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Successful performance of minimally invasive parathyroidectomy (MIP) is based on the accuracy of preoperative parathyroid localization studies. Despite the various methodologies available, no consensus has been reached so far on the optimal imaging technique. The aim of our meta-analysis was to determine the accuracy of technetium-99m-hexakis methoxyisobutylisonitrile single photon emission tomography/computed tomography ((99m)Tc-MIBI SPET/CT), SPET and MIBI scintigraphy for the preoperative localization of primary hyperparathyroidism (PHPT) lesions, thus facilitating better management of these patients.Publications were screened by a comprehensive computer search of PubMed and EMBASE for 25 years. Data were extracted from included articles and forest plots of sensitivity and positive predictive value were calculated to investigate the diagnostic accuracy of SPET/CT, SPET and MIBI scintigraphy.Eighteen articles were included in our study. The sensitivities of SPET/CT, SPET and planar scintigraphy were 84% (95% CI: 78%-90%), 66% (95% CI: 57%-74%) and 63% (95% CI: 51%-74%), respectively. The PPV of the above three imaging modalities were: 95% (95% CI: 92%-98%), 82% (95% CI: 73%-89%) and 90% (95% CI: 96%-99%), respectively.Our present meta-analysis showed that using (99m)Tc-MIBI, combining anatomical information of CT and functional abnormalities on SPET, as presented on SPET/CT was by far more sensitive and accurate than SPET or planar scintigraphy in localizing PHPT lesions. We firmly believe that this technique will be the main diagnostic means, to detect PHPT lesions and support minimally invasive parathyroidectomy.

Differentiated thyroid carcinoma (DTC) usually behaves in an indolent manner with low metastatic potential. The major sites of distant metastases are the lung and bone. Metastases to the brain, eye, breast, liver, kidney, muscle and skin are rare or relatively rare. These metastases have almost always appeared in patients with advanced disease and are often associated with poor prognosis but overlooked in clinical practice. Recognizing them has a significant impact on clinical decision-making and prognosis of the patients. Treatment in these patients should be individualized and an alternative therapeutic approach should be considered. Care should be taken to determine whether a (131)I uptake focus found at an unexpected site of (131)I- whole body scan (WBS) is a DTC metastasis or a false-positive (131)I uptake. Imaging with (131)I-SPET/CT is of incremental value in the finding of rare metastases from DTC. In conclusion, DTC can have unusual metastatic presentations and patterns. Post-therapy (131)I-WBS and (131)I-SPET/CT play an important role in the management of patients with DTC.

Our aim was to compare the differences in serum protein fingerprints between papillary thyroid carcinoma (PTC) patients with (131)I-avid lung metastases and those with non-(131)I-avid lung metastases, and to establish a screening model for screening (131)I uptake in lung metastases. We collected serum samples from 46 PTC patients with (131)I-avid lung metastases (Group A) and 23 PTC patients with non-(131)I-avid lung metastases (Group B) respectively, and both groups were matched for age and sex, without history of other tumors. Among them, 28 cases (19 cases in Group A, and 9 cases in Group B) were enrolled in the training set to establish the decision tree model, and another 41 cases (27 cases in Group A, and 14 cases in Group B)were incorporated for blind test set. The serum protein fingerprints were profiled using surface enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS, USA) and the difference between the two groups was compared using the Ciphergen Proteinchip 3.1 software. Bioinformatics analysis was performed to construct the decision tree model based on the data of the training set, and the blind test was also conducted for blind test set. Our results showed that a total of 151 valid protein peaks were detected at the molecular range of 1300 Da to 15,000 Da, among which 7 were significantly different between Group A and Group B (P0.05). The blind test was conducted via the decision tree model, with a sensitivity of 92.6% (25/27) and a specificity of 85.7% (12/14). In conclusion, the difference in the serum protein fingerprints between Group A and Group B is quite accurate for screenning (131)I uptake in the lung metastases from PTC, conferring important clinical value for the prediction of (131)I uptake and guiding of personalized (131)I treatment decisions.

We present three papillary thyroid carcinoma PTC patients with brain metastases who are unusual in many aspects. The first case is a unique 3mm papillary thyroid microcarcinoma (PTMC) patient with metastases to the cerebrum and lung. The solitary cerebral lesion was identified by iodine-131 whole- body scan ((131)I-WBS) and (131)I single photon emission tomography/computed tomography (SPET/CT). Almost complete response achieved after radiosurgery. The second case is a unique PTC patient with coexistent (131)I-negative cerebrum, adrenal gland and ilium metastases, which were identified by (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI). Partial response achieved after radiosurgery. The third case is a patient with an incident solitary cystic cerebellar mass as a primary presentation of follicular variant of PTC and absent other distant metastases. In conclusion, widespread metastases from small PTMC may occur. Concomitant brain and adrenal metastases may occur in a same PTC patient. Brain metastasis may present as a cystic lesion.

Technetium-extraosseous accumulation of technetium-99m-methyl diphosphonate ((99m)Tc-MDP) on bone scan is not usual. It was described and in various diseases with solitary spleen or lung uptake. Simultaneous splenic, pulmonary and renal concentration of (99m)Tc-MDP has not been illustrated previously. Herein, we present a 17 years old man with acute lymphocytic leukemia (ALL) in whom (99m)Tc-MDP was accumulated in the spleen, both lungs and the kidneys. Related literature was mentioned.