Nuclear Medicine in Endocrine Disorders: Diagnosis and Therapy

332 Pages·2022·14.256 MB·English

by  George Barberio Coura-Filho, Mayara Torres Silva de Oliveira, Ana Luiza Morais de Campos

Nuclear Medicine
in Endocrine
Disorders
Diagnosis and Therapy
George Barberio Coura-Filho
Mayara Torres Silva de Oliveira
Ana Luiza Morais de Campos
123
Nuclear Medicine in Endocrine Disorders
George Barberio Coura- Filho
Mayara Torres Silva de Oliveira
Ana Luiza Morais de Campos
Nuclear Medicine
in Endocrine Disorders
Diagnosis and Therapy
George Barberio Coura-Filho Mayara Torres Silva de Oliveira
Nuclear Medicine Physician and Researcher DIMEN Medicina Nuclear
São Paulo State Cancer Institute–University São Paulo, São Paulo, Brazil
of São Paulo Medical School (HCFMUSP)
São Paulo, São Paulo, Brazil
Ana Luiza Morais de Campos
DIMEN Medicina Nuclear
São Paulo, São Paulo, Brazil
ISBN 978-3-031-13223-0 ISBN 978-3-031-13224-7 (eBook)
https://doi.org/10.1007/978-3-031-13224-7
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2022
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the whole or part of the material is concerned, specifically the rights of reprinting, reuse of illustrations,
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methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
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The publisher, the authors, and the editors are safe to assume that the advice and information in this book
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editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional affiliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
This book is dedicated to my family that has
been of constant support and a safe haven,
as well as to all my teachers and colleagues
that share a passion for the Nuclear
Medicine and Endocrinology fields.
George Barberio Coura-Filho
To my father, who introduced Nuclear
Medicine into my life and inspires me
every day.
To my mother, who gave me strength to write
this book and taught me everything
about life.
With all my love,
Ana Luiza Morais de Campos
I dedicate this book to my parents, who gave
me the opportunity to be who I am and to
study medicine. To my beloved husband who
always supported me. To my teachers and
coworkers who always inspire me.
With love,
Mayara Torres Silva de Oliveira
Preface
Nuclear Medicine is a medical specialty that has an important role in the manage-
ment of endocrine disorders, but frequently is not completely addressed at medical
schools. Many non-Nuclear Medicine physicians are eager to better understand how
it can be used to help differentiate between illnesses, how it can improve clinical
decisions, or how it can be used in the treatment of benign and malignant endocrine
diseases.
This book is meant to be an accessory tool to medical doctors better understand
Nuclear Medicine and its role in endocrinology. It takes the mission of clarifying
how basic nuclear medicine works, why patient preparation is necessary, and how it
is performed before procedures and also in which clinical settings benefits of nuclear
medicine are mostly obtained.
It is also a book that helps those initiating or already working in the Nuclear
Medicine field to improve knowledge in its endocrine use. And hopefully this book
will help directly or indirectly many patients that are always at the center of our
concerns.
São Paulo, São Paulo, Brazil George Barberio Coura-Filho
São Paulo, São Paulo, Brazil Mayara Torres Silva de Oliveira
São Paulo, São Paulo, Brazil Ana Luiza Morais de Campos
vii
Contents
Part I Basics and Principles of Nuclear Medicine
1 Basic Principles of Radiopharmaceuticals . . . . . . . . . . . . . . . . . . . . . . 3
1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.2 Cyclotron-Produced Radionuclides . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.3 Nuclear Reactor-Produced Radionuclides . . . . . . . . . . . . . . . . . . . . 5
1.4 Radionuclide Generators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.5 Ideal Diagnostic Radiopharmaceuticals . . . . . . . . . . . . . . . . . . . . . . 5
1.6 Diagnosis: SPECT Radionuclides . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.7 Diagnosis: PET Radionuclides . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.8 Therapeutic Radiopharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.9 Factors Affecting the Biodistribution of Radiopharmaceuticals . . . 6
1.10 Quality Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2 Basic Principles of Scintigraphy and SPECT (Single-Photon
Emission Computed Tomography) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.2 Main Modalities of Scintigraphic Acquisitions . . . . . . . . . . . . . . . . 9
2.3 Gamma Camera Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2.4 Gamma Camera SPECT Systems . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.5 Main Forms of Radiation Used in Nuclear Imaging in
Endocrinology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
3 Basic Principles of Positron Emission Tomography . . . . . . . . . . . . . . 15
3.1 Positron Emission Tomography (PET) . . . . . . . . . . . . . . . . . . . . . . 15
3.2 Coincidence Timing Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
3.3 Image Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.4 Events Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.5 PET Scanner Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
3.6 Spatial Resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
ix
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3.7 Time of Flight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3.8 PET/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
4 Principles of Radionuclide Treatments . . . . . . . . . . . . . . . . . . . . . . . . . 21
4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
4.2 Alpha and Beta Particles Characteristics . . . . . . . . . . . . . . . . . . . . . 22
4.3 Energy Transfer to Tissues and Associated Biological Effects . . . . 23
4.4 Post-treatment Radionuclide Imaging . . . . . . . . . . . . . . . . . . . . . . . 24
4.5 Basic Concepts of Medical Internal Radiation Dosimetry . . . . . . . 26
4.6 The General Use of Radionuclide Treatments
in Endocrinological Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
5 Basic Principles of Radioguided Surgery . . . . . . . . . . . . . . . . . . . . . . . 33
5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
5.2 Scintigraphy and Radioguidance Protocols for Occult Lesion
Localization General Advantages . . . . . . . . . . . . . . . . . . . . . . . . . . 34
5.3 Concepts of Sentinel Lymph Node Localization . . . . . . . . . . . . . . . 35
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Part II Benign Thyroid Diseases
6 Thyroid Diseases: Procedures and Techniques . . . . . . . . . . . . . . . . . . 39
6.1 Thyroid Scan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
6.2 Patient Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
6.3 Radiopharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
