Imaging Methods for Medullary Thyroid Cancer

  • C. Reiners
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 125)


Imaging of multiple endocrine neoplasia (MEN) syndromes is a challenge not only for the radiologist but for every physician engaged in ultrasonography (US), conventional radiology, computerized tomography (CT), magnetic resonance imaging (MRI), and scintigraphy (SC). Doppman (1985) called the MEN syndromes “a nightmare” for the diagnostician because of the difficulty of detecting and localizing small tumors or even only hyperplasia of endocrine organs. Nevertheless, the primary aim of allefforts is detection of preclinical stages of organ involvement, as it is only in those early stages that curative therapy of medullary thyroid cancer (MTC) may be possible. On the other hand, sensitive imaging methods are needed for follow-up to localize suspected recurrences or metastases of MTC in patients with elevated serum tumor markers. In this context, the diagnostic efficacy of US, SC, CT, and MRI must be discussed. Additionally, the clinical value of fine needle aspiration (FNA) biopsy has to be considered.


Thyroid Cancer Medullary Thyroid Carcinoma Medullary Thyroid Multiple Endocrine Neoplasia Medullary Thyroid Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Arnstein NB, Juni JE, Sisson JC, Lloyd RV, Thompson NW (1986) Recurrent medullary thyroid carcinoma of the thyroid demonstrated by thallium-201 scintigraphy. J Nucl Med 27: 1564–1568PubMedGoogle Scholar
  2. Baulieu JL, Guilleteau D, Delisle MJ, Perdrisot R, Gardet P, Delepine N, Baulieu F, Dupont JL, Talbot JN, Coutris G (1987) Radioiodinated meta-iodobenzylguanidine uptake in medullary thyroid cancer. Cancer 60: 2189–2194PubMedCrossRefGoogle Scholar
  3. Becker W, Spiegel W, Reiners C, Börner W (1986) Besonderheiten bei der Nachsorge des C-Zellkarzinoms. Nuklearmediziner 9: 167–181Google Scholar
  4. Becker W, Börner W, Reiners C (1989) Tc-99m-(V)-DMSA: the new sensitive and specific radiopharmaceutical for imaging metastases of medullary thyroid carcinomas? Horm Metab Res Suppl 21: 38–42PubMedGoogle Scholar
  5. Berché C, Mach J-P, Lumbroso J-D, Langlais C, Aubrey F, Buchegger F, Carrel S, Rougier P, Parmentier C, Tubiana M (1982) Tomoscintigraphy for detecting gastrointestinal and medullary thyroid cancers: first clinical results using radiolabelled monoclonal antibodies against carcinoembryonic antigen. Br Med J 285: 1447–1451CrossRefGoogle Scholar
  6. Cabezas RC, Berna L, Estorch M, Carrio I, Garcia-Ameijeiras A (1989) Localization of metastases from medullary thyroid carcinoma using different methods. Henry Ford Hosp Med J 37: 169–172PubMedGoogle Scholar
  7. Castellani MR, Crippa F, del Bo L, Gasparini M, Grassi M, Maffioli L, Cusumano F, Bombardieri E, Buraggi GL (1991) Tc-99m(V) DMSA scintigraphy in diagnosis of occult recurrences of medullary thyroid carcinoma: preliminary results. In: Schmidt HAE, van der Schoot JB (eds) Nuclear medicine. State of the art in Europe. Schattauer, Stuttgart, pp 334–336Google Scholar
  8. Clarke SEM, Lazarus CR, Maisey MN (1987) Radionuclide imaging in medullary thyroid carcinoma: evaluation of two new radiopharmaceuticals. Henry Ford Hosp Med J 35: 124–126PubMedGoogle Scholar
