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Thymic Lesions in Patients with Myasthenia Gravis: Characterization with Thallium 201 Scintigraphy¹

¹ From the Departments of Nuclear Medicine (T.H., J.T., S.K., H.B., N.T.), Neurology (M.Y.), First Surgery (M.K.), Radiology (O.M.), and Pathology (A.N.), Kanazawa University School of Medicine, Takaramachi 13-1, Kanazawa, Ishikawa, Japan. Received June 5, 2000; revision requested July 28; final revision received April 3, 2001; accepted April 9. Address correspondence to T.H. (e-mail: higuchi@med.kanazawa-u.ac.jp).

PURPOSE: To assess thallium 201 (²⁰¹Tl) single photon emission computed tomography (SPECT) for evaluation of thymic lesions associated with myasthenia gravis (MG), including lymphoid follicular hyperplasia (LFH) and thymoma.

MATERIALS AND METHODS: ²⁰¹Tl SPECT and computed tomography (CT) were performed preoperatively in 46 patients with MG who had undergone thymectomy. SPECT was conducted 15 (early image) and 180 (delayed image) minutes after ²⁰¹Tl injection. Results were visually assessed, and ²⁰¹Tl uptake ratios (thymic lesion count density/lung count density) were measured for quantitative analysis. Uptake was analyzed among the normal thymus, LFH, and thymoma patient groups.

RESULTS: Histopathologic results indicated a normal thymus, LFH, and thymoma in 19, 16, and 11 patients, respectively. Mean uptake ratios in the normal thymus, LFH, and thymoma were 0.96 (95% CI: 0.90, 1.03), 1.14 (95% CI: 1.04, 1.25), and 1.87 (95% CI: 1.56, 2.25), respectively, on early images and 1.09 (95% CI: 1.00, 1.18), 1.65 (95% CI: 1.48, 1.85), and 2.03 (95% CI: 1.65, 2.50), respectively, on delayed images. Thymoma showed more intense ²⁰¹Tl accumulation than did the normal thymus (P < .001) and LFH (P < .001) on early images. Both thymoma (P < .001) and LFH (P < .001) displayed more intense uptake than did the normal thymus on delayed images.

CONCLUSION: ²⁰¹Tl SPECT can enable differentiation between normal thymus, LFH, and thymoma in patients with MG.

Index terms: Mediastinum, radionuclide studies, 675.12162 • Myasthenia gravis • Thallium, radioactive • Thymus, CT, 675.1211 • Thymus, neoplasms, 675.3154, 675.3155, 675.3169 • Thymus, radionuclide studies, 675.12162

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