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Vol. 33. Issue 1.
Pages 36-38 (January - February 2014)
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Vol. 33. Issue 1.
Pages 36-38 (January - February 2014)
Clinical note
“Hidden” bone metastasis from thyroid carcinoma: A clinical note
Metástasis ósea “oculta” en el carcinoma tiroideo: estudio de un caso clínico
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C. Siokaa, M.C. Skarulisb, M.K. Tulloch-Reidc, J.D. Heissd, J.C. Reynoldsa,??
Corresponding author
jreynolds@mail.cc.nih.gov

Corresponding author at: Section of Nuclear Medicine, Department of Radiology and Imaging Sciences, Building 10, Clinical Center, 10 Center Drive, Room 1C/461, MSC 1074 Bethesda, MD 20892-1074, USA. Tel.: +1 301 496 5675.
a Nuclear Medicine Division, Department of Radiology and Imaging Sciences, Bethesda, MD, USA
b Diabetes, Obesity and Endocrinology Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
c Epidemiology Research Unit, Tropical Medicine Research, The University of the West Indies, Kingston, Jamaica
d Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, Bethesda, MD, USA
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Abstract

The 131I-iodide (131I) whole-body scan, for thyroid carcinoma is at times difficult to interpret. In a diagnostic whole body 131I scan of a patient with follicular carcinoma, a posterior skull lesion was partially hidden by overlapping facial structures. On lateral head view, the abnormality was clearly evident. SPECT/CT and MRI showed the lesion originated in the occipital bone and had enlarged into the posterior fossa. The mass was surgically removed and the patient received 131I therapy for residual tissue. The study demonstrates a pitfall in the reading of two dimensional radioiodine images which can be overcome by SPECT or lateral imaging.

Keywords:
Follicular thyroid cancer
Metastatic disease
131I-Iodide
SPECT
Radioiodine therapy
Resumen

La gammagrafía de cuerpo entero con yodo radiactivo (131I) para el cáncer de tiroides es, a veces, difícil de interpretar. En una gammagrafía diagnóstica de cuerpo entero con 131I en un paciente con carcinoma folicular, las estructuras faciales sobrepuestas ocultaban parcialmente una lesión craneal posterior. En una proyección lateral de la cabeza, la anomalía quedó claramente manifiesta. Las tomografías por emisión de fotón simple y axial computarizada (SPECT/TAC) y de resonancia magnética nuclear (RMN) mostraron que la lesión se originaba en el hueso occipital y se extendía hasta la fosa posterior. La masa fue extirpada quirúrgicamente y al paciente se le trató con 131I para tratar el tejido residual. Este estudio demuestra un fallo en la lectura de dos imágenes bidimensionales de yodo radioactivo que puede evitarse mediante el uso de SPECT o de la adquisición de imágenes laterales.

Palabras clave:
Cáncer folicular de tiroides
Enfermedad metastásica
Yodo radioactivo 131I
SPECT
Terapia con yodo radioactivo

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