  9. Clarke SEM, Lazarus CR, Maisey MN (1989) Experience in imaging medullary thyroid carcinoma using 99mTc(V)dimercaptosuccinic acid ( DMSA ). Henry Ford Hosp Med J 37: 167–168Google Scholar
  10. Coutris G, Talbot JN, Kabla G, Calmettes C, Milhaud G (1986) Uptake of I-131MIBG by medullary carcinoma of thyroid in familial cases. Eur J Nucl Med 12: 77–79PubMedCrossRefGoogle Scholar
  11. Dahir ND, Hesslewood SR, Jack DB (1989) Preparation and protein binding of pentavalent Tc DMSA. In: Schmidt HAE, Buraggi GL (eds) Nuclear medicine. Trends and possibilities in nuclear medicine. Schattauer, Stuttgart, p 131Google Scholar
  12. Doppman JL (1985) Multiple endocrine syndromes a nightmare for the endocrinologie radiologist. Semin Roentgenol 20: 7–16PubMedCrossRefGoogle Scholar
  13. Edington HD, Watson CG, Levine G, Tauxe WN, Yousem SA, Unger M, Kowal CD (1988) Radioimmunimaging of metastatic medullary carcinoma of the thyroid using an In-111-labeled monoclonal antibody to CEA. Surgery 104: 1004–1010PubMedGoogle Scholar
  14. Endo K, Shiomi K, Kasagi K, Konish J, Torizuka K, Nakao K, Tanimura H (1984) Imaging of medullary thyroid cancer with I-131-MIBG. Lancet 233Google Scholar
  15. Endo K, Ohta H, Torizuka K, Horiucht K, Yomoda I, Yokoyama A (1987) Technetium-99m(V)-DMSA in the imaging of medullary thyroid carcinoma. J Nucl Med 28: 252–253Google Scholar
  16. Francis IR, Glazer GM, Shapiro B, Sisson JC, Gross BH (1983) Complementary roles of CT and I-131-MIBG scintigraphy in diagnosing pheochromocytoma. AJR 141: 719–725PubMedGoogle Scholar
  17. Frank K, Raue F, Lorenz D, Herfart C, Ziegler R (1987) Importance of ultrasound examination for the follow-up of medullary thyroid carcinoma: comparison with other localization methods. Henry Ford Hosp Med J 35: 122–123PubMedGoogle Scholar
  18. Gautvik KM, Svindahl K, Skretting A, Stenberg B, Myhre L, Ekeland A, Johannesen JV (1982) Uptake and localization of I-131-labeled anti-calcitonin immunoglobulins in rat medullary thyroid carcinoma tissue. Cancer 50: 1107–1114PubMedCrossRefGoogle Scholar
  19. Georgi M, Hofbauer J, Weiss H, Keller EW, Wunschik F, von Mittelstadt G, Linder M (1984) Wertigkeit von Sonographie, Computertomographie and Angiographie in der Nebennierendiagnostik. ROFO 140: 373–379Google Scholar
  20. Gorman B, Charboneau JW, James EM, Reading CC, Wold LE, Grant CS, Gharib H, Hay ID (1987) Medullary thyroid carcinoma: Role of high-resolution ultrasound. Radiology 162: 147–150Google Scholar
  21. Guerra UP, Pizzocaro C, Terzi A, Giubbini R, Maira G, Pagliani RP, Bestagno M (1989) New tracers for the imaging of medullary thyroid carcinoma. Nucl Med Commun 10: 285–295PubMedCrossRefGoogle Scholar
  22. Guilletau D, Baulieu J-L, Besnard J-C (1985) Medullary thyroid carcinoma imaging in an animal model: use of radiolabeled anticalcitonin F(ab’)2 and metaiodobenzyl guanidine. Eur J Nucl Med 11: 198–200CrossRefGoogle Scholar
  23. Hilditch TE, Conell JMC, Murray T, Reed NS (1986) Poor results with technetium99m-(V)-DMSA and I-131-MIBG in the imaging of medullary thyroid carcinoma. J Nucl Med 27: 1150–1153PubMedGoogle Scholar
