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The Role of Metabolic Volumetric Parameters in Predicting Malignancy in Incidental Thyroid Nodules Detected in 18F-FDG PET/CT Scans

  • Erdoğan, Mehmet1
  • Korkmaz, Hakan2
  • Torus, Bora2
  • Avcı, Mustafa1
  • Boylubay, Şerife Mehtap2
  • Çiriş, Metin3
  • Yıldız, Mustafa1
  • Şengül, Sevim Süreyya1
  • 1 Süleyman Demirel University Faculty of Medicine, Department of Nuclear Medicine, Isparta, Turkey
  • 2 Süleyman Demirel University Faculty of Medicine, Department of Endocrinology and Metabolism, Isparta, Turkey
  • 3 Süleyman Demirel University Faculty of Medicine, Department of Pathology, Isparta, Turkey
Published Article
Molecular Imaging and Radionuclide Therapy
Galenos Publishing
Publication Date
Jun 03, 2021
DOI: 10.4274/mirt.galenos.2021.75983
PMID: 34082507
PMCID: PMC8185484
PubMed Central
  • Original Article


Objectives: The metabolic activities of tumors can be calculated volumetrically during positron emission tomography/computed tomography (PET/CT) imaging using metabolic tumor volume (MTV) and total lesion glycolysis (TLG). This study aimed to evaluate the roles of MTV and TLG in predicting the malignancy risk of incidental thyroid nodules detected by PET/CT imaging. Methods: Active metabolic areas of each section were manually drawn by region of interest to calculate the MTV of nodules, and all obtained values were then summed. TLG, the product of mean standardized uptake value and MTV, was calculated by multiplying two values. All participants underwent thyroid ultrasonography imaging. All nodules were divided into risk classes according to the European Thyroid Image Reporting and Data System (EU-TIRADS) that was developed by the European Thyroid Association. The American Thyroid Association Guidelines were used to determine which thyroid nodules would undergo thyroid fine-needle biopsy (FNAB). Results were classified according to the Bethesda scoring system. Results: TLG levels were significantly higher in malignant or malignant-suspicious nodules than in benign nodules (p=0.013). Although MTV levels were high in malignant or malignant-suspicious nodules than in benign and non-diagnostic nodules, it was statistically insignificant at limit values (p=0.079). Areas under curve (AUC) were 0.726 (p=0.005) and AUC: 0.668 (p=0.039) for TLG and MTV, respectively. The 2.3 g cut-off value of TLG has a sensitivity of 85.7% and specificity of 59.0%. The 1.7 mL cut-off value of MTV has a sensitivity of 78.6% and specificity of 60.4%. Conclusion: We believe that TLG evaluation will be useful in predicting high-risk malignancy or malignancy suspicion based on EU-TIRADS risk classification of incidental thyroid nodules detected in PET/CT images. We believe that unnecessary thyroid FNABs can be avoided for thyroid incidental nodules if such relation and cut-off values are determined and that it will be useful in hastening the operation of the necessary patients.

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