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¹³¹I Therapeutic Efficacy Is Not Influenced by Stunning after Diagnostic Whole-Body Scanning¹

¹ From the Department of Radiology, Division of Nuclear Medicine, Thomas Jefferson University Hospital, Philadelphia, Pa. Received March 31, 2003; revision requested June 19; revision received October 9; accepted November 12. Address correspondence to H.Q.D., Department of Medicine, Division of Nuclear Medicine, Christiana Care, 4755 Ogletown-Stanton Rd, Newark, DE 19718 (e-mail: hdam@christianacare.org).

View larger version (180K): [in a new window]   Figure 1a. Images in a 46-year-old woman with stage III papillary-follicular thyroid carcinoma who underwent total thyroidectomy 8 weeks earlier. (a) Diagnostic anterior image of the neck obtained 48 hours after administration of 185 MBq (5 mCi) of 131I demonstrates two functioning cervical lymph node metastases (arrows). (b) After treatment with 5,550 MBq (150 mCi) of 131I 8 days after the diagnostic dose, a postablation anterior scan of the neck obtained 7 days after the ablative dose shows much less uptake in the lymph nodes (arrows). The patient remained disease-free after this treatment.

View larger version (210K): [in a new window]   Figure 1b. Images in a 46-year-old woman with stage III papillary-follicular thyroid carcinoma who underwent total thyroidectomy 8 weeks earlier. (a) Diagnostic anterior image of the neck obtained 48 hours after administration of 185 MBq (5 mCi) of 131I demonstrates two functioning cervical lymph node metastases (arrows). (b) After treatment with 5,550 MBq (150 mCi) of 131I 8 days after the diagnostic dose, a postablation anterior scan of the neck obtained 7 days after the ablative dose shows much less uptake in the lymph nodes (arrows). The patient remained disease-free after this treatment.

View larger version (206K): [in a new window]   Figure 2a. Images in a 40-year-old woman with stage I papillary thyroid carcinoma who underwent total thyroidectomy 4 weeks previously. (a) Diagnostic anterior image of the neck acquired 48 hours after administration of 185 MBq (5 mCi) of 131I reveals a functioning thyroid remnant, as evidenced by the star pattern of activity. (b) After 3,700 MBq of (100 mCi) 131I was administered 8 days later, the thyroid bed activity is seen again. (c) One-year follow-up diagnostic scan shows mild residual activity (arrow) in the thyroid bed. (d) After another treatment with 3,700 MBq of 131I, a postablation scan obtained 7 days later does not demonstrate any activity in the thyroid bed, thus indicating stunning. (e) Another 1-year follow-up diagnostic scan obtained 48 hours after administration of 185 MBq of 131I again shows no activity in the thyroid bed.

View larger version (101K): [in a new window]   Figure 2b. Images in a 40-year-old woman with stage I papillary thyroid carcinoma who underwent total thyroidectomy 4 weeks previously. (a) Diagnostic anterior image of the neck acquired 48 hours after administration of 185 MBq (5 mCi) of 131I reveals a functioning thyroid remnant, as evidenced by the star pattern of activity. (b) After 3,700 MBq of (100 mCi) 131I was administered 8 days later, the thyroid bed activity is seen again. (c) One-year follow-up diagnostic scan shows mild residual activity (arrow) in the thyroid bed. (d) After another treatment with 3,700 MBq of 131I, a postablation scan obtained 7 days later does not demonstrate any activity in the thyroid bed, thus indicating stunning. (e) Another 1-year follow-up diagnostic scan obtained 48 hours after administration of 185 MBq of 131I again shows no activity in the thyroid bed.

View larger version (93K): [in a new window]   Figure 2c. Images in a 40-year-old woman with stage I papillary thyroid carcinoma who underwent total thyroidectomy 4 weeks previously. (a) Diagnostic anterior image of the neck acquired 48 hours after administration of 185 MBq (5 mCi) of 131I reveals a functioning thyroid remnant, as evidenced by the star pattern of activity. (b) After 3,700 MBq of (100 mCi) 131I was administered 8 days later, the thyroid bed activity is seen again. (c) One-year follow-up diagnostic scan shows mild residual activity (arrow) in the thyroid bed. (d) After another treatment with 3,700 MBq of 131I, a postablation scan obtained 7 days later does not demonstrate any activity in the thyroid bed, thus indicating stunning. (e) Another 1-year follow-up diagnostic scan obtained 48 hours after administration of 185 MBq of 131I again shows no activity in the thyroid bed.

View larger version (100K): [in a new window]   Figure 2d. Images in a 40-year-old woman with stage I papillary thyroid carcinoma who underwent total thyroidectomy 4 weeks previously. (a) Diagnostic anterior image of the neck acquired 48 hours after administration of 185 MBq (5 mCi) of 131I reveals a functioning thyroid remnant, as evidenced by the star pattern of activity. (b) After 3,700 MBq of (100 mCi) 131I was administered 8 days later, the thyroid bed activity is seen again. (c) One-year follow-up diagnostic scan shows mild residual activity (arrow) in the thyroid bed. (d) After another treatment with 3,700 MBq of 131I, a postablation scan obtained 7 days later does not demonstrate any activity in the thyroid bed, thus indicating stunning. (e) Another 1-year follow-up diagnostic scan obtained 48 hours after administration of 185 MBq of 131I again shows no activity in the thyroid bed.

View larger version (102K): [in a new window]   Figure 2e. Images in a 40-year-old woman with stage I papillary thyroid carcinoma who underwent total thyroidectomy 4 weeks previously. (a) Diagnostic anterior image of the neck acquired 48 hours after administration of 185 MBq (5 mCi) of 131I reveals a functioning thyroid remnant, as evidenced by the star pattern of activity. (b) After 3,700 MBq of (100 mCi) 131I was administered 8 days later, the thyroid bed activity is seen again. (c) One-year follow-up diagnostic scan shows mild residual activity (arrow) in the thyroid bed. (d) After another treatment with 3,700 MBq of 131I, a postablation scan obtained 7 days later does not demonstrate any activity in the thyroid bed, thus indicating stunning. (e) Another 1-year follow-up diagnostic scan obtained 48 hours after administration of 185 MBq of 131I again shows no activity in the thyroid bed.