Imaging Medullary Thyroid Carcinoma with Persistent Elevated Calcitonin Levels

Author:

Giraudet Anne Laure1,Vanel Daniel2,Leboulleux Sophie1,Aupérin Anne3,Dromain Clarisse2,Chami Linda2,Ny Tovo Noël3,Lumbroso Jean1,Lassau Nathalie2,Bonniaud Guillaume4,Hartl Dana5,Travagli Jean-Paul5,Baudin Eric1,Schlumberger Martin1

Affiliation:

1. Departments of Nuclear Medicine and Endocrine Oncology (A.L.G., S.L., J.L., E.B., M.S.), Institut Gustave Roussy and Faculté de Médecine Paris-Sud, 94805 Villejuif Cédex, France

2. Departments of Radiology (D.V., C.D., L.C., N.L.), Institut Gustave Roussy and Faculté de Médecine Paris-Sud, 94805 Villejuif Cédex, France

3. Departments of Biostatistics and Epidemiology (A.A., N.N.T.), Institut Gustave Roussy and Faculté de Médecine Paris-Sud, 94805 Villejuif Cédex, France

4. Departments of Medical Physics Unit (G.B.), Institut Gustave Roussy and Faculté de Médecine Paris-Sud, 94805 Villejuif Cédex, France

5. Departments of Surgery (D.H., J.-P.T.), Institut Gustave Roussy and Faculté de Médecine Paris-Sud, 94805 Villejuif Cédex, France

Abstract

Abstract Purpose: Because calcitonin level remains elevated after initial treatment in many medullary thyroid carcinoma (MTC) patients without evidence of disease in the usual imaging work-up, there is a need to define optimal imaging procedures. Patients and Methods: Fifty-five consecutive elevated calcitonin level MTC patients were enrolled to undergo neck and abdomen ultrasonography (US); neck, chest, and abdomen spiral computed tomography (CT); liver and whole-body magnetic resonance imaging (MRI); bone scintigraphy; and 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)/CT scan (PET). Results: Fifty patients underwent neck US, CT, and PET, and neck recurrence was demonstrated in 56, 42, and 32%, respectively. Lung and mediastinum lymph node metastases in the 55 patients were demonstrated in 35 and 31% by CT and in 15 and 20% by PET. Liver imaging with MRI, CT, US, and PET in 41 patients showed liver in 49, 44, 41, and 27% patients, respectively. Bone metastases in 55 patients were demonstrated in 35% by PET, 40% by bone scintigraphy, and 40% by MRI; bone scintigraphy was complementary with MRI for axial lesions but superior for the detection of peripheral lesions. Ten patients had no imaged tumor site despite elevated calcitonin level (median 196 pg/ml; range 39–816). FDG uptake in neoplastic foci was higher in progressive patients but with a considerable overlap with stable ones. Conclusion: The most efficient imaging work-up for depicting MTC tumor sites would consist of a neck US, chest CT, liver MRI, bone scintigraphy, and axial skeleton MRI. FDG PET scan appeared to be less sensitive and of low prognostic value.

Publisher

The Endocrine Society

Subject

Biochemistry (medical),Clinical Biochemistry,Endocrinology,Biochemistry,Endocrinology, Diabetes and Metabolism

Reference42 articles.

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