Taner ERSELCAN, Zekiye HASBEK, Fatih KILIÇLI, Serdar Savaş GÜL, Bulent TURGUT

Abnormal right lower abdominal focal re- tention in the radioiodine (131I) whole- body scan

Amaç: Diferansiye tiroid kanserleri (DTK) iyotu yakalama, organifiye ve sentez etme vetiroglobulin (Tg) salma yeteneğine sahiptir. Bu özelliğinden dolayı, DTKler total tiroidektomisonrası yüksek doz radyoaktif iyot I-131 ile tedavi edilebilir. I-131 ile tüm vücut taramadiferansiye tiroid kanserli hastalarda metastatik veya rezidüel tümör alanlarının deteksiyonu içiniyi yapılandırılmış bir yöntemdir. Yanlış pozitif radyoaktif iyot tutulumu birçok organ sistemi içinrapor edilmiştir. Bizim bu çalışmamızın amacı I-131 ile tüm vücut taramada sadece kadınhastalarda rastladığımız sağ alt abdominal bölgede sıradışı fokal radyoaktivite retansiyonubulgusunun fizyolojik olup olmadığını araştırmaktı.Yöntem: Mevcut çalışmaya, I-131 ile ablasyon sonrası ablasyon sonrası veya tanısal amaçlı tümvücut tarama için gönderilen ardışık total 405 DTKli hasta dahil edildi.Bulgular: Toplam 405 hastanın 22sinde (%5,4) sağ alt abdominal alanda radyoaktivitenin fokalretansiyonu gözlendi, 14 hastada ileri radyolojik inceleme yapıldı. Bu grubun yaş ortalaması 44 ±13 yıl ve yaş aralığı 24-66 yıl idi. Tüm hastalar kadındı. Yanlış pozitif kontaminasyon kaynaklarıek görüntülemelerin ve hastaların dikkatli incelenmesiyle açığa kavuştu. Hastaların on ikisindeabdominal ultrasonografi veya abdominal BT ve iki hastada 18F-FDG PET/BT yapıldı. Bununlabirlikte bu fokal tutulumu açıklayacak gerçek bir neden bulunmadı.Sonuç: I-131 tüm vücut tarama sintigrafisinde, sağ alt abdominal alandaki fokal radyoaktiviteretansiyonu fizyolojik olabilir, bununla birlikte bu bulgunun açıklanmaya ihtiyaç olduğu sonucunavarılmıştır.

Radyoiyot (I-131) tüm vücut tarama sintigrafisinde anormal sağ alt abdominal fokal retansiyon

Objective: Differentiated thyroid cancer (DTC) capture, organify iodine and have the ability tosynthesize and release thyroglobulin. Because of this feature, DTCs can be treated with high dosesof 131I after total thyroidectomy. Whole body scan (WBS) with 131I is a well-established methodfor the detection of metastatic or residual tumor sites in patients with differentiated thyroid cancer.False-positive radioiodine uptake has been reported in many organ systems. Our aim in the presentstudy was to investigate whether an uncommon focal retention of radioactivity in right lower ab- dominal region which we coincide only in woman patients in whole body scan with 131I was aphysiological finding.Method: A total of 405 consecutive patients with DTC who all were referred for either post- ablation or diagnostic whole body scan with 131I, were included in the the present study.Results: A focal retention of radioactivity in right lower abdominal region was observed in 22 pa- tients (5.4%) out of 405, in whom 14 patients had further radiological investigations. This group smean age was 44 ±13 years, ranging between 24 to 66 years. All patients were female. False posi- tive contamination sources were clarified by careful examination of patients and further images.Abdominal ultrasound or abdominal CT was performed 12 of patients, and 18F-FDG PET/CT totwo patients. However, no clear reason was found to explain relating uptake foci.Conclusion: We concluded that, a focal retention of radioactivity in right lower abdominal regionin 131I WBS would be a physiological uptake, however this finding needs clarification.

