Download PDF
Der Nuklearmediziner 2020; 43(03): 201-212
DOI: 10.1055/a-1131-9692
Schilddrüse und Nebenschilddrüse

Die „Standard“-Schilddrüsenszintigrafie – ist sie noch zeitgemäß?

Thyroid scintigraphy – is its clinical significance still justified?
Rainer Görges
1   Klinik für Nuklearmedizin, Universitätsklinikum Essen, Hufelandstraße 55, 45147 Essen
2   Gemeinschaftspraxis Nuklearmedizin Duisburg, Tonhallenstraße 19, 47051 Duisburg
,
Andreas Bockisch
1   Klinik für Nuklearmedizin, Universitätsklinikum Essen, Hufelandstraße 55, 45147 Essen
,
Philipp Seifert
3   Klinik für Nuklearmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Zusammenfassung

Aus fachfremder Sicht wird der Stellenwert der „konventionellen“ Schilddrüsenszintigrafie zur Klärung diverser thyreologischer Fragestellungen international mittlerweile weit niedriger eingeschätzt, als dies dem hierzulande tätigen Nuklearmediziner bewusst ist. Dieser Aufsatz gibt einen Überblick über häufig geäußerte Kritikpunkte an der Schilddrüsenszintigrafie und möchte einiges hierzu klarstellen sowie in berechtigten Fällen fundierte Gegenargumente liefern. In diesem Rahmen wird ein Überblick über die weiterhin bestehenden Indikationen gegeben, es werden aber auch Aspekte angeschnitten, bei denen Verbesserungsbedarf besteht. Abschließend erfolgt eine Aussicht auf zukünftige Perspektiven und Weiterentwicklungen der funktionellen Charakterisierung von thyreoidalem Gewebe.

Abstract

From a non-nuclear medicine perspective, the importance of "conventional" thyroid scintigraphy in various indications is nowadays deemed far lower internationally than the nuclear medicine specialists of the German-speaking area are aware of. This article provides an overview of frequently voiced criticisms regarding the thyroid scintigraphy and would like to clarify some aspects as well as provide well-founded counter-arguments in eligible cases. In this context, the following article gives an overview of the indications that still exist, but also addresses issues that need to be improved. Finally, a prospect of future perspectives and further developments in the functional characterization of thyroid tissue is given.

Schlüsselwörter

Schilddrüsenszintigrafie - Schilddrüsenknoten - Malignitätsrate - Indikationen - Differenzialdiagnose der Hyperthyreose - Fusionsbildgebung

Keywords

Thyroid scintigraphy - thyroid nodule - malignancy rate - indications - differential diagnosis of hyperthyroidism - fusion imaging


