Yan-Hong Xu

Rare metastases of differentiated thyroid carcinoma: pictorial review

Differentiated thyroid cancer (DTC) is usually indolent with good prognosis and long-term survival. However, DTC distant metastasis is often a grave event and accounts for most of its disease-specific mortality. The major sites of distant metastases are the lung and bone. Metastases to the brain, breast, liver, kidney, muscle, and skin are rare or relatively rare. Nevertheless, recognizing rare metastases from DTC has a significant impact on the clinical decision making and prognosis of patients. (131)I single photon emission computed tomography/computed tomography ((131)I-SPECT/CT) can provide both metabolic and anatomic information about a lesion; therefore, it can better localize and define the (131)I-WBS findings in DTC patients. In this pictorial review, the imaging features of a range of rare metastases from DTC are demonstrated, with a particular emphasis on the (131)I-SPECT/CT diagnostic aspect.

Efficacy and Survival Analysis of 131I Therapy for Bone Metastases from Differentiated Thyroid Cancer

OBJECTIVE Our objective was to investigate the clinical efficacy of (131)I therapy for bone metastases from differentiated thyroid cancer (DTC) and prognostic factors as well as to assess patient survival and variables influencing survival. METHODS One hundred six DTC patients with bone metastases treated with (131)I were retrospectively analyzed. The therapeutic efficacy was evaluated based on the change in serum thyroglobulin (Tg), the palliation of bone pain, and the anatomical imaging changes in bone lesions. The overall survival rates were estimated using the life-table method. RESULTS After (131)I therapy, a significant decrease in serum Tg was seen in 37 cases (34.9%), and serum Tg remained stable in 56 patients (52.8%). Among the 61 patients with painful bone metastases, 39 patients obtained a significant relief of bone pain, and the effective rate was 63.9%. The majority of DTC patients (76.4%) exhibited no obvious anatomical imaging changes in metastatic bone lesions after (131)I therapy. Only histopathological type and whether combined with nonosseous distant metastases had statistically significant impacts on changes in serum Tg (P = 0.009 and 0.023), and age over 45 yr and papillary thyroid carcinoma had favorable response on changes in anatomical imaging (P = 0.027 and 0.014). The 5- and 10-yr survival rates were 86.5 and 57.9%, respectively. Multivariate analyses showed that the presence of solitary bone metastases, only bone metastases, and (131)I therapy with previous bone surgery were independent factors associated with a better prognosis (P = 0.024, 0.009, and 0.031). CONCLUSION (131)I therapy is a feasible and effective treatment for DTC bone metastases. A better prognosis can be accomplished in patients who had a single metastatic lesion, only bone metastasis, or underwent bone surgery before (131)I therapy.

Localization and identification of parapharyngeal metastases from differentiated thyroid carcinoma by 131I-SPECT/CT.

Parapharyngeal metastasis is a rare event in differentiated thyroid carcinoma (DTC). The 131I‐single photon emission CT (SPECT)/CT allows better localization and definition for metastases in DTC. The aim of this study was to assess the value of 131I‐SPECT/CT for the diagnosis of parapharyngeal metastasis in patients with DTC.

Unusual 131i Uptake in a Benign Mucinous Cystadenoma of the Ovary in a Patient With Papillary Thyroid Cancer

Abstract:We present a huge benign mucinous cystadenoma of the ovary, incidentally discovered by 131I whole-body scan and 131I-SPECT/CT as a false-positive 131I uptake in a patient with papillary thyroid cancer. 131I whole-body scan and 131I-SPECT/CT performed after 131I administration revealed an ab

Association of Serum Fetuin-A Levels With the Risk of Albuminuria in Middle-Aged and Elderly Chinese

CONTEXT Fetuin-A is an important hepatokine associated with many cardiometabolic abnormities. The association between fetuin-A and albuminuria has not been investigated in a prospective cohort. OBJECTIVE The objective of the study was to prospectively investigate whether serum fetuin-A levels were associated with albuminuria in middle-aged and elderly Chinese. DESIGN, SETTING, AND PARTICIPANTS A community-based study was conducted at baseline in 2009, including 3102 individuals aged 40 years or older and followed up for 4 years. MAIN OUTCOME MEASURES Baseline and follow-up urine samples were collected to measure urinary albumin and creatinine concentrations. Albuminuria was defined as urinary albumin to creatinine ratio (UACR) of 30 mg/g or greater. RESULTS A total of 194 participants (8.5%) developed albuminuria during the follow-up. Men who developed albuminuria had significantly higher baseline levels of fetuin-A compared with those who did not (338.2 vs 292.9 mg/L, P = .02). Among men, after adjustment for traditional risk factors, each 1-SD increase of fetuin-A level (131.6 mg/L) was associated with a 32% higher risk for developing albuminuria (odds ratio 1.32, 95% confidence interval 1.07-1.62). In addition, among men, compared with participants in the lowest tertile (<253.1 mg/L) of serum fetuin-A levels, those in the highest tertile (>338.2 mg/L) had a 2-fold risk for developing albuminuria (odds ratio 2.07, 95% confidence interval 1.04-4.12) after multivariate adjustment. No association between fetuin-A levels and incident albuminuria was observed in women. CONCLUSIONS High serum fetuin-A levels were independently associated with an increased risk of developing albuminuria in middle-aged and elderly men, whereas no significant associations were found in women.

