Diagnostic Performance of <sup>99m</sup>Tc-Methoxy-Isobuty-Isonitrile (MIBI) for Risk Stratification of Hypofunctioning Thyroid Nodules: A European Multicenter Study
Simone Agnes Schenke,
Alfredo Campennì,
Murat Tuncel,
Gianluca Bottoni,
Sait Sager,
Tatjana Bogovic Crncic,
Damir Rozic,
Rainer Görges,
Pinar Pelin Özcan,
Daniel Groener,
Hubertus Hautzel,
Rigobert Klett,
Michael Christoph Kreissl,
Luca Giovanella
Affiliations
Simone Agnes Schenke
Clinic of Nuclear Medicine Bayreuth Hospital, Preuschwitzer Straße 101, 95445 Bayreuth, Germany
Alfredo Campennì
Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Via Consolare Valeria, 98125 Messina, Italy
Murat Tuncel
Department of Nuclear Medicine, Hacettepe University, Sihhiye, Ankara 06230, Turkey
Gianluca Bottoni
Department of Nuclear Medicine, E.O. “Ospedali Galliera”, 16128 Genoa, Italy
Sait Sager
Department of Nuclear Medicine, Medical Faculty, Istanbul University-Cerrahpaşa, Koca Mustafapasa Caddesi No: 53, Fatih, Istanbul 34096, Turkey
Tatjana Bogovic Crncic
Department of Nuclear Medicine, Faculty of Medicine, University of Rijeka, Brace Branchetta 20/1, 51 000 Rijeka, Croatia
Damir Rozic
Department of Nuclear Medicine, University Hospital Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina
Rainer Görges
Department of Nuclear Medicine, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
Pinar Pelin Özcan
Department of Nuclear Medicine, University Hospital Mersin, Ciftlikkoy District, MEU Ciftlikkoy Campus, Yenisehir, Mersin 33110, Turkey
Daniel Groener
Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany
Hubertus Hautzel
Department of Nuclear Medicine, University Hospital Essen & German Cancer Consortium (DKTK), Hufelandstraße 55, 45147 Essen, Germany
Rigobert Klett
Practice of Nuclear Medicine Hanau/Giessen/Frankfurt/Offenbach, Paul-Zipp-Straße 171, 35398 Giessen, Germany
Michael Christoph Kreissl
Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
Luca Giovanella
Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Via Officina 3, 6500 Bellinzona, Switzerland
99mTc-MIBI (MIBI) imaging is able to exclude malignancy of hypofunctioning thyroid nodules (TNs) with high probability but false positive results are frequent due to low specificity. Therefore, pre-test selection of appropriate TNs is crucial. For image evaluation visual and semiquantitative methods (Washout index, WOInd) are used. Aim of this study was to evaluate the diagnostic performance of MIBI imaging in hypofunctioning TNs with indeterminate fine-needle aspiration cytology results in a multicentric European setting. Patients with hypofunctioning TNs, EU-TIRADS 4 or 5, Bethesda III/IV and MIBI imaging were included. For visual evaluation the intensity of MIBI uptake in the TN was compared to normal thyroid tissue. 358 patients with 365 TNs (n = 68 malignant) were included. Planar imaging (SPECT) showed a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 96% (94%), 21% (22%), 22% (15%), 96% (96%), and 35% (32%). The WOInd (38.9% of all cases, optimal cutoff: −19%) showed a sens 100% (spec 89%, PPV 82%, NPV 100%, ACC 93%). For hypofunctioning TNs at intermediate or high risk with indeterminate cytology, a MIBI negative result on visual evaluation is an effective tool to rule-out thyroid malignancy. The semi-quantitative method could considerably improve overall diagnostic performance of MIBI imaging.