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1. Wang QC, Cheng W, Wen X, Li JB, Jing H, Nie CL. Shorter dis- tance between the nodule and cap- sule has greater risk of cervical lymph node metastasis in papillary thyroid carcinoma. Asian Pac J Cancer Prev 2014; 15: 855-60.
2. Mazzaferri EL. The diagnosis and imaging of thyroid cancer. Spring- er science business media, Inc 2005: 39-120.
3. Dietlein M, Moka D, Schicha H. Radioiodine therapy for thyroid cancer. in: bierscak h.-j, grünwald f. thyroid cancer. Springer-Verlag Berlin Heidelberg; Germany 2005; 95-126.
4. Tuttle RM, Becker DV, Hurley JR, Sandler MP, Coleman RE, Patton JA, Wackers FJ, Gottschalk A. Di- agnostic Nuclear Medicine. 4th ed. Lippincott Williams&Wilkins; Philadelphia 2003; 653-70.
5. Joyce WT, Cowan RJ. A Potential False-positive posttherapy radioio- dine scan secondary to i-131 ex- cretion in perspiration. Clin Nucl Med 1995; 20: 368-9.
6. Oh JR, Ahn BC. False-positive Uptake on radioiodine whole-body scintigraphy: physiologic and pathologic variants unrelated to thyroid cancer. Am J Nucl Med Mol Imaging 2012; 2: 362-85.
7. Rutherford GC, Franc B, OConnor A. Nuclear Medicine in the assessment of differentiated thyroid cancer. Clin Radiol 2008; 63: 453-63.
8. Ozguven M, Ilgan S, Arslan N, Karacalioglu AO, Yuksel D, Dundar S. Unusual patterns of i- 131 contamination. Ann Nucl Med 2004; 18: 271-4.
9. Ash L, Bybel B, Neumann D, Beebe W. The helmet sign: phys- iologic radioactive accumulation after 131i therapy-a case report. J Nucl Med Technol 2004; 32: 164- 5.
10. Shin-Loong TC, Ki W, Sing-Fai L. False-Positive 131i uptake in fixed prosthetic denture. Clin Nucl Med 2012; 37: 64-6.
11. Sinha A, Bradley KM, Steatham J, Weaver A. Asymmetric breast up- take of radioiodine in a patient with thyroid malignancy: Metasta- ses or not? J R Soc Med 2008; 101: 319-20.
12. Moslehi M, Assadi M. Bilateral radioiodine uptake by the non- lactating breast of a single nullipa- rous woman: a case report and lit- erature review. Arch Med Sci 2012; 8-3: 575-7.
13. Hu LH, Wang SJ, Liu RS. Hy- perprolactinemia-related 131I Up- take in Nonlactating Breasts. Clin Nucl Med 2012; 37: 57-8.
14. Kao PF, Chang HY, Tsai MF, Lin KJ, Tzen KY, Chang CN. Breast uptake of iodine-131 mimicking lung metastases in a thyroid cancer patient with a pituitary tumour. Br J Radiol 2001; 74: 378-81.
15. Serafini A, Sfakianakis G, Geor- giou M, Morris J. Breast cyst sim- ulating metastases on iodine-131 imaging in thyroid carcinoma. J Nucl Med 1996; 39: 1910-12.
16. Hammami MM, Bakheet SM. Ra- dioiodine breast uptake in non- breastfeeding women: Clinical and Scintigraphic Characteristics. J Nucl Med 1996; 37: 26-31.
17. You D, Tzen KY, Chen JF, Kao PF, Tsai MF. Fale-positive whole- body iodine-131 scan due to intra- hepatic duct dilatation. J Nucl Med 1997; 38: 1977-9.
18. McEwan LM, Fong W. Unusual Extrathyroidal Iodine Accumula- tion in a Post-ablative I-131 Scan. Australas Radiol 2001; 45: 512-3.
19. Seok JW, Kim SJ, Kim IJ, Kim YS, Kim YK. Normal Gallbladder Visualization during Post-ablative Iodine-131 Scan of Thyroid Cancer. J Korean Med Sci 2005; 20: 521-3.
20. Mitchell G, Pratt BE, Vini L, McCready VR, Harmer CL. False Positive 131I Whole Body Scans in Thyroid Cancer. Br J Radiol 2000; 73: 627-35.
21. Kim EE, Pjura G, Gobuty A, Verani R. 131I Uptake in a Benign Serous Cystadenoma of the Ovary. Eur J Nucl Med 1984; 9: 433-5.
22. Peralta MCI, Emanuele NV, Gordon DL, Spies S, Camacho P. Thymic hyperplasia presenting as a false positive whole body 131I scan in a patient with well- differentiated thyroid carcinoma: a case report and review of the liter- ature. The Endocrinologist 2003; 13: 13-6.
23. Regalbuto C, Buscema M, Arena S, Vigneri R, Squatrito S, Pezzino V. False-positive findings on 131i whole-body scans because of post- traumatic superficial scabs. J Nucl Med 2002; 43: 207-9.
24. Achong DM, Oates E, Lee SL, Doherty FJ. Gallbladder Visualiza- tion During Post-Therapy Iodine- 131 Imaging of Thyroid Carcinoma. J Nucl Med 1991; 32: 2275-7.
25. Ak I, Uslu I, Yıldız C, Ozalp S. A Pitfall of I-131 Whole Body Scans Interpretation: Mucinous Cyst in External Genitalia: Original Im- age. Turkiye Klinikleri J Med Sci 2009; 29: 1792-4.