Publication History

Article published online:
21 September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Mahlstedt J, Bähre M, Börner W. et al. Indikationen zur Schilddrüsenszintigraphie. Der Nuklearmediziner 1989; 12: 223-228
    PubMedSearch in Google Scholar
  • 2 Schwarzrock R. Schilddrüsenszintigraphie mit dem Pinhole-Kollimator. Der Nuklearmediziner 2004; 27: 98-105
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Mahlstedt J. Szintigraphie bei benignen Schilddrüsenerkrankungen. Der Nuklearmediziner 2004; 27: 106-119
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Mahlstedt J. Schilddrüsenknoten: Szintigraphie des funktionsfähigen Schilddrüsenknotens. Der Nuklearmediziner 2008; 31: 237-240
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Verburg FA, Krohn T. Schilddrüsendiagnostik – Algorithmen und Leitlinien: Schilddrüsendiagnostik in der guten klinischen Praxis. Der Nuklearmediziner 2012; 35: 12-21
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Dunkelmann S, Schümichen C. Schilddrüsenszintigraphie – Normalbefunde, Fehlerquellen und Pitfalls. Der Nuklearmediziner 2015; 38: 8-13
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Kirsch CM. Nuklearmedizinische Standardprozeduren: Schilddrüse und Nebenschilddrüse. Der Nuklearmediziner 2017; 40: 191-192
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Perros P, Boelaert K, Colley S. et al. British Thyroid Association. Guidelines for the management of thyroid cancer. Clin Endocinol (Oxf) 2014; 81 (Suppl. 01) 1-122
    CrossrefPubMedSearch in Google Scholar
  • 9 American Thyroid Association Guidelines Taskforce. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006; 16: 109-142
    CrossrefPubMedSearch in Google Scholar
  • 10 Haugen BR, Alexander EK, Bible KC. et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26: 1-133
    CrossrefPubMedSearch in Google Scholar
  • 11 Dietlein M, Eschner W, Lassmann M. et al. DGN-Handlungsempfehlung (S1-Leitlinie) Schilddrüsenszintigraphie (Version 4). Stand: 10/2014–AWMF-Registernummer: 031-011. https://www.nuklearmedizin.de/leistungen/leitlinien/docs/031-011l_S1_Schilddruesenszintigraphie_2014-10.pdf
    PubMed
  • 12 Giovanella L, Avram AM, Iakovou I. et al. EANM practice guideline/SNMMI procedure standard for RAIU and thyroid scintigraphy. Eur J Nucl Med Mol Imaging 2019; 46: 2514-2525
    CrossrefPubMedSearch in Google Scholar
  • 13 Röher HD, Rudolph H, Wunsch H. et al. Der szintigraphisch kalte Knoten der Schilddrüse als Malignomverdacht und seine tatsächliche Bestätigung. Langenbecks Archiv für Chirurgie. In: Linder F, Krebs H, Rudolph H. (eds) Chirurgisches Forum für experimentelle und klinische Forschung. 72. Berlin, Heidelberg.: Springer; 1972.
    CrossrefSearch in Google Scholar
  • 14 Schicha H, Hellmich M, Lehmacher W. et al. Should all patients with thyroid nodules > or = 1 cm undergo fine-needle aspiration biopsy?. Nuklearmedizin 2009; 48: 79‐83
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Görges R, Kandror T, Kuschnerus S. et al. Szintigraphisch mehranreichernde Schilddrüsenknoten gehen überwiegend mit normwertigem TSH einher. Nuklearmedizin 2011; 50: 179-88
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Graf D, Helmich-Kapp B, Graf S. et al. Funktionelle Aktivität fokaler Schilddrüsenautonomien in Deutschland. Dtsch Med Wochenschr 2012; 137: 2089-2092
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Treglia G, Trimboli P, Verburg FA. et al. Prevalence of normal TSH value among patients with autonomously functioning thyroid nodule. Eur J Clin Invest 2015; 45: 739-744
    CrossrefPubMedSearch in Google Scholar
  • 18 Giovanella L, D‘Aurizio F, Campenni’ A. et al. Searching for the most effective thyrotropin (TSH) threshold to rule-out autonomously functioning thyroid nodules in iodine deficient regions. Endocrine 2016; 54: 757-761
    CrossrefPubMedSearch in Google Scholar
  • 19 Baser H, Topaloglu O, Bilginer MC. et al. Are cytologic and histopathologic features of hot thyroid nodules different from cold thyroid nodules?. Diagn Cytopathol 2019; 47: 898-903
    CrossrefPubMedSearch in Google Scholar
