Department of Radiology, Mayo Clinic, Rochester, MN.
PET Imaging Center, University Hospital of North Norway, Tromso, Norway.
Medicine (Baltimore). 2024 Sep 6;103(36):e39602. doi: 10.1097/MD.0000000000039602.
The purpose was to evaluate the pathological nature of focal thyroid uptake seen in 11C-Choline PET/CT performed for prostate cancer.
The study was IRB-approved. All 11C-Choline PET/CT exam reports for studies performed between January 01, 2018, and July 30, 2021, in male patients with prostate cancer in our institution were retrospectively reviewed. Exams with "focal thyroid uptake" on their final report were selected. Patients with surgery or ablation in the thyroid prior to the PET/CT, proven parathyroid adenomas or absent thyroid ultrasound were excluded. Repeated PET/CT exams of same patient were excluded. PET images were analyzed visually and semi-quantitatively by measuring the maximum standardized uptake value (SUVmax) of the focal thyroid uptake. Available thyroid ultrasound images, cytology and pathology reports were reviewed. Statistical analyses were performed.
Out of 10,047 sequential 11C-Choline PET/CT studies, 318 reports included "focal thyroid uptake." About 128 of these studies were repeat exams and were excluded. Additional 87 patients were excluded, because the uptake was determined to be adjacent, rather than confined to the thyroid gland. Out of the remaining 103 patients, 74 patients had focal thyroid uptake and concurrent thyroid sonographic evaluation. Out of the 74 focal uptakes evaluated with ultrasound, 21 were presumed benign thyroid nodules based on the ultrasound and 53 had further evaluation with biopsy. Sixty three nodules were benign (21 presumed benign on ultrasound and 42 cytology or surgical pathology-proven), 9 nodules were malignant and 2 remained indeterminate. There was no significant difference between the SUVs of the benign and malignant groups (P > .3).
In this retrospective study of patients with prostate cancer who underwent 11C-Choline PET/CT, we identified a group of patients who underwent thyroid ultrasound for incidental finding of focal 11C-Choline thyroid uptake. Incidence of malignancy in this group was 12%. Therefore, further investigation with ultrasound and possibly ultrasound-guided biopsy may be warranted when a choline avid thyroid nodule is found incidentally on choline PET.
评估 11C-胆碱 PET/CT 检查前列腺癌时发现的局灶性甲状腺摄取的病理性质。
本研究获得了机构审查委员会的批准。回顾性分析了 2018 年 1 月 1 日至 2021 年 7 月 30 日期间在我院行前列腺癌 11C-胆碱 PET/CT 检查的男性患者的所有 11C-胆碱 PET/CT 检查报告。选择最终报告中出现“局灶性甲状腺摄取”的患者。排除了在 PET/CT 检查前有甲状腺手术或消融、甲状旁腺腺瘤或甲状腺超声缺失的患者。也排除了同一患者重复的 PET/CT 检查。通过测量局灶性甲状腺摄取的最大标准化摄取值（SUVmax）对 PET 图像进行了视觉和半定量分析。回顾了可用的甲状腺超声图像、细胞学和病理报告。进行了统计学分析。
在连续的 10047 次 11C-胆碱 PET/CT 检查中，318 份报告显示“局灶性甲状腺摄取”。其中约 128 份检查为重复检查，予以排除。另外 87 例患者因摄取物被确定为毗邻而不是局限于甲状腺而被排除。在剩余的 103 例患者中，74 例患者有局灶性甲状腺摄取并伴有甲状腺超声评估。在 74 例经超声评估的局灶性摄取中，根据超声结果，21 例为良性甲状腺结节，53 例行活检。63 个结节为良性（21 个为超声诊断的良性，42 个为细胞学或手术病理证实的良性），9 个结节为恶性，2 个结节为不确定。良性组和恶性组的 SUV 值无显著差异（P>.3）。
在这项回顾性研究中，我们对行 11C-胆碱 PET/CT 检查的前列腺癌患者进行了研究，发现了一组因偶然发现局灶性 11C-胆碱甲状腺摄取而行甲状腺超声检查的患者。该组恶性肿瘤的发生率为 12%。因此，当在胆碱 PET 上偶然发现胆碱摄取的甲状腺结节时，可能需要进行超声检查和（或）超声引导下活检。