6.4 Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
6.5 Image Acquisition/Instrumentation . . . . . . . . . . . . . . . . . . . . . . . . . 42
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
7 Thyroid Scintigraphy in the Workup of a Thyroid Nodule . . . . . . . . . 45
7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
7.2 Benign Nodules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
7.3 Malignant Nodule and Thyroid Cancer . . . . . . . . . . . . . . . . . . . . . . 47
7.4 Pediatric Thyroid Nodules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
7.5 Initial Evaluation of Thyroid Nodules . . . . . . . . . . . . . . . . . . . . . . . 49
7.6 Scintigraphy Evaluation of Thyroid Nodules . . . . . . . . . . . . . . . . . 50
7.7 Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
7.8 Image/Interpretation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
7.9 Toxic Multinodular Goiter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
7.10 Radioiodine Thyroid Uptake (RAIU) . . . . . . . . . . . . . . . . . . . . . . . 55
7.11 99mTc-Sestamibi (MIBI) Scan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
7.12 Contraindications of Thyroid Scintigraphy . . . . . . . . . . . . . . . . . . . 57
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Contents xi
8 Positron Emission Tomography-Computed Tomography
(PET-CT) in Thyroid Nodules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
8.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
8.2 PET/CT Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
8.3 Indeterminate Thyroid Nodules . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
8.4 Preoperative 18F-FDG PET/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
8.5 Malignancy in Thyroid Incidentalomas Detected
with Whole-Body PET/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
9 Scintigraphy in Hyperthyroidism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
9.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
9.2 Hyperthyroidism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
9.3 Scintigraphy in Hyperthyroidism . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
9.3.1 Radiopharmaceuticals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
9.3.2 Procedure and Imaging Protocols . . . . . . . . . . . . . . . . . . . . 73
9.4 Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
9.4.1 Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
9.4.2 Interpretation Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
9.5 Suppression Thyroid Scintigraphy . . . . . . . . . . . . . . . . . . . . . . . . . . 77
9.6 Potassium Perchlorate Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
9.7 Scintigraphy in Graves’ Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
9.8 Marine-Lenhart Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
9.9 Autonomously Functioning Thyroid Nodule . . . . . . . . . . . . . . . . . . 79
9.10 Toxic Autonomous Thyroid Nodule. . . . . . . . . . . . . . . . . . . . . . . . . 80
9.11 Toxic Multinodular Goiter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
9.12 Hyperthyroidism in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
9.13 Hyperthyroidism in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
9.14 Subclinical Hyperthyroidism Associated with Decreased
RAIU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
9.14.1 Iatrogenic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
9.14.2 Subacute Thyroiditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
9.15 Diagnostic Provisional Dosimetry . . . . . . . . . . . . . . . . . . . . . . . . . . 83
9.16 99m-Tc-Sestamibi Scintigraphy for Thyroid Nodule
Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
10 Hyperthyroidism and Benign Thyroid Nodules Therapy:
Role of Nuclear Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
10.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
10.2 Graves’ Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
10.3 Toxic Multinodular Goiter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
10.4 Toxic Adenoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
10.5 Thyroiditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
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10.6 Treatment-Induced Hyperthyroidism . . . . . . . . . . . . . . . . . . . . . . . 89
10.7 Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
10.8 Diagnostic Work-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
10.9 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
10.10 Radioactive Iodine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
10.11 Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
10.12 Cares Before Radioiodine Therapy . . . . . . . . . . . . . . . . . . . . . . . . 92
10.13 Stimulation with Recombinant Human Thyrotropin Prior
to Iodine 131 Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
10.14 Radioiodine Therapy Recommended Activity . . . . . . . . . . . . . . . . 93
10.15 Care After Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
10.16 Costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
10.17 Adverse Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Part III Parathyroid Diseases
11 Parathyroid Diseases: Procedure’s Techniques . . . . . . . . . . . . . . . . . . 103
11.1 Introduction to Hyperparathyroidism . . . . . . . . . . . . . . . . . . . . . . 103
11.2 Scintigraphy, SPECT, and SPECT-CT . . . . . . . . . . . . . . . . . . . . . . 104
11.3 PET-CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
12 Scintigraphy in Hyperparathyroidism . . . . . . . . . . . . . . . . . . . . . . . . . 109
12.1 Parathyroid Scintigraphy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
12.2 Diagnostic Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
12.3 Combination with Thyroid Scintigraphy and Subtraction
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
12.4 SPECT-CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
12.5 Combined Interpretation with Ultrasound . . . . . . . . . . . . . . . . . . . 118
12.6 Cost-Effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
13 Hyperparathyroidism and Positron Emission Tomography . . . . . . . . 125
13.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
13.2 Radiopharmaceuticals: 18F-Fluoro-D-Deoxyglucose
(18F-FDG) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
13.3 Radiopharmaceuticals: L-11C-Methionine (11C-MET) . . . . . . . . . . 126
13.4 Radiopharmaceuticals: 11C or 18F Radiolabeled Choline
(11C-Choline or 18F-Fluorocholine) . . . . . . . . . . . . . . . . . . . . . . . . 128
13.5 Radiopharmaceuticals: Other Tracers . . . . . . . . . . . . . . . . . . . . . . 129
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
14 Radioguided Localization of Parathyroid Glands . . . . . . . . . . . . . . . . 131
14.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
14.2 Images Before Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
14.3 Radioguided Surgery Performance . . . . . . . . . . . . . . . . . . . . . . . . 132
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133