engleski

F-18-DOPA PET/CT in medullary thyroid carcinoma patients

Introduction: Thyroid carcinoma is currently the topic of many discussions and there are ongoing debates on the best moment for F-18 dihydroxyphenylalanine PET/CT scan. The aim of this study was to examine the value of F-18-DOPA PET/CT scan in patients with medullary thyroid carcinoma and increased calcitonin levels. Subjects and Methods: Twenty-eight patients with medullary thyroid carcinoma after initial total thyroidectomy and rising calcitonin levels were scanned with F- 18-dihydroxyphenylalanine (DOPA) PET/CT from November 2012 to April 2016. Conventional imaging findings (ultrasound or MSCT) suggestive for active disease were equivocal or negative. Mean patient age was 57 years (range 13-78 years). Mean calcitonin level was 108.5 pmol/l (range 6.7-290 pmol/l) and mean CEA level was 15.7 ug/l (range 1.1-221.9 ug/l). The mean follow-up period was 19.7 months (range 6-47 months). Results: Sixteen patients had a positive F-18-DOPA PET/CT scan (57%). Increased tracer uptake was found in the neck and mediastinal lymph nodes, with a mean SUVmax value 5.6 (range 2.7- 10.9). Bone metastases were found in six patients, with the mean SUVmax value 4.7 (range 2.9-6.2). A positive scan was reported in four patients (25% of positive scans) with a calcitonin value lower than 49.9 pmol/l. Change of management or therapy approach was reported 16 patients in the follow-up period. Surgical procedure was performed in eight patients, radiotherapy or palliative bone radiotherapy was started in five patients and chemotherapy in two patients. Conclusions: Functional imaging with F-18-DOPA PET/CT provides clinicians with valuable information in patients with medullary thyroid carcinoma. It presents additional data necessary for individual patient management, especially in patients with low and moderately elevated calcitonin levels as tumor volume in these patients is small and treatment can be personalized and made more efficient.

F-18-DOPA ; medullary carcinoma, calcitonin

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