  24. Hoefnagel CA, Voute PA, de Kraker J, Marcuse HR (1986) Detection and treatment of neural crest tumors using I-131-meta-iodobenzylguanidine. In: Schmidt HAE, Ell PJ, Britton KE (eds) Nuclear medicine in research and practice. Schattauer, Stuttgart, pp 474–476Google Scholar
  25. Hoefnagel CA, Delprat CC, Zanin D, van der Schoot JB (1988) New radionuclide tracers for the diagnosis and therapy of medullary thyroid carcinoma. Clin Nucl Med 13: 159–165PubMedCrossRefGoogle Scholar
  26. Holub V, Nemec J, Neradilova M, Benova M, Blazek T, Dusek M (1987) Positive scintigraphy of medullary thyroid cancer using 201-TI and alkalized 99m-TcDMSA. Radiobiol Radiother 28: 640–645Google Scholar
  27. Horiuchi K, Yomoda I, Okta H, Endo K, Yokoyama A (1991) Search for polynuclear pentavalent technetium complex of dimercaptosuccinic acid Tc(V)DMS tumour localization mechanism. Eur J Nucl Med 18: 796–800PubMedCrossRefGoogle Scholar
  28. Ikeda I, Inoue O, Kurata K (1977) Preparation of various Tc-99mdimercaptosuccinate complexes and their evaluation as radiotracers. J Nucl Med 18: 1222–1229PubMedGoogle Scholar
  29. Johnson DG, Coleman RE, McCook TA, Dale JK, Wells SA (1984) Bone and liver images in medullary carcinoma of the thyroid gland: concise communication. J Nucl Med 25: 419–422PubMedGoogle Scholar
  30. Kafaghi FA, Shapiro B, Fischer M, Sisson JC, Hutchinson R, Beierwalter WH (1991) Phaechromocytoma and functioning paraganglioma in childhood and adolescence: role of iodine 131 metaiodobenzylguanidine. Eur J Nucl Med 18: 191–198CrossRefGoogle Scholar
  31. Kujath C, Panitz N (1989) Vereinfachte Präparation von 99m-Tc(V)-DMSA. Nuklearmediziner 12: 291–293Google Scholar
  32. Mathieu E, Despres E, Delepine N, Taieb A (1987) MR imaging of the adrenal gland in Sipple’s disease. J Comput Assist Tomogr 11: 790–794PubMedCrossRefGoogle Scholar
  33. Mojiminiyi OA, Udelsman R, Soper NDW, Shepstone BJ, Dudley NE (1991) Clinical application of Tc-99m(V)DMSA scintigraphy in patients with medullary carcinoma of the thyroid (MTC). In: Schmidt HAE, van der Schoot JB (eds) Nuclear medicine. The state of the art in Europe. Schattauer, Stuttgart, pp 344–346Google Scholar
  34. Müller SP, Guth-Tougelidis B, Piotrowski B, Farahati J, Reiners C (1990) Tl-201 scintigraphy in the follow-up of eosinophilic thyroid carcinoma. J Nucl Med 31: 767Google Scholar
  35. Ohta H, Yamamoto K, Endo K, Mori T, Hamanaka D, Shimazu A, Ikekubo K, Makimoto K, Iida Y, Konishi J, Morita R, Hata N (1984) A new imaging agent for medullary carcinoma of the thyroid. J Nucl Med 25: 323–325PubMedGoogle Scholar
  36. Parmentier C, Lumbroso J, Schlumberger M, Gardet P, Mach J-P, Berché C, Rougier P, Caillou B, Tubiana M (1984) Immunoscintigraphie avec tomographie d’émission dans les cancers de la thyroide. Ann Med Interne (Paris) 135: 345–350Google Scholar
  37. Parthasarathy KL, Shimaoka K, Bakshi SP, Razack MS (1980) Radiotracer uptake in medullary carcinoma of the thyroid. Clin Nucl Med 5: 45–48PubMedCrossRefGoogle Scholar
  38. Patel MC, Petel RB, Ramamoorthy N, Krishna BA, Sharma SM (1988) Clinical evaluation of 99mTc(V)-dimercaptosuccinic acid ( DMSA) for imaging medullary carcinoma of thyroid and its metastasis. Eur J Nucl Med 13: 507–510Google Scholar