Percutaneous osteoplasty combined with radioiodine therapy as a treatment for bone metastasis developing after differentiated thyroid carcinoma.

BACKGROUND Bone metastasis developing after differentiated thyroid carcinoma (DTC) is common, and in most cases, this condition leads to osteolysis. However, treatment of bone metastases in DTC patients is a great challenge. The purpose of this study was to evaluate the effectiveness of percutaneous osteoplasty (POP) combined with radioiodine therapy for treating bone metastasis developing after DTC. PATIENTS AND METHODS We retrospectively studied 8 patients who had undergone POP combined with radioiodine therapy for bone metastases after DTC. All patients underwent total thyroidectomy and were administered an oral dose of 131I (3.7 GBq, 100 mCi) for ablation of the residual thyroid. Thereafter, a POP was performed at 2 to 3 months followed by 2 to 5 sessions of radioiodine therapy every 4 to 6 months after the first 131I therapy. The therapeutic effectiveness of this treatment was evaluated on the basis of the changes in serum thyroglobulin (Tg) level and imaging characteristics, palliation of bone pain, and alleviation of neurologic symptoms. RESULTS After POP, the mean serum Tg level decreased by 86.0% (range, 68.1%-99.3%). The mean serum Tg level markedly declined further by 67.4% (range, 37.1%-90.2%) after repeated radioiodine therapy. All the patients experienced immediate and substantial alleviation of bone pain and neurologic symptoms, and their quality of life markedly improved. The bone-destructive lesions were filled with bone cement to enhance skeletal stability. No severe complications developed. CONCLUSION POP, a minimally invasive procedure, combined with radioiodine therapy seems to be highly effective in providing pain relief and bone stability and in improving the quality of life of DTC patients with bone metastases. After POP, radioiodine therapy is essential.

131I-SPECT/CT found an ovarian metastasis covered by iliac metastasis on 131I whole-body scan in a patient with papillary thyroid carcinoma.

Abstract:Ovarian metastasis from differentiated thyroid carcinoma is very exceptional. In this study, we describe a case of a 42-year-old woman with an 131I-uptake lesion in the left pelvic cavity from papillary thyroid carcinoma incidentally found by 131I-SPECT/CT, which was concealed by the iliac

Abnormal ¹³¹I uptake in a benign serous ovarian cystadenoma mimicking bladder physiological uptake.

Iodine-131 (I) whole-body scan is usually a routine practice for the management of patients with differentiated thyroid carcinoma after I therapy. The correct interpretation of radioiodine scans is critical and can avoid unnecessary therapeutic doses. I SPECT/CT plays an important role in the precise localization and characterization of I avid foci. We present a special case imaging resulting from a benign serous cystadenoma of the ovary mimicking physiological uptake of the urinary bladder, which was identified by I whole-body scan and I SPECT/CT.

Maternal High Triglyceride Levels During Early Pregnancy and Risk of Preterm Delivery: A Retrospective Cohort Study.

CONTEXT Maternal obesity increases the risk of preterm delivery. Obesity is known to be associated with altered lipid metabolism. OBJECTIVE To investigate the associations between high maternal triglyceride (mTG) levels during early pregnancy and risks of preterm delivery stratified by early pregnancy body mass index (BMI). DESIGN Retrospective cohort study. SETTING University-based maternity center. PATIENTS 49,612 women with singleton pregnancy who underwent fasting serum lipid screening during early pregnancy. MAIN OUTCOME MEASURES Risk of preterm delivery (total, <37 weeks; early, 28 to 33 weeks; and late, 34 to 36 weeks). RESULTS Among women enrolled, 2494 had a preterm delivery, including 438 early preterm and 2056 late preterm delivery. High mTG (>90th percentile, 2.04 mM) was associated with shortened gestation. Risks of total, early, and late preterm deliveries increased with mTG levels, and the high mTG-related risk was highest for early preterm delivery [adjusted odds ratio (AOR) 1.72; 95% CI, 1.30 to 2.29]. After stratification by BMI, high mTG was associated with risk of preterm delivery in both overweight or obese (OWO) women (AOR 1.32; 95% CI, 1.02 to 1.70) and women with normal BMI (AOR 1.36; 95% CI, 1.16 to 1.59). In additional sensitivity analyses, we found that high mTG was related to higher risks of preterm delivery among OWO women and women with normal BMI (AOR, 1.54; 95% CI, 1.07 to 2.22 and 1.62, 1.34 to 1.96, respectively), especially early preterm delivery (AOR 2.47; 95% CI, 1.19 to 5.10, and AOR 2.50; 95% CI, 1.65 to 3.78, respectively). CONCLUSIONS High mTG level during early pregnancy increased the risks of preterm delivery not only in OWO women but also in women with normal BMI.