  • 20 Horst W, Rösler H, Schneider C. et al. 306 cases of toxic adenoma: clinical aspects, findings in radioiodine diagnostics, radiochromatography and histology; results of 131-I and surgical treatment. J Nucl Med 1967; 8: 515-528
    PubMedSearch in Google Scholar
  • 21 Thermann M, Raute-Kreinsen U, Blomenkamp K. Carcinomincidenz bei folliculären Neoplasien der Schilddrüse. Chirurg 1992; 63: 817-821
    PubMedSearch in Google Scholar
  • 22 Seifert P, Freesmeyer M. Preoperative diagnostics in differentiated thyroid carcinoma. Nuklearmedizin 2017; 56: 201-210
    Thieme ConnectPubMedSearch in Google Scholar
  • 23 Bongiovanni M, Spitale A, Faquin WC. et al. The Bethesda System for Reporting Thyroid Cytopathology: a meta-analysis. Acta Cytol 2012; 56: 333-339
    CrossrefPubMedSearch in Google Scholar
  • 24 Seifert P, Gühne F, Freesmeyer M. Hyperfunctioning Papillary Microcarcinoma Diagnosed by 124I PET/Ultrasound Fusion Imaging. Clin Nucl Med 2019; 44: 404-405
    CrossrefPubMedSearch in Google Scholar
  • 25 Schröder S, Marthaler B. Autonomie und Malignität bei Schilddrüsentumoren. Eine kritische Literaturanalyse zur Existenz hyperfunktionierender follikulärer und papillärer Schilddrüsenkarzinome. Pathologe 1996; 17: 349-357
    CrossrefPubMedSearch in Google Scholar
  • 26 Reschini E, Ferrari C, Castellani M. et al. The trapping-only nodules of the thyroid gland: prevalence study. Thyroid 2006; 16: 757-762
    CrossrefPubMedSearch in Google Scholar
  • 27 Eszlinger M, Niedziela M, Typlt E. et al. Somatic mutations in 33 benign and malignant hot thyroid nodules in children and adolescents. Mol Cell Endocrinol 2014; 393: 39-45
    CrossrefPubMedSearch in Google Scholar
  • 28 Schenke S, Seifert P, Zimny M. et al. Risk Stratification of Thyroid Nodules Using the Thyroid Imaging Reporting and Data System (TIRADS): The Omission of Thyroid Scintigraphy Increases the Rate of Falsely Suspected Lesions. J Nucl Med 2019; 60: 342-347
    CrossrefPubMedSearch in Google Scholar
  • 29 Kwak JY, Han KH, Yoon JH. et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology 2011; 260: 892-899
    CrossrefPubMedSearch in Google Scholar
  • 30 Castellana M, Virili C, Paone G. et al. Ultrasound systems for risk stratification of thyroid nodules prompt inappropriate biopsy in autonomously functioning thyroid nodules. Clin Endocrinol (Oxf) 2020; 93: 67-75
    CrossrefPubMedSearch in Google Scholar
  • 31 Veer V, Puttagunta S. The role of elastography in evaluating thyroid nodules: a literature review and meta-analysis. Eur Arch Otorhinolaryngol 2015; 272: 1845-1855
    CrossrefPubMedSearch in Google Scholar
  • 32 Ruhlmann M, Stebner V, Görges R. et al. Diagnosis of hyperfunctional thyroid nodules: impact of US-elastography. Nuklearmedizin 2014; 53: 173-177
    Thieme ConnectPubMedSearch in Google Scholar
  • 33 Trimboli P, Paone G, Zatelli MC. et al. Real-time elastography in autonomously functioning thyroid nodules: relationship with TSH levels, scintigraphy, and ultrasound patterns. Endocrine 2017; 58: 488-494
    CrossrefPubMedSearch in Google Scholar
  • 34 Tumino S, Fornito C, Laudani A. et al. Transition from cold to hot thyroid nodules. Thyroid 1997; 7: 897-900
    CrossrefPubMedSearch in Google Scholar
  • 35 Allelein S, Diana T, Ehlers M. et al. Comparison of a Bridge Immunoassay with Two Bioassays for Thyrotropin Receptor Antibody Detection and Differentiation. Horm Metab Res 2019; 51: 341-346
    Thieme ConnectPubMedSearch in Google Scholar
  • 36 Stasiak M, Michalak R, Stasiak B. et al. Clinical characteristics of subacute thyroiditis is different than it used to be - current state based on 15 years own material. Neuro Endocrinol Lett 2019; 39: 489-495
    PubMedSearch in Google Scholar
  • 37 Ross DS, Burch HB, Cooper DS. et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 2016; 26: 1343-1421
    CrossrefPubMedSearch in Google Scholar
  • 38 Yanagisawa T, Sato K, Kato Y. et al. Rapid differential diagnosis of Graves' disease and painless thyroiditis using total T3/T4 ratio, TSH, and total alkaline phosphatase activity. Endocr J 2005; 52: 29-36
    CrossrefPubMedSearch in Google Scholar
  • 39 Sriphrapradang C, Bhasipol A. Differentiating Graves' disease from subacute thyroiditis using ratio of serum free triiodothyronine to free thyroxine. Ann Med Surg (Lond) 2016; 10: 69-72
