Novel application of quantitative single-photon emission computed tomography/computed tomography to predict early response to methimazole in graves’ disease

Hyun Joo Kim, Ji In Bang, Ji Young Kim, Jae Hoon Moon, Young So, Won Woo Lee

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective: Since Graves’ disease (GD) is resistant to antithyroid drugs (ATDs), an accurate quantitative thyroid function measurement is required for the prediction of early responses to ATD. Quantitative parameters derived from the novel technology, single-photon emission computed tomography/computed tomography (SPECT/CT), were investigated for the prediction of achievement of euthyroidism after methimazole (MMI) treatment in GD. Materials and Methods: A total of 36 GD patients (10 males, 26 females; mean age, 45.3 ± 13.8 years) were enrolled for this study, from April 2015 to January 2016. They underwent quantitative thyroid SPECT/CT 20 minutes post-injection of 99mTc-pertechnetate (5 mCi). Association between the time to biochemical euthyroidism after MMI treatment and %uptake, standardized uptake value (SUV), functional thyroid mass (SUVmean x thyroid volume) from the SPECT/CT, and clinical/biochemical variables, were investigated. Results: GD patients had a significantly greater %uptake (6.9 ± 6.4%) than historical control euthyroid patients (n = 20, 0.8 ± 0.5%, p < 0.001) from the same quantitative SPECT/CT protocol. Euthyroidism was achieved in 14 patients at 156 ± 62 days post-MMI treatment, but 22 patients had still not achieved euthyroidism by the last follow-up time-point (208 ± 80 days). In the univariate Cox regression analysis, the initial MMI dose (p = 0.014), %uptake (p = 0.015), and functional thyroid mass (p = 0.016) were significant predictors of euthyroidism in response to MMI treatment. However, only %uptake remained significant in a multivariate Cox regression analysis (p = 0.034). A %uptake cutoff of 5.0% dichotomized the faster responding versus the slower responding GD patients (p = 0.006). Conclusion: A novel parameter of thyroid %uptake from quantitative SPECT/CT is a predictive indicator of an early response to MMI in GD patients.

Original languageEnglish
Pages (from-to)543-550
Number of pages8
JournalKorean Journal of Radiology
Volume18
Issue number3
DOIs
StatePublished - 1 Jan 2017

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Methimazole
Graves Disease
Thyroid Gland
Antithyroid Agents
Regression Analysis
Sodium Pertechnetate Tc 99m
Therapeutics
Single Photon Emission Computed Tomography Computed Tomography
Technology
Injections

Keywords

  • Computed tomography
  • Euthyroidism
  • Graves’ disease
  • Methimazole
  • Single-photon emission computed tomography

Cite this

@article{60778d8b5226489dbfd78e2f74e78f98,
title = "Novel application of quantitative single-photon emission computed tomography/computed tomography to predict early response to methimazole in graves’ disease",
abstract = "Objective: Since Graves’ disease (GD) is resistant to antithyroid drugs (ATDs), an accurate quantitative thyroid function measurement is required for the prediction of early responses to ATD. Quantitative parameters derived from the novel technology, single-photon emission computed tomography/computed tomography (SPECT/CT), were investigated for the prediction of achievement of euthyroidism after methimazole (MMI) treatment in GD. Materials and Methods: A total of 36 GD patients (10 males, 26 females; mean age, 45.3 ± 13.8 years) were enrolled for this study, from April 2015 to January 2016. They underwent quantitative thyroid SPECT/CT 20 minutes post-injection of 99mTc-pertechnetate (5 mCi). Association between the time to biochemical euthyroidism after MMI treatment and {\%}uptake, standardized uptake value (SUV), functional thyroid mass (SUVmean x thyroid volume) from the SPECT/CT, and clinical/biochemical variables, were investigated. Results: GD patients had a significantly greater {\%}uptake (6.9 ± 6.4{\%}) than historical control euthyroid patients (n = 20, 0.8 ± 0.5{\%}, p < 0.001) from the same quantitative SPECT/CT protocol. Euthyroidism was achieved in 14 patients at 156 ± 62 days post-MMI treatment, but 22 patients had still not achieved euthyroidism by the last follow-up time-point (208 ± 80 days). In the univariate Cox regression analysis, the initial MMI dose (p = 0.014), {\%}uptake (p = 0.015), and functional thyroid mass (p = 0.016) were significant predictors of euthyroidism in response to MMI treatment. However, only {\%}uptake remained significant in a multivariate Cox regression analysis (p = 0.034). A {\%}uptake cutoff of 5.0{\%} dichotomized the faster responding versus the slower responding GD patients (p = 0.006). Conclusion: A novel parameter of thyroid {\%}uptake from quantitative SPECT/CT is a predictive indicator of an early response to MMI in GD patients.",
keywords = "Computed tomography, Euthyroidism, Graves’ disease, Methimazole, Single-photon emission computed tomography",
author = "Kim, {Hyun Joo} and Bang, {Ji In} and Kim, {Ji Young} and Moon, {Jae Hoon} and Young So and Lee, {Won Woo}",
year = "2017",
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language = "English",
volume = "18",
pages = "543--550",
journal = "Korean journal of radiology : official journal of the Korean Radiological Society",
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Novel application of quantitative single-photon emission computed tomography/computed tomography to predict early response to methimazole in graves’ disease. / Kim, Hyun Joo; Bang, Ji In; Kim, Ji Young; Moon, Jae Hoon; So, Young; Lee, Won Woo.