  39. Perdrisot R, Rohmer V, Lejeune JJ, Bigorgne JC, Jallet P (1988) Thyroid uptake of MIBG in Sipple’s syndrome. Eur J Nucl Med 14: 37–38PubMedCrossRefGoogle Scholar
  40. Quint LE, Glazer GM, Francis IR, Shapiro B, Chenevert TL (1987) Pheochromocytoma and paraganglioma: comparison of MR imaging with CT and I-131 MIBG scintigraphy. Radiology 165: 89–93PubMedGoogle Scholar
  41. Ramamoorthy N, Shetye SV, Pandey PM, Mani RS, Patel MC, Patel RB, Ramanathan P, Krishna BA, Sharma SM (1987) Preparation and evaluation of 99mTc(V)DMSA complex: studies in medullary carcinoma of the thyroid. Eur J Nucl Med 12: 623–628PubMedCrossRefGoogle Scholar
  42. Raue F, Winter J, Frank-Raue K, Lorenz D, Herfarth C, Ziegler R (1989) Diagnostic procedure before reoperation in patients with medullary thyroid carcinoma. Horm Metab Res Suppl 21: 31–34PubMedGoogle Scholar
  43. Reiners C (1988) Tumorszintigraphie mit Tc-99m-V-DMSA: Lokalisation von Rezidiven und Metastasen des C-Zell-Karzinoms der Schilddrüse. Nuklearmediziner 11: 123–131Google Scholar
  44. Reiners C (1991) Nuklearmedizinische Diagnostik des medullären Schilddrüsenkarzinoms und des Sipple-Syndroms. Med Welt 42: 1001–1006Google Scholar
  45. Reiners C, Becker W, Spiegel W, Börner W, Müller H-A (1986a) Schildrüsendiagnostik: Nutzen von Sonographie, Szintigraphie und Punktionszytologie für die Praxis. Intern Welt 10: 294–304Google Scholar
  46. Reiners C, Eilles C, Spiegel W, Becker W, Börner W (1986b) Immunoscintigraphy in medullary thyroid cancer using an I-123- or In-111-labelled monoclonal antiCEA antibody fragment. Nuklearmedizin 25: 227–231PubMedGoogle Scholar
  47. Reinig JW, Doppman JL, Dwyer AJ, Johnson AR, Knop RH (1986) Adrenal masses differentiated by MR. Radiology 158: 81–84PubMedGoogle Scholar
  48. Reuter E, Bethge N, Matthes M, Koppenhagen K (1983) Tc99m-phosphonates for imaging of amyloid in C-cell carcinoma. Eur J Nucl Med 8: 398–400PubMedCrossRefGoogle Scholar
  49. Rodrigues M, Vieira MR, Santos R, Limbert E (1989) Clinical evaluation of 99mTc(V)-dimercaptosuccinic acid ( DMSA) for follow-up of patients with medullary thyroid carcinoma. Eur J Nucl Med 15: 522Google Scholar
  50. Rufini V, Troncone L, Giordano A, Daidone MS (1989) Evaluation of diagnostic effectiveness of new scintigraphic techniques in medullary thyroid carcinoma ( MTC ). Eur J Nucl Med 15: 473Google Scholar
  51. Samaan NA, Yang K-P (1987) Localization of radiolabeled monoclonal antibody to calcitonin in rat medullary thyroid carcinoma allografts. Henry Ford Hosp Med J 35: 153–156PubMedGoogle Scholar
  52. Sandrock D, Blossey H-C, Steinroeder M, Munz DL (1989) Contribution of different scintigraphic techniques to the management of medullary thyroid carcinoma. Henry Ford Hosp Med J 37: 173–174PubMedGoogle Scholar
  53. Scheidhauer K, Puskas C, Sciuk J, Brandau W, Bartenstein P, Schober 0 (1990) CEA-Immunszintigraphie in der Nachsorge des medullären Schilddrüsen-Ca. Nuklearmedizin 29: A50Google Scholar
  54. Schwerk WB, Grün R, Wahl R (1985) Ultrasound diagnosis of C-cell carcinoma of the thyroid. Cancer 55: 624–630PubMedCrossRefGoogle Scholar
  55. Shigeno C, Fukunaga M, Yamamoto I, Dokoh S, Morita R, Hino M, Torizuka K (1984) Accumulation of Tc-99m phosphorus compounds in medullary carcinoma of the thyroid. Report of two cases. Clin Nucl Med 7: 297–298Google Scholar
  56. Sisson JC, Shapiro B, Beierwaltes WH (1984) Scintigraphy with I-131 MIBG as an aid to the treatment of pheochromocytomas in patients with the multiple endocrine neoplasia type 2 syndromes. Henry Ford Hosp Med J 32: 254–261PubMedGoogle Scholar
  57. Spiegel W, Eilles C, Becker W (1988) Die Szintigraphie chromaffiner Tumoren mit Metajodobenzylguanidin ( MIBG ). Nuklearmediziner 11: 109–121Google Scholar
  58. Sullivan DC, Silva JS, Cox CE, Haagensen DE, Harris CC, Birner WH, Wells SA (1982) Localization of I-131-labeled goat and primate anti-carcinoembryonic antigen ( CEA) antibodies in patients with cancer. Invest Radiol 17: 350–355Google Scholar
  59. Talpos GB, Jackson CE, Froelich JW, Kambouris AA, Block MA, Tashijan AH (1985) Localization of residual medullary thyroid cancer by thallium/technetium scintigraphy. Surgery 98: 1189–1196PubMedGoogle Scholar
  60. Troncone L, Rufini V, DeRosa G, Testa A (1989) Diagnostic and therapeutic potential of new radiopharmaceutical agents in medullary thyroid carcinoma. Henry Ford Hosp Med J 37: 178–184PubMedGoogle Scholar
  61. Urgancioglu I, Üzüm F, Özker K (1989) 99mTc(V)-DMSA scanning of the follow-up patients with medullary thyroid carcinoma. Eur J Nucl Med 15:540Google Scholar
  62. Valk TW, Frager MS, Gross MD, Sisson JC, Wieland DM, Swanson DP, Mangner TJ, Beierwaltes WH (1981) Spectrum of pheochromocytoma in multiple endocrine neoplasia. A scintigraphic portrayal using I-131-Imetaiodobenzylguanidine. Ann Intern Med 94: 762–767PubMedGoogle Scholar
  63. Velchik MG, Alavi A, Kressel HY, Engelmann K (1989) Localization of pheochromocytoma: MIBG, CT, and MRI correlation. J Nucl Med 30: 328–336Google Scholar
  64. Verga U, Muratori F, DiSacco G, Banfi F, Libroia A (1989) The role of radiopharmaceuticals MIBG and ( V)DMSA in the diagnosis of medullary thyroid carcinoma. Henry Ford Hosp Med J 37: 175–177Google Scholar
  65. Westera G, Gadze A, Horst W (1985) A convenient method for the preparation of 99mTc(V)dimercaptosuccinic acid (99mTc(V)DMSA). Int J Appl Radiat Isot 36: 311–312PubMedCrossRefGoogle Scholar
  66. Wieland DM, Wu J-L, Brown LE, Mangner TJ, Swanson DP, Beierwaltes WH (1980) Radiolabeled adrenergic neuron-blocking agents: adrenomedullary imaging with I-131 iodobenzylguanidine. J Nucl Med 21: 349–353PubMedGoogle Scholar
  67. Wulfrank DA, Schelstrate KH, Small F, Fallais CJ (1989) Analogy between tumor uptake of technetium(V)-99m dimercaptosuccinic acid (DMSA) and technetium99m-MDP. Clin Nucl Med 14: 588–593PubMedCrossRefGoogle Scholar
  68. Zanin DEA, van Dongen A, Hoefnagel CA, Bruning PF (1990) Radioimmunscintigraphy using iodine-131-anti-CEA monoclonal antibodies and thallium-201 scintigraphy in medullary thyroid carcinoma: a case report. J Nucl Med 31: 1854–1855PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin · Heidelberg 1992

Authors and Affiliations

  • C. Reiners
    • 1
  1. 1.Klinik für NuklearmedizinUniversitätsklinikum EssenEssenGermany

Personalised recommendations