Korean J Radiol.  2018 Jun;19(3):470-480. 10.3348/kjr.2018.19.3.470.

Utility of Quantitative Parameters from Single-Photon Emission Computed Tomography/Computed Tomography in Patients with Destructive Thyroiditis

• Kim JY
• Kim JH
• Moon JH
• Kim KM
• Oh TJ
• Lee DH
• So Y
• Lee WW

• KMID: 2410818
• DOI: http://doi.org/10.3348/kjr.2018.19.3.470

Abstract

OBJECTIVE
Quantitative parameters from Tc-99m pertechnetate single-photon emission computed tomography/computed tomography (SPECT/CT) are emerging as novel diagnostic markers for functional thyroid diseases. We intended to assess the utility of SPECT/CT parameters in patients with destructive thyroiditis.
MATERIALS AND METHODS
Thirty-five destructive thyroiditis patients (7 males and 28 females; mean age, 47.3 ± 13.0 years) and 20 euthyroid patients (6 males and 14 females; mean age, 45.0 ± 14.8 years) who underwent Tc-99m pertechnetate quantitative SPECT/CT were retrospectively enrolled. Quantitative parameters from the SPECT/CT (%uptake, standardized uptake value [SUV], thyroid volume, and functional thyroid mass [SUVmean × thyroid volume]) and thyroid hormone levels were investigated to assess correlations and predict the prognosis for destructive thyroiditis. The occurrence of hypothyroidism was the outcome for prognosis.
RESULTS
All the SPECT/CT quantitative parameters were significantly lower in the 35 destructive thyroiditis patients compared to the 20 euthyroid patients using the same SPECT/CT scanner and protocol (p < 0.001 for all parameters). T3 and free T4 did not correlate with any SPECT/CT parameters, but thyroid-stimulating hormone (TSH) significantly correlated with %uptake (p = 0.004), SUVmean (p < 0.001), SUVmax (p = 0.002), and functional thyroid mass (p < 0.001). Of the 35 destructive thyroiditis patients, 16 progressed to hypothyroidism. On univariate and multivariate analyses, only T3 levels were associated with the later occurrence of hypothyroidism (p = 0.002, exp(β) = 1.022, 95% confidence interval: 1.008 - 1.035).
CONCLUSION
Novel quantitative SPECT/CT parameters could discriminate patients with destructive thyroiditis from euthyroid patients, suggesting the robustness of the quantitative SPECT/CT approach. However, disease progression of destructive thyroiditis could not be predicted using the parameters, as these only correlated with TSH, but not with T3, the sole predictor of the later occurrence of hypothyroidism.

Keyword

Thyroiditis; Single-photon emission computed tomography; Computed tomography; Tc-99m pertechnetate; Quantitation

MeSH Terms

Disease Progression
Female
Humans
Hypothyroidism
Male
Multivariate Analysis
Prognosis
Retrospective Studies
Sodium Pertechnetate Tc 99m
Thyroid Diseases
Thyroid Gland*
Thyroiditis*
Thyrotropin
Sodium Pertechnetate Tc 99m
Thyrotropin

Figure

• 

  Fig. 1 SPECT/CT findings in patient with destructive thyroiditis (65-year-old female) compared with findings in euthyroid patient (32-year-old male).Reduced uptake of Tc-99m pertechnetate was typical scintigraphic finding and thyroid contour was barely identifiable on planar scintigraphy in destructive thyroiditis patient. However, thyroid was readily visualized in corresponding CT (yellow arrows), enabling accurate segmentation for quantitative parameters. Upper row, planar anterior images; middle row, CT images of SPECT/CT (left, transaxial; right, coronal); and bottom row, SPECT/CT fusion images with thyroid contour being highlighted (left, transaxial; right, coronal). CT = computed tomography, SPECT/CT = single-photon emission computed tomography/CT, SUV = standardized uptake value

• 

  Fig. 2 Comparison of quantitative parameters between destructive thyroiditis (n = 35) and euthyroid patients (n = 20).Patients with destructive thyroiditis had significantly lower %uptake (mean ± standard deviation: 0.28 ± 0.19%, range: 0.06 – 0.85%) (A), SUVmean (6.67 ± 5.58 g/mL, 0.97 – 27.41 g/mL) (B), SUVmax (15.62 ± 14.86 g/mL, 4.57 – 78.50 g/mL) (C), and functional thyroid mass (163.78 ± 117.27 g, 33.56 – 520.07 g) (D) than euthyroid patients (%uptake: 0.78 ± 0.50%, 0.22 – 1.87%; SUVmean: 33.51 ± 23.54 g/mL, 8.61 – 89.08 g/mL; SUVmax: 45.56 ± 30.74 g/mL, 13.55 – 115.80 g/mL; and functional thyroid mass: 692.00 ± 491.94 g, 149.97 – 1780.70 g). *p < 0.001.

• 

  Fig. 3 Receiver-operating-characteristic curve analyses for differentiation of destructive thyroiditis patients from euthyroid patientsSUVmean had highest area-under-curve (0.954 with 95% CI of 0.861 – 0.992) compared to functional thyroid mass (0.931 with 95% CI of 0.830 – 0.982), SUVmax (0.867 with 95% CI of 0.748 – 0.944) and %uptake (0.846 with 95% CI of 0.724 – 0.929). CI = confidence interval

• 

  Fig. 4 Correlations between TSH level and SPECT/CT parameters.TSH correlated with %uptake (p = 0.004) (A), SUVmean (p < 0.001) (B), SUVmax (p = 0.002) (C), and functional thyroid mass (p < 0.001) (D). In 20 cases with undetectable TSH (levels under detection limit of 0.05 µIU/mL), lower detection limit value of 0.05 µIU/mL was used for analyses. TSH = thyroid-stimulating hormone

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