    CrossrefPubMedSearch in Google Scholar
  • 40 Sahlmann CO, Siefker U, Lehmann K. et al. Quantitative thyroid scintigraphy for the differentiation of Graves' disease and hyperthyroid autoimmune thyroiditis. Nuklearmedizin 2004; 43: 124-128
    CrossrefPubMedSearch in Google Scholar
  • 41 Kidokoro-Kunii Y, Emoto N, Cho K. et al. Analysis of the factors associated with Tc-99m pertechnetate uptake in thyrotoxicosis and graves' disease. J Nippon Med Sch 2006; 73: 10-7
    CrossrefPubMedSearch in Google Scholar
  • 42 Cakir M. Marine-Lenhart syndrome. J Natl Med Assoc 2005; 97: 1036-1038
    PubMedSearch in Google Scholar
  • 43 Brahma A, Beadsmoore C, Dhatariya K. The oldest case of Marine-Lenhart syndrome?. JRSM Short Rep 2012; 3: 21
    CrossrefPubMedSearch in Google Scholar
  • 44 Giuffrida G, Giovinazzo S, Certo R. et al. An uncommon case of Marine-Lenhart syndrome. Arq Bras Endocrinol Metabol 2014; 58: 398-401
    CrossrefPubMedSearch in Google Scholar
  • 45 Brian SR, Cheng DW, Goldberg PA. Unusual case of amiodarone-induced thyrotoxicosis: "illicit" use of a technetium scan to diagnose a transiently toxic thyroid nodule. Endocr Pract 2007; 13: 413-416
    CrossrefPubMedSearch in Google Scholar
  • 46 Reinhardt MJ, Trupkovic T, Schumacher T. et al. Änderung des 99mTechnetium-Pertechnetat-Uptakes der Schilddrüse unter Suppression (TcTUs) bei Verbesserung der Iodversorgung in Deutschland. Nuklearmedizin 1998; 37: 202-207
    Thieme ConnectPubMedSearch in Google Scholar
  • 47 Meller J, Becker W. Scintigraphy with 99mTc-pertechnetate in the evaluation of functional thyroidal autonomy. Q J Nucl Med 1999; 43: 179-187
    PubMedSearch in Google Scholar
  • 48 Gotthardt M, Stübinger M, Pansegrau J. et al. Decrease of (99m)Tc-uptake in autonomous thyroid tissue in Germany since the 1970s. Clinical implications for radioiodine therapy. Nuklearmedizin 2006; 45: 122-125
    CrossrefPubMedSearch in Google Scholar
  • 49 Ghanem MA, Elgazzar AH, Elsaid MM. et al. Comparison of pinhole and high-resolution parallel-hole imaging for nodular thyroid disease. Clin Nucl Med 2011; 36: 770-771
    CrossrefPubMedSearch in Google Scholar
  • 50 Sarikaya I, Al-Banna Z, Baqer A. Recognizing Pinhole Parallax Error for Accurate Localization of Thyroid and Parathyroid Disease. J Nucl Med Technol 2018; 46: 288-289
    CrossrefPubMedSearch in Google Scholar
  • 51 Winkens T, Seifert P, Hollenbach C. et al. The FUSION iENA Study: Comparison of I-124-PET/US Fusion Imaging with Conventional Diagnostics for the Functional Assessment of Thyroid Nodules by Multiple Observers. Nuklearmedizin 2019; 58: 434-442
    Thieme ConnectPubMedSearch in Google Scholar
  • 52 Seifert P, Winkens T, Kühnel C. et al. I-124-PET/US Fusion Imaging in Comparison to Conventional Diagnostics and Tc-99m Pertechnetate SPECT/US Fusion Imaging for the Function Assessment of Thyroid Nodules. Ultrasound Med Biol 2019; 45: 2298-2308
    CrossrefPubMedSearch in Google Scholar
  • 53 Freesmeyer M, Winkens T, Kuehnel C. et al. 99mTc-Pertechnetate-SPECT/US Hybrid Imaging Enhances Diagnostic Certainty Compared With Conventional Thyroid Imaging With Scintigraphy and Ultrasound. Clin Nucl Med 2019; 43: 747-748
    CrossrefPubMedSearch in Google Scholar
  • 54 Freesmeyer M, Winkens T, Kühnel C. et al. Technetium-99m SPECT/US Hybrid Imaging Compared with Conventional Diagnostic Thyroid Imaging with Scintigraphy and Ultrasound. Ultrasound Med Biol 2019; 45: 1243-1252
    CrossrefPubMedSearch in Google Scholar
  • 55 Freesmeyer M, Opfermann T, Winkens T. Hybrid integration of real-time US and freehand SPECT: proof of concept in patients with thyroid diseases. Radiology 2014; 271: 856-861
    CrossrefPubMedSearch in Google Scholar
  • 56 Freesmeyer M, Winkens T, Kühnel C. Real-time handheld emission spot allocator (rthESA) for simultaneous fusion imaging with ultrasound. Nuklearmedizin- 2014; 53: 265-271
    Thieme ConnectPubMedSearch in Google Scholar
  • 57 Desmonts C, Bouthiba MA, Enilorac B. et al. Evaluation of a new multipurpose whole-body CzT-based camera: comparison with a dual-head Anger camera and first clinical images. EJNMMI Phys 2020; 7: 18
    CrossrefPubMedSearch in Google Scholar