F-18-Dopa PET/CT is more sensitive than whole body MRI for the localization of persistent/recurrent disease of medullary thyroid cancer patients.

Abstract

Background Elevated post-operative serum calcitonin (Ctn) level indicates persistent/recurrent disease in patients with medullary thyroid carcinoma (MTC). Its location is a challenge. The aim of our study was to compare the disease detection rates of F-18-Dopa (dihydroxyfluorophenyalanin) Positon Emission Tomography (PET)/ Computed Tomography (CT), whole body (WB) Magnetic Resonance Imaging (MRI), F-18-FDG (fluorodeoxyglucose) PET/CT, WB CT scanning, neck ultrasonography (US), and bone scintigraphy in MTC patients with increased Ctn levels and unknown localization of the source. Methods We compared independent reading of each imaging procedure to a reference assessment for structural disease defined by pathology or concordance between two imaging or with subsequent follow-up. The detection rate of each imaging modality was determined in a per patient, per organ and per lesion analysis. Results Thirty six consecutive patients (21 females, mean age: 57 years, sporadic MTC in 26 cases, median serum Ctn level: 760 pg/mL; range: 21-10121) were analyzed. The reference assessment localized disease in 24 (64%) patients with 74 lesions detected in the thyroid bed (8), in neck lymph nodes (15), mediastinal lymph nodes (6), lung (1), liver (2), bones (3), and other site (1). At the patient level, the detection rates were 64% (IC: 48-80%) for F-18-Dopa PET/CT with early acquisitions, 40% (IC: 24-56%) for F-18-FDG PET/CT, 40% (IC: 24-56%) for WB MRI, 48% (IC: 31-66%) for WB CT scan. Conclusions: In MTC patients with increased Ctn and no known distant metastases, F-18-Dopa PET/CT is more sensitive to detect structural disease than any other imaging modality, including WB MRI.