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LETTER TO EDITOR
Year : 2014  |  Volume : 29  |  Issue : 2  |  Page : 127-128  

Utility of single photon emission tomography/computed tomography in characterizing an additional focus of iodine uptake in post-treatment whole body iodine scan


Department of Nuclear Medicine, PET-CT and Therapy, Amala Institute of Medical Sciences, Amalanagar, Thrissur, Kerala, India

Date of Web Publication9-Apr-2014

Correspondence Address:
Chidambaram Natrajan Balasubramanian Harisankar
Department of Nuclear Medicine, PET-CT and Therapy, Amala Institute of Medical Sciences, Amalanagar, Thrissur - 680 555, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.130325

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How to cite this article:
Chandran VM, Soujya T, Harisankar CB. Utility of single photon emission tomography/computed tomography in characterizing an additional focus of iodine uptake in post-treatment whole body iodine scan. Indian J Nucl Med 2014;29:127-8

How to cite this URL:
Chandran VM, Soujya T, Harisankar CB. Utility of single photon emission tomography/computed tomography in characterizing an additional focus of iodine uptake in post-treatment whole body iodine scan. Indian J Nucl Med [serial online] 2014 [cited 2019 Dec 8];29:127-8. Available from: http://www.ijnm.in/text.asp?2014/29/2/127/130325

Sir,

A 27-year-old female, a known case of follicular variant of papillary thyroid cancer (pT2, Nx, M0) was referred to nuclear medicine department after thyroidectomy. She underwent whole body iodine scanning 48 h after oral administration of 74 MBq of 131-Iodine. There was iodine avid residual thyroid tissue and cervical lymph nodal metastases in the neck. No other site of abnormal iodine avidity was noted.

Patient was treated with high dose radioiodine (100 mCi) in another center. Post-therapy scans acquired after 7 days at our center showed a focus of tracer uptake in the left side of face [Figure 1]. Hybrid single photon emission tomography/computed tomography (SPECT/CT) imaging localized the uptake to a mucosal thickening in the left maxillary sinus [[Figure 1] arrow]. A detailed history from the patient revealed that the patient developed upper respiratory infection and features of left maxillary sinusitis after the high dose therapy. The accumulation in the left maxillary sinus was attributed to the sinusitis, which was also evident on SPECT/CT images.
Figure 1: Whole body images (anterior view) of pre-radioiodine therapy scan (a) Post-treatment scan (b) Along with computed tomography (CT) images of the head in coronal (c) Sagittal (d) and axial (e) Views and fused single photon emission tomography/CT images of the head in coronal (f) Sagittal (g) and axial (h) Views showing tracer accumulation in the left maxillary sinus. Also note is minimal mucosal thickening in the left maxillary sinus (arrow)

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Iodine is actively taken up into the thyroid follicles by sodium iodine symporter (NIS). [1] NIS is expressed at the highest level in the thyroid and lactating breast. [2] NIS is also expressed in the salivary glands, nasal mucosa, lacrimal sac and nasolacrimal ducts. [3] The expression of NIS and the ability to trap iodine explains the retention of radioiodine in maxillary sinus in this patient with maxillary sinusitis. SPECT/CT is of benefit in variety of thyroid diseases. [4],[5],[6],[7] Although post-therapy scanning can identify new sites of metastases that were missed in pre-therapy scanning in 10-26% of the patients, [8] it must be remembered that not all new sites noted are due to metastatic disease.

 
   References Top

1.Kogai T, Brent GA. The sodium iodide symporter (NIS): Regulation and approaches to targeting for cancer therapeutics. Pharmacol Ther 2012;135:355-70.  Back to cited text no. 1
    
2.Kogai T, Taki K, Brent GA. Enhancement of sodium/iodide symporter expression in thyroid and breast cancer. Endocr Relat Cancer 2006;13:797-826.  Back to cited text no. 2
    
3.Morgenstern KE, Vadysirisack DD, Zhang Z, Cahill KV, Foster JA, Burns JA, et al. Expression of sodium iodide symporter in the lacrimal drainage system: Implication for the mechanism underlying nasolacrimal duct obstruction in I (131)-treated patients. Ophthal Plast Reconstr Surg 2005;21:337-44.  Back to cited text no. 3
    
4.Harisankar CN, Preethi GR, Chungath BB. Hybrid SPECT/CT evaluation of Marine-Lenhart syndrome. Clin Nucl Med 2013;38:e89-90.  Back to cited text no. 4
    
5.Harisankar CN. Dual ectopic thyroid in the presence of atrophic orthotopic thyroid gland in a patient with acquired hypothyroidism: Evaluation with hybrid single-photon emission computed tomography/computed tomography. Indian J Nucl Med 2013;28:26-7.  Back to cited text no. 5
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6.Harisankar CN, Preethi GR, George M. Hybrid SPECT/CT evaluation of dual ectopia of thyroid in the absence of orthotopic thyroid gland. Clin Nucl Med 2012;37:602-3.  Back to cited text no. 6
    
7.Bhattacharya A, Venkataramarao SH, Bal CS, Mittal BR. Utility of Iodine-131 hybrid SPECT-CT fusion imaging before high-dose radioiodine therapy in papillary thyroid carcinoma. Indian J Nucl Med 2010;25:29-31.  Back to cited text no. 7
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8.Fatourechi V, Hay ID, Mullan BP, Wiseman GA, Eghbali-Fatourechi GZ, Thorson LM, et al. Are posttherapy radioiodine scans informative and do they influence subsequent therapy of patients with differentiated thyroid cancer? Thyroid 2000;10:573-7.  Back to cited text no. 8
    


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