26. Rashid K, Johns W, Chasse K, Walker M, Gupta SM. Esophageal Diverticulum Presenting as Meta- static Thyroid Mass on Iodine-131 Scintigraphy. Clin. Nucl. Med 2006; 31: 405-8.
27. Freeman M, Roach P, Robinson B, Shields M. Hiatal Hernia in Io- dine-131 Scintigraphy: A Potential Cause of False-Positive Midline Thoracic Uptake. Clin. Nucl. Med 2003; 28: 709-10.
28. Kraft O, Sirucek P, Mrhac L, Havel M. I-131 false positive uptake in a huge parapelvic renal cyst. Nucl. Med. Rev. Cent. East Eur 2011; 14: 36-7.
29. Gultekin SS, Dilli A, Arıkök AT, Bostancı H, Hasdemir AO: The false-positive radioiodine i-131 uptake in the foreign body granu- loma located in gluteal adipose tis- sue. Radiol Oncol 2012; 46: 28-31.
30. Tsai DH, Hsiao HC, Tu ST, Hung GU, Yang KT. concomitant false- positive and false-negative iodine- 131 scintigraphy secondary to bronchiectasis and cervical lymph node metastasis in a patients with tyhroid cancer: The Usefulness of FDG-PET/CT. Ann Nucl Med Sci 2007; 20: 217-21.
31. Bakheet SM, Hammami MM, Powe J, Bazarbashi M, Al Suhai- bani H. Radioiodine uptake in in- active pulmonary tuberculosis. Eur J Nucl Med 1999; 26: 659-62.
32. Höschl R, Choy DH, Gandevia B. Iodine-131 uptake in inflammatory lung disease: A potential pitfall in treatment of thyroid carcinoma. J Nucl Med 1988; 29: 701-6.
33. Muherji S, Ziessman HA, Earll JM, Keyes JW. False-positive io- dine-131 whole body scan. Clın Nucl Med 1988; 13: 207-8.
34. Manka-Waluch A, Palmedo H, Tasci S, Biersack HJ, Bucerius J. False-positive 131I whole-body scan and shrinkage of a pulmonary aspergilloma under 131I therapy in a patient with thyroid cancer. Thy- roid 2006; 16: 197-8.
35. Agriantonis DJ, Hall L, Wilson MA. Pitfalls of I-131 whole body scan interpretation bronchogenic cyst and mucinous cystadenoma. Clin Nucl Med 2008; 33: 325-7.
36. Haubold-Reuter BG, Landolt U, von Schulthess GK. Bronchogenic Carcinoma Mimicking Metastatic Thyroid Carcinoma. J Nucl Med 1993; 34: 809-11.
37. Sinha P, Conrad GR, Holzhauer M. Incidental Detection of a Falx Meningioma on Post-therapy Ra- dioiodine Whole-Body Imaging. Clin Nucl Med 2002; 27: 916-7.
38. Huang SH, Hu YH, Huang YE, Chen HY, Cheng YF, Lee CH. Liver cavernous hemangioma mimicking metastatic thyroid car- cinoma on 131I. Ann Nucl Med Sci 2004; 17: 179-83.
39. Deandreis D, Lumbroso J, Al Ghuzlan A, Baudin E, Schlum- berger M, Leboulleux S. Abnormal pelvic uptake on post-therapeutic radioiodine 131I. Eur J Nucl Med Mol Imaging 2011; 38: 1957.
40. Wu SY, Koliin J, Coodiey E, Lockyer T, Lyons KP, Moran E. Parker LN. 131I Total-Body Scan: Localization of Disseminated Gas- tric Adenocarcinoma. Case report and survey of the Literature. J Nucl Med 1984; 25: 1204-9.
41. Sioka C, Dimakopoulos N, Koura- klis G, Kotsalou I, Zouboulidis A. False-positive Whole-body scan after I-131 Therapy in a Patient with Intestinal Scar. Clin Nucl Med 2006; 31: 232-3.
42. Spanu A, Solinas ME, Chessa F, Sanna D, Nuvoli S, Madeddu G. 131-I SPECT/CT in the follw-up of-differentiated-thyroid- carcinoma: Incremental value ver- sus planar imaging. J Nucl Med 2009; 50: 184-90.
43. Spitzweg C, Joba W, Schriever K, Goellner JR, Morris JC, Heufelder AE. Analysis of human sodium ioide/symporter.immunoreactivity in human exocrine glands. J Clin Endocrinol Metab 1999; 84: 4178- 84.
44. Ahn BC. Physiologic and false positive pathologic uptakes on ra- dioiodine whole body scan. .In:12 Chapters on Nuclear Medicine, Dr.Ali Gholamrezanezhad 2011; 1-24.
45. Wapnir IL, van de Rijn M, Nowels K, Amenta PS, Walton K, Mont- gomery K. Immunohistochemical profile of the sodium/iodide sym- porter in thyroid, breast and other carcinomas using high density tis- sue microarrays and conventional sections. J Clin Endocrinol Metab 2003; 88: 1880-6.
46. Harun-Or-Rashid M, Asai M, Sun XY, Hayashi Y, Sakamoto J, Mu- rata Y. Effect of thyroid statuses on sodium/iodide symporter gene expression in the extrathyroidal tissues in mice. Thyroid Res 2010; 3: 3.
47. Altorjay Á, Dohán O, Szilágyi A, Paroder M, Wapnir IL, Carrasco N. Expression of the Na+/I- Symporter (NIS) is markedly de- creased or absent in gastric cancer and intestinal metaplastic mucosa of barrett esophagus. BMC Cancer 2007; 7: 5.