In: Korean Journal of Radiology, Vol. 18, No. 3, 01.01.2017, p. 543-550.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Novel application of quantitative single-photon emission computed tomography/computed tomography to predict early response to methimazole in graves’ disease

AU - Kim, Hyun Joo

AU - Bang, Ji In

AU - Kim, Ji Young

AU - Moon, Jae Hoon

AU - So, Young

AU - Lee, Won Woo

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Objective: Since Graves’ disease (GD) is resistant to antithyroid drugs (ATDs), an accurate quantitative thyroid function measurement is required for the prediction of early responses to ATD. Quantitative parameters derived from the novel technology, single-photon emission computed tomography/computed tomography (SPECT/CT), were investigated for the prediction of achievement of euthyroidism after methimazole (MMI) treatment in GD. Materials and Methods: A total of 36 GD patients (10 males, 26 females; mean age, 45.3 ± 13.8 years) were enrolled for this study, from April 2015 to January 2016. They underwent quantitative thyroid SPECT/CT 20 minutes post-injection of 99mTc-pertechnetate (5 mCi). Association between the time to biochemical euthyroidism after MMI treatment and %uptake, standardized uptake value (SUV), functional thyroid mass (SUVmean x thyroid volume) from the SPECT/CT, and clinical/biochemical variables, were investigated. Results: GD patients had a significantly greater %uptake (6.9 ± 6.4%) than historical control euthyroid patients (n = 20, 0.8 ± 0.5%, p < 0.001) from the same quantitative SPECT/CT protocol. Euthyroidism was achieved in 14 patients at 156 ± 62 days post-MMI treatment, but 22 patients had still not achieved euthyroidism by the last follow-up time-point (208 ± 80 days). In the univariate Cox regression analysis, the initial MMI dose (p = 0.014), %uptake (p = 0.015), and functional thyroid mass (p = 0.016) were significant predictors of euthyroidism in response to MMI treatment. However, only %uptake remained significant in a multivariate Cox regression analysis (p = 0.034). A %uptake cutoff of 5.0% dichotomized the faster responding versus the slower responding GD patients (p = 0.006). Conclusion: A novel parameter of thyroid %uptake from quantitative SPECT/CT is a predictive indicator of an early response to MMI in GD patients.

AB - Objective: Since Graves’ disease (GD) is resistant to antithyroid drugs (ATDs), an accurate quantitative thyroid function measurement is required for the prediction of early responses to ATD. Quantitative parameters derived from the novel technology, single-photon emission computed tomography/computed tomography (SPECT/CT), were investigated for the prediction of achievement of euthyroidism after methimazole (MMI) treatment in GD. Materials and Methods: A total of 36 GD patients (10 males, 26 females; mean age, 45.3 ± 13.8 years) were enrolled for this study, from April 2015 to January 2016. They underwent quantitative thyroid SPECT/CT 20 minutes post-injection of 99mTc-pertechnetate (5 mCi). Association between the time to biochemical euthyroidism after MMI treatment and %uptake, standardized uptake value (SUV), functional thyroid mass (SUVmean x thyroid volume) from the SPECT/CT, and clinical/biochemical variables, were investigated. Results: GD patients had a significantly greater %uptake (6.9 ± 6.4%) than historical control euthyroid patients (n = 20, 0.8 ± 0.5%, p < 0.001) from the same quantitative SPECT/CT protocol. Euthyroidism was achieved in 14 patients at 156 ± 62 days post-MMI treatment, but 22 patients had still not achieved euthyroidism by the last follow-up time-point (208 ± 80 days). In the univariate Cox regression analysis, the initial MMI dose (p = 0.014), %uptake (p = 0.015), and functional thyroid mass (p = 0.016) were significant predictors of euthyroidism in response to MMI treatment. However, only %uptake remained significant in a multivariate Cox regression analysis (p = 0.034). A %uptake cutoff of 5.0% dichotomized the faster responding versus the slower responding GD patients (p = 0.006). Conclusion: A novel parameter of thyroid %uptake from quantitative SPECT/CT is a predictive indicator of an early response to MMI in GD patients.

KW - Computed tomography

KW - Euthyroidism

KW - Graves’ disease

KW - Methimazole

KW - Single-photon emission computed tomography

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DO - 10.3348/kjr.2017.18.3.543

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VL - 18

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EP - 550

JO - Korean journal of radiology : official journal of the Korean Radiological Society

JF - Korean journal of radiology : official journal of the Korean Radiological Society

SN - 1229-6929

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ER -