Early and delayed thallium-201 scintigraphy in thyroid nodules: the relationship between early thallium-201 uptake and perfusion.

Seventy-six patients with thyroid nodules were studied. Initially, 74 MBq of thallium-201 was injected. The thyroid gland was imaged 15 min (early) and 3 h (delayed) after the injection. Thereafter, 185 MBq technetium-99m pertechnetate was injected. Immediately after the injection, a 1-min perfusion image was acquired, followed by an image at 20 min. Increased early and delayed 201Tl uptake compared with the contralateral thyroid tissue was adopted as the criterion for malignancy. Sensitivity, specificity and negative predictive values were found to be 85%, 64% and 78%, respectively, in operated patients, but these values were 86%, 87% and 95%, respectively, in the whole group, including patients followed with fine-needle aspiration biopsy. With the purpose of investigating the relationship between perfusion and early 201Tl uptake, both perfusion and early images were graded comparing nodular activity with contralateral thyroid activity. There was a poor correlation between perfusion and 201Tl uptake. The correlation was even worse in hyperactive nodules. It is concluded that early and delayed 201Tl imaging should not be used in the differential diagnosis of cold nodules and that early 201Tl uptake seems to be more closely related to factors other than perfusion.