131I Uptake in Bronchiectasis Detected by Single Photon Emission Computed Tomography/Computed Tomography during Follow-up of Thyroid Cancer

Ferdinando Calabria; Antonio Lanzillotta; Mario Leporace; Giuliana Guadagnino; Orazio Schillaci; Antonio Bagnato

doi:10.4103/ijnm.IJNM_157_18

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34 (

); 235-236

doi:

10.4103/ijnm.IJNM_157_18

¹³¹I Uptake in Bronchiectasis Detected by Single Photon Emission Computed Tomography/Computed Tomography during Follow-up of Thyroid Cancer

Ferdinando Calabria^,, Antonio Lanzillotta, Mario Leporace, Giuliana Guadagnino¹, Orazio Schillaci^2,3, Antonio Bagnato

Department of Nuclear Medicine and Theranostics, “Mariano Santo” Hospital, 87100, Cosenza, Italy

1Department of Infectious and Tropical Diseases, “St. Annunziata” Hospital, 87100, Cosenza, Italy

2Department of Biomedicine and Prevention, University “Tor Vergata”, Rome, Italy

3Department of Nuclear Medicine and Molecular Imaging, IRCCS INM Neuromed, Pozzilli (IS), Italy

Address for correspondence: Dr. Ferdinando Calabria, Department of Nuclear Medicine and Theranostics, “Mariano Santo” Hospital, 87100, Cosenza, Italy. E-mail: ferdinandocalabria@hotmail.it

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Abstract

During follow-up of thyroid cancer, ¹³¹I whole-body scan showed intense tracer uptake in the right hemithorax of a patient previously submitted to thyroidectomy and radioiodine therapy for differentiated thyroid cancer. Thyroglobulin was undetectable at the time of the scan. Single-photon emission computed tomography/computed tomography (SPECT/CT) of the thorax correctly identified widespread bronchiectasis ¹³¹I-avid in the middle lobe of the right lung. After bronchoalveolar lavage, a bronchial specimen was positive for Mycobacterium avium infection. Hybrid imaging with SPECT/CT allowed to correctly identify a false-positive case of ¹³¹I uptake due to inflammation in a single diagnostic session, minimizing patient discomfort or misdiagnoses.

Keywords

131I

bronchiectasis

pitfalls

single-photon emission computed tomography/computed tomography

uptake

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A 46-year-old female underwent thyroidectomy for differentiated thyroid cancer [Figure 1]. Postoperative ¹³¹I whole-body scan showed tracer uptake, higher than surrounding background, in the neck (a) and in the right hemithorax (a, arrow). The patient underwent radioiodine therapy (1850 MBq). Nine months after, the patient underwent ¹³¹I whole-body scan (b): diffuse ¹³¹I uptake was observed in the right hemithorax; thyroglobulin serum level was 0.1 ng/ml at the time of the second ¹³¹I scan, but the patient's anamnesis was positive for chronic dyspnea and cough. Single-photon emission computed tomography/computed tomography (SPECT/CT) was performed. CT (c) and SPECT/CT (d) showed ¹³¹I uptake in widespread bronchiectasis in the middle lobe of the right lung.

Postoperative 131I whole-body scan shows tracer uptake in the neck (a) and in the right hemithorax (a, arrow). A following further 131I whole-body scan confirms diffuse 131I uptake in the right hemithorax (b); CT (c) and SPECT/CT (d) showed 131I uptake in association with bronchiectasis in the middle lobe of the right lung. A CT of the thorax (e) performed at follow-up, showed partial resolution of bronchiectasis

A bronchial specimen was positive for Mycobacterium avium infection. CT of the thorax (e), performed at 3-month follow-up, showed partial resolution of bronchiectasis.

¹³¹I is a useful radiopharmaceutical in imaging thyroid cancer;[1] it is well known the possibility to detect ¹³¹I uptake in inflammatory lesions.[2] Moreover, other malignant tumors show ¹³¹I-avid uptake that can be managed by SPECT/CT.[3]

Hybrid scanners allowed nuclear medicine physicians to identify diagnostic pitfalls occurring in clinical practice.[4] Similarly, to other reports on this topic,[5 6] the use of CT with “lung window” allowed to identify diffuse ¹³¹I-avid bronchiectasis in a single diagnostic session, minimizing patient discomfort. The ¹³¹I uptake in bronchiectasis is due to expression of sodium-iodide symporter in secretions.[7] Nuclear medicine physicians should be aware of tracer physiological distribution and pitfalls, to avoid misdiagnosis. Laboratory data, expertise on CT,[8] and hybrid imaging are of the utmost importance.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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Espírito Santo R, Marques P, João Bugalho M, . False-positive uptake on radioiodine whole-body scan due to bronchiectasis. BMJ Case Rep 2015 2015 pii: bcr2015213169
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Glazer DI, Brown RK, Wong KK, Savas H, Gross MD, Avram AM, . SPECT/CT evaluation of unusual physiologic radioiodine biodistributions: Pearls and pitfalls in image interpretation. Radiographics. 2013;33:397-418.
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Declaration of patient consent
Financial support and sponsorship
Conflicts of interest

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[1] Pitoia F, Bueno F, Cross G, . Long-term survival and low effective cumulative radioiodine doses to achieve remission in patients with 131Iodine-avid lung metastasis from differentiated thyroid cancer. Clin Nucl Med. 2014;39:784-90.
[Google Scholar]

[2] Jia C, Moadel R, Freeman LM, . Focal thoracic uptake mimicking lung metastasis on 131I post-therapy whole-body scan in patients with thyroid carcinoma. Clin Nucl Med. 2014;39:360-2.
[Google Scholar]

[3] Sainz-Esteban A, de Luis Román D, García-Talavera San Miguel P, Pacheco Sánchez D, González Selma ML, Ruiz Gómez MÁ, . Incidental finding on a SPECT/CT of a retroperitoneal leiomyosarcoma imitating a hiatal hernia in 131I whole-body scan in thyroid cancer evaluation. Rev Esp Med Nucl Imagen Mol. 2013;32:406-7.
[Google Scholar]

[4] Calabria F, . Fifty shades of meningioma: Challenges and perspectives of different PET molecular probes. Clin Transl Imaging. 2017;5:403-5.
[Google Scholar]

[5] Padma S, Sundaram PS, Firuz MD, . Bronchiectasis masquerading as lung metastasis in a patient with papillary carcinoma thyroid identified by 131I whole body scintigraphy. J Nucl Med Radiat Ther. 2015;6:252.
[Google Scholar]

[6] Espírito Santo R, Marques P, João Bugalho M, . False-positive uptake on radioiodine whole-body scan due to bronchiectasis. BMJ Case Rep 2015 2015 pii: bcr2015213169
[Google Scholar]

[7] Glazer DI, Brown RK, Wong KK, Savas H, Gross MD, Avram AM, . SPECT/CT evaluation of unusual physiologic radioiodine biodistributions: Pearls and pitfalls in image interpretation. Radiographics. 2013;33:397-418.
[Google Scholar]

[8] Tagliabue L, Schillaci O, . SPECT/CT in oncology: The fusion of two imaging modalities is a new standard of care. Q J Nucl Med Mol Imaging. 2007;51:285-9.
[Google Scholar]