Prostate cancer (PCa) is the most commonly diagnosed malignancy in men, and aleading cause of cancer-related death. Accurate imaging is essential for diagnosis, staging,and therapy planning. Prostate-specific membrane antigen (PSMA)-targeted radiotracersprovide superior sensitivity and specificity across clinical scenarios. In biochemicalrecurrence, PSMA positron emission tomography/computed tomography (PET/CT) offersthe highest detection rates, especially at low prostate-specific antigen (PSA) levels. Cholineand fluciclovine PET/CT remain valuable alternatives. Bone scintigraphy, fluoride PET/CT,and MRI contribute to skeletal staging. Molecular imaging has significantly advanced PCamanagement, enabling more precise diagnosis and treatment. This review summarizesrecent advances in PSMA-targeted nuclear imaging.

Background Papillary carcinoma is the most frequent type of thyroid carcinoma, while primary thyroid lymphoma is uncommon disease. The coexistence of these entities has already been described, and the common risk factor is considered Hashimoto thyroiditis. The two most frequent histotypes of primary thyroid lymphoma are diffuse large B-cell and mucosa-associated lymphoid tissue lymphoma, but the coexistence of both with papillary carcinoma is rarely reported. Methods We present a case of a previously healthy 57-years old male with rapidly growing lump on the right side of the neck. Ultrasonography revealed nodules in both thyroid lobes. Fine needle aspiration cytology and pertechnetate scintigraphy were performed. Due to the Bethesda T-5 in the “cold” nodule of the right lobe, surgery with histopathological and immunohistochemistry analysis was indicated. Results Histopathological and immunohistochemistry methods confirmed concomitant malignancies in the thyroid gland: diffuse large B-cell lymphoma and papillary carcinoma in the right, and mucosa-associated lymphoid tissue lymphoma in the left lobe with Hashimoto thyroiditis in the remaining tissue. Patient underwent therapy procedures and was without signs of local recurrence or metastatic spread on subsequent follow-up. Conclusions Sudden appearance of the neck mass in patients with Hashimoto thyroiditis should raise suspicion on primary thyroid lymphoma and be promptly taken in the diagnostic workup, including fine needle aspiration cytology. Pathology with immunohistochemistry is crucial for further clinical decision making. Since the standardized protocol in management of these complex patients is missing, personal approach and close collaboration between cytologist, pathologist, surgeon, haematologist and nuclear medicine specialist is essential.

Background and Objectives: The available research suggests that dietary patterns with high inflammatory potential, as indicated by a high DII score, may exacerbate inflammation and potentially influence thyroid function. Therefore, the aim of this study was to investigate the associations between the inflammatory potential of a diet and thyroid function in adults with Hashimoto’s thyroiditis (HT). Materials and Methods: A total of 149 adults diagnosed with Hashimoto’s thyroiditis were enrolled in this observational, cross-sectional, multicenter study. The Dietary Inflammatory Index (DII®) was calculated using a 141-item food frequency questionnaire (FFQ). The serum levels of the thyroid-stimulating hormone (TSH), free thyroxine (fT4), thyroid peroxidase antibodies (TPO-Ab), and high-sensitivity C-reactive protein (hsCRP) were determined. Results: The DII® scores ranged from −3.49 (most anti-inflammatory) to +4.68 (most pro-inflammatory), whereas three DII® tertile ranges were defined as <−1.4, −1.39 to +1.20, and >+1.21, respectively. Participants in tertile 1 (more anti-inflammatory diet) had significantly higher levels of fT4 than those adhering to a more pro-inflammatory diet (p = 0.007). The levels of hsCRP and TSH appeared to increase with increasing the DII® score, but without statistical significance. A significant association was found between the DII® and TSH (β = 0.42, p < 0.001) and between DII® and free thyroxine (β = 0.19, p < 0.001). After adjustment for age, gender, energy intake, and physical activity, a significant positive correlation remained between the DII® and TSH (β = 0.33, p = 0.002) and between the DII® and body mass index (BMI) (β = 0.14, p = 0.04). Conclusions: Adherence to an anti-inflammatory diet appears to be beneficial in patients with Hashimoto’s thyroiditis, suggesting that dietary modification aimed at lowering DII® levels may be a valuable strategy to improve clinical outcomes in these patients.

