Abstract
BackgroundHigh-intensity focused ultrasound (HIFU) allows to inflict intracorporal thermal lesions without penetrating the skin or damaging the surrounding tissue. This analysis intends to assess the magnitude of HIFU-induced ablations within benign thyroid nodules using scintigraphic imaging with 99mTc.MethodsTen cold, hot, or indifferent nodules were treated using multiple pulses of HIFU to induce temperatures of around 85°C within the ablation zone. Pre- and posttreatment, uptake values of 99mTc-pertechnetate or 99mTc-MIBI were recorded. The pre-post reduction of nodular uptake was evaluated to assess ablation magnitude.ResultsRelative nodular uptake in relation to total thyroidal uptake decreased after one session of HIFU in all cases. Median 99mTc-MIBI uptake reduction was 35.5% (ranging from 11% to 57%; p < 0.1), while 99mTc-pertechnetate scintigraphy showed a median uptake reduction of 27% (range 10% to 44%; p < 0.1). No major complications were observed.ConclusionsHIFU appears to be safe and is an easy to perform means of thermal ablation. This study shows that HIFU treatment in thyroidal nodules can be evaluated by scintigraphic means shortly after the intervention. Due to small sample size, the exact magnitude of HIFU ablation efficiency in thyroidal nodules remains a value to be assessed in a larger study.
Highlights
High-intensity focused ultrasound (HIFU) allows to inflict intracorporal thermal lesions without penetrating the skin or damaging the surrounding tissue
Exclusion criteria The exclusion criteria are the presence of a malignant nodule (diagnosed by an atypical finding in cold nodules in preliminary 99mTc-MIBI scintigraphy confirmed by histological indication of follicular proliferation based on fine needle aspiration biopsy (FNAB)) or critical closeness of the nodule to sensible structures such as recurrent nerve, trachea, esophagus, or carotid artery
Compared to the baseline, median nodular 99mTc-MIBI uptake reduction was 35.5% (p = 0.016; ranging from 11% to 57%; see Figures 1 and 2), while 99mTc-pertechnetate scintigraphy showed a median uptake reduction of 27% (p = 0.063; range 10% to 44%; see Figures 1, 3, 4) after the intervention
Summary
High-intensity focused ultrasound (HIFU) allows to inflict intracorporal thermal lesions without penetrating the skin or damaging the surrounding tissue. This analysis intends to assess the magnitude of HIFU-induced ablations within benign thyroid nodules using scintigraphic imaging with 99mTc. Thyroid surgeries are among the most common ones in western countries; the prevalence of thyroidal nodules (TNs) in the general population of a developed society is rather high (found in 4%–8% with the use of palpation, in 19%–67% using ultrasound (US) [1], in Germany, 21.9% of the working population have undetected TNs [2]). The ablated tissue presents itself as a coagulation necrosis that over time will be disintegrated by immunology cells, resulting in lasting shrinkage of the nodule
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