected] 1
Nuclear Medicine, Spedali Civili Brescia, Brescia, Italy
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Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
the referring clinicians, because it needs further investigations to clarify its nature [3]. Incidental thyroid uptake can be diffuse or focal: diffuse uptake is usually encountered in the presence of inflammatory conditions like thyroiditis or Grave’s disease, while focal uptakes usually refer to thyroid nodules [4]. The pooled
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