Autoimmune thyroid disease (AITD) is the leading cause of thyroid dysfunction globally, characterized primarily by two distinct clinical manifestations: Hashimoto’s thyroiditis (HT) and Graves’ disease (GD). The prevalence of AITD is approximately twice as high in women compared to men, with a particularly pronounced risk during the reproductive years. Pregnancy exerts profound effects on thyroid physiology and immune regulation due to hormonal fluctuations and immune adaptations aimed at fostering maternal–fetal tolerance, potentially triggering or exacerbating AITD. The impact of AITD on pregnancy outcomes is multifaceted. Both HT and GD have been associated with adverse obstetric and neonatal outcomes, including miscarriage, preterm delivery, preeclampsia and fetal growth restriction. Inadequately managed AITD can also affect fetal neurodevelopment due to disrupted maternal thyroid hormone availability during critical periods of brain maturation. This review explores the complex interplay between the genetic, epigenetic and environmental factors that drive AITD during pregnancy, highlighting their roles in disease development and impacts on pregnancy outcomes. Gaining a deeper understanding of these mechanisms is crucial for improving diagnostic tools, treatment options and preventive measures to enhance the health and well-being of both the mother and the newborn.

Lymphedema is a chronic, progressive condition caused by impaired lymphatic transport, leading to edema in the lower and/or upper extremities, depending on the underlying cause. The diagnosis is based on clinical examination, ultrasound findings, and imaging tests. Treatment is mostly conservative, usually long-term, and often yielding unsatisfactory results. Recently, surgical options have also become available. Lymphoscintigraphy, a non-invasive and simple nuclear medicine imaging technique, is considered the method of choice in diagnostic workup. It consists of intracutaneous or subcutaneous application of colloidal particles labelled with radioactive technetium-99m and two-dimensional or three-dimensional gamma camera imaging. Lymphoscintigraphy helps differentiate lymphedema from edema of another origin, assess disease severity, and evaluate surgery outcome. However, the procedure is not fully standardized, especially in terms of semiquantitative methods, which are additionally used in disease staging; however, their implementation varies depending on local experience and expertise.

Background: Technetium (99mTc)-labelled Methoxy-2-Isobutylisonitrile (MIBI) is a diagnostic lipophilic cationic radiotracer used to evaluate the cardiac, breast, thyroid, and parathyroid pathology. This study aimed to evaluate the role of MIBI combined with Tc-99m pertechnetate thyroid scintigraphy, thyroid ultrasonography, and measurement of thyrotropin, thyroid hormones, and autoantibodies to subtype amiodarone-induced thyrotoxicosis (AIT) and the contribution of semi-quantitative analysis of MIBI uptake. Material/Methods: This cross-sectional study included 36 patients with AIT who underwent thyrotropin, thyroid hormone, and autoantibody analysis using chemiluminescent method, ultrasonography, pertechnetate, and MIBI thyroid scintigraphy with semi-quantitative uptake, including calculation of the target-to-background ratio (TBR) with 2 different background regions. The MIBI washout rate (WR) was analyzed in all groups. Statistical analysis was performed using descriptive statistics, correlations, and the receiver operating characteristic curve - area under the curve (ROC-AUC). The results were compared with the control group. Results: Based on visual and semi-quantitative analyses, patients were successfully categorized into AIT groups (AIT-1, AIT-2 and AIT-3) but the latter method enabled better differentiation of MIBI uptake between all groups. Additionally, ROC-AUC analysis determined cutoff values which enabled discerning between AIT-1 and AIT-2 groups, and AIT-1 and AIT-3 groups. WR showed no significant difference between all AIT groups and controls (P>0.05). Conclusions: Visual MIBI analysis enabled differentiation between AIT-1 and 2 groups, but the method was substantially improved with semi-quantitative analysis, especially in defining AIT-3 group. However, multicenter collaboration with larger studies is needed to standardize the method and obtain more accurate and consistent results.

BACKGROUND:Both insufficient and excessive iodine intake can lead to a broad range of disorders. A cross-sectional survey was conducted to assess iodine status in schoolchildren from Croatia. DESIGN:957 healthy 6 to 12-year-olds were enrolled (381 from northwestern region, 190 from eastern region, 215 from north Adriatic, and 171 from central Dalmatia region). Urinary iodine concentration (UIC) was measured in spot urine samples. Thyroid volume (Tvol) was recorded by ultrasound device. Standard anthropometric measures were taken, and body surface area (BSA) was determined. Tvol medians were calculated as a function of age, sex and BSA and compared with reference values. RESULTS:Total sample size included 490 boys and 467 girls. Overall median UIC was 250.68 µg/L, with statistically significant variance in geographical regions (median UIC was 244.71 µg