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Abstract: We present a 38-year-old man who underwent total thyroidectomy with radical right neck dissection due to papillary thyroid cancer was referred for 131I treatment. The patient was in subclinical hypothyroidism with remarkable stimulated Tg level after 4 weeks of l-thyroxine withdrawal before 131I treatment, which indicated hyperfunctioning metastasis. Posttherapeutic 131I whole-body scan combined with 131I SPECT/CT performed on day 3 after 131I administration revealed an elevated 131I uptake mass in cervicothoracic region. To our surprise, the mass was histologically confirmed to be a retrosternal goiter., Competing Interests: Conflicts of interest and sources of funding: This work was supported by the National Natural Science Foundation of China (grant number 81771865). The authors have no conflicts of interest to declare., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Extraskeletal osteosarcomas are uncommon entities in clinical practice, which account for 1% to 2% of all soft tissue sarcomas. We here reported a case of multiple extraskeletal osteosarcomas and nuclear medicine imaging findings of this disease in Tc-MDP bone scan as well as F-FDG PET/CT.

A 54-year-old man with a history of nasopharyngeal carcinoma was treated with TPF (docetaxel + cisplatin + 5-fluorouracil) neoadjuvant chemotherapy, presented with clinical features of acute hepatic failure. F-FDG PET/CT revealed diffuse hepatic radioactivity uptake without pathological radioactivity elsewhere in the body and similar to superscan by bone scan. Increased focal uptake of FDG was more commonly seen in nasopharyngeal carcinoma with metastatic involvement of the liver. This unusual liver superscan indicated that patients with nasopharyngeal carcinoma may show diffuse hepatic involvement by cancer cells and inspired our interests.

Adefovir-induced hypophosphatemic osteomalacia in the context of hepatocarcinoma is rare and needs to be differentiated from metastatic hepatocarcinoma. We here report a case of severe osteomalacia whose focal uptakes of radiotracer on the Tc-MDP SPECT/CT images mimicked that of metastatic hepatocarcinoma.

Metastatic malignant fibrous histiocytoma (MFH) in the colon is extremely rare, although MFH is one of the most common soft tissue sarcomas in adults. We report the case of a 45-year-old woman with metastatic MFH in the sigmoid colon, descending colon, and right lung with FDG PET/CT findings.

Purpose: This study aimed to evaluate the diagnostic accuracy of F-fluoride PET or PET/CT compared with Tc-MDP bone scintigraphy and F-FDG PET/CT in the detection of bone metastases., Patients and Methods: An electronic search was conducted using PubMed/MEDLINE and EMBASE. The methodological quality of the included studies was assessed with Quality Assessment of Diagnostic Accuracy Studies 2. All analyses were performed on Stata version 12.0 and Meta-DiSc version 1.4., Results: Twenty articles containing 1170 patients were identified. On a patient basis, the pooled sensitivity, specificity, and the area under the summary receiver operating characteristic curve of F-fluoride PET or PET/CT were 92% (95% confidence interval [CI], 89%-95%), 93% (95% CI, 91%-95%), and 0.985, respectively. On a lesion basis, the pooled sensitivity, specificity, and area under the summary receiver operating characteristic curve of F-fluoride PET or PET/CT were 87% (95% CI, 85%-88%), 95% (95% CI, 94%-96%), and 0.979, respectively. When compared with Tc-MDP bone scintigraphy, F-fluoride PET or PET/CT showed both higher sensitivity (96% vs. 88%, P = 0.002) and specificity (91% vs. 80%, P = 0.001). When compared with F-FDG PET/CT, F-fluoride PET/CT showed higher sensitivity (94% vs. 73%, P = 0.003), whereas no significant difference was observed in specificity (88% vs. 98%, P = 0.06)., Conclusions: F-fluoride PET or PET/CT has an excellent diagnostic capacity for the detection of bone metastases and shows advantages when compared with Tc-MDP bone scintigraphy and F-FDG PET/CT.

Follicular thyroid carcinoma (FTC) is the second most common thyroid malignancy after papillary thyroid carcinoma (PTC). It has a greater tendency than PTC to metastasize to distant organs such as the lung and bone. FTC metastasis to skeletal muscle is extremely rare. Here, we report a 65-year-old woman with large thigh and buttock muscle metastases as the first manifestation of FTC.

A 63-year-old man with papillary thyroid carcinoma (PTC) and bone metastases was treated with 131I residual thyroid ablation (RTA) and 2 repeated post-ablation 131I therapies after total thyroidectomy. 131I whole-body scans (WBS) demonstrated sustained and diffuse 131I avid bone metastases, accompanied by persistent very low thyroglobulin (Tg) levels and negative antithyroglobulin antibody (TgAb) in post-ablation 131I therapies in hypothyroid state after levothyroxine withdrawal. The spread of bone metastases were found on the last therapeutical 131I WBS. The benefit of 131I therapy after levothyroxine withdrawal should be weighed even if the metastases are 131I avid in poorly differentiated thyroid carcinoma.

The adrenal gland is an uncommon site of metastasis from differentiated thyroid carcinoma, and I-avid adrenal metastatic lesions are even rarer. Here, we describe a 54-year-old woman with I-avid adrenal metastasis from follicular thyroid carcinoma identified using I whole-body scan (I-WBS) and I-SPECT/CT. I-SPECT/CT allowed superior localization of the equivocal I uptake in the I-WBS. It provides metabolic and anatomic information about a lesion, resulting in accurate localization and improved definition of I-WBS findings.

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.

Metastatic lesions from differentiated thyroid cancer (DTC) are usually seen in the cervical lymph nodes, lungs, or bones. Skeletal muscle, especially erector spinae metastasis from DTC, is extremely rare. In this report, 2 cases of DTC metastasizing to the erector spinae incidentally found by I-131 whole-body scanning and low-dose I-131 SPECT/CT scan are described. One is a PTC and the other is the follicular variant of PTC. I-131 whole-body scan is indispensable for the management of patients with DTC. However, precise localization of the foci of I-131 uptake is formidable because of the lack of anatomic landmarks. Low-dose integrated SPECT/CT allows for better location and definition of I-131 whole-body scan findings for residual or metastases in DTC. Metastases to skeletal muscle in DTC may be incidental findings and are more common on I-131 whole-body scans combined with SPECT/CT scans.