Correlation analysis between the quantitative parameters of iodine-131 single-photon emission computed tomography-computed tomography thyroid bed uptake and the efficacy of radioactive iodine adjuvant therapy for papillary thyroid cancer.

Background: Single-photon emission computed tomography-computed tomography (SPECT/CT) quantification has emerged as a valuable tool for assessing disease prognosis by accurately identifying and characterizing abnormal lesions with accumulated radionuclides. Papillary thyroid carcinoma (PTC) is the most prevalent type of thyroid cancer, and radioactive iodine (RAI) therapy is a standard treatment following total thyroidectomy. This study aimed to explore the potential utility the quantitative parameters of the thyroid bed under iodine-131 (I-131) SPECT/CT in the efficacy of RAI adjuvant therapy for patients with PTC.

Methods: The retrospective cohort study enrolled 107 patients with PTC who underwent RAI adjuvant therapy from June 2020 to January 2023. Three days after the RAI adjuvant therapy, all patients underwent I-131 whole-body scans and SPECT/CT imaging. The quantitative parameters, including maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), and percent injected dose (%ID), were measured using image analysis software based on I-131 SPECT/CT thyroid bed uptake. Successful therapy was defined as inhibitory thyroglobulin (Tg) <0.2 ng/mL with negative thyroglobulin antibody (TgAb) and negative imaging examination 6 months after RAI adjuvant therapy. The relationship between the quantitative parameters and the treatment efficacy, in addition to the potential influencing factors, were analyzed.

Results: The quantitative parameters from the successful group [SUVmax: median 6.15 g/mL, interquartile range (IQR) 2.34-13.80 g/mL; SUVmean: median 2.02 g/mL, IQR 0.89-4.93 g/mL; %ID: median 2.00%, IQR 1.00-4.00%] were significantly lower than those from the unsuccessful group (SUVmax: median 19.03 g/mL, IQR 5.31-45.10 g/mL, SUVmean 4.64 g/mL, IQR 2.07-19.05 g/mL; %ID: median 8.00%, IQR 3.00-18.00%) (SUVmax: Z=-3.755; SUVmean; Z=-3.671; %ID: Z=-4.070; all P values <0.001). SUVmax, SUVmean and %ID were positively correlated with the stimulated thyroglobulin (sTg) and inhibitory Tg at 6 months after RAI adjuvant therapy, respectively (all P values <0.001). SUVmax [odds ratio (OR) =1.045], SUVmean (OR =1.130), and %ID (OR =1.092) were predictive factors for the failure of RAI adjuvant therapy (all P values <0.001).

Conclusions: Our study suggested that quantitative parameters (SUVmax, SUVmean, and %ID) derived from I-131 SPECT/CT imaging of the thyroid bed can serve as useful tools for predicting therapy outcomes following RAI adjuvant therapy.