Assessment of Minimum 124I Activity Required in Uptake Measurements Before Radioiodine Therapy for Benign Thyroid Diseases

• Published in: Journal of nuclear medicine (Chicago, Ill.) Vol. 57; no. 8; p. 1201
• Main Authors: Gabler, Anja S, Kühnel, Christian, Winkens, Thomas, Freesmeyer, Martin
• Format: Journal Article
• Language: English
• Published: United States 01.08.2016
• Subjects: Aged; Algorithms; Clinical Decision-Making - methods; Female; Humans; Image Enhancement - methods; Image Interpretation, Computer-Assisted - methods; Iodine Radioisotopes - pharmacokinetics; Iodine Radioisotopes - therapeutic use; Male; Middle Aged; Positron Emission Tomography Computed Tomography - methods; Prognosis; Radiometry - methods; Radiopharmaceuticals - pharmacokinetics; Radiopharmaceuticals - therapeutic use; Reproducibility of Results; Sensitivity and Specificity; Thyroid Diseases - diagnostic imaging; Thyroid Diseases - metabolism; Thyroid Diseases - therapy; 124I; pretherapeutic uptake measurement; 124I PET; reconstruction parameters; benign thyroid disorders
• ISSN: 2159-662X; 1535-5667
• DOI: 10.2967/jnumed.115.171066

This study aimed to assess a hypothetical minimum administered activity of (124)I required to achieve comparability between pretherapeutic radioiodine uptake (RAIU) measurements by (124)I PET/CT and by (131)I RAIU probe, the clinical standard. In addition, the impact of different reconstruction algorithms on (124)I RAIU and the evaluation of pixel noise as a parameter for image quality were investigated. Different scan durations were simulated by different reconstruction intervals of 600-s list-mode PET datasets (including 15 intervals up to 600 s and 5 different reconstruction algorithms: filtered-backprojection and 4 iterative techniques) acquired 30 h after administration of 1 MBq of (124)I. The Bland-Altman method was used to compare mean (124)I RAIU levels versus mean 3-MBq (131)I RAIU levels (clinical standard). The data of 37 patients with benign thyroid diseases were assessed. The impact of different reconstruction lengths on pixel noise was investigated for all 5 of the (124)I PET reconstruction algorithms. A hypothetical minimum activity was sought by means of a proportion equation, considering that the length of a reconstruction interval equates to a hypothetical activity. Mean (124)I RAIU and (131)I RAIU already showed high levels of agreement for reconstruction intervals of as short as 10 s, corresponding to a hypothetical minimum activity of 0.017 MBq of (124)I. The iterative algorithms proved generally superior to the filtered-backprojection algorithm. (124)I RAIU showed a trend toward higher levels than (131)I RAIU if the influence of retrosternal tissue was not considered, which was proven to be the cause of a slight overestimation by (124)I RAIU measurement. A hypothetical minimum activity of 0.5 MBq of (124)I obtained with iterative reconstruction appeared sufficient both visually and with regard to pixel noise. This study confirms the potential of (124)I RAIU measurement as an alternative method for (131)I RAIU measurement in benign thyroid disease and suggests that reducing the administered activity is an option. CT information is particularly important in cases of retrosternal expansion. The results are relevant because (124)I PET/CT allows additional diagnostic means, that is, the possibility of performing fusion imaging with ultrasound. (124)I PET/CT might be an alternative, especially when hybrid (123)I SPECT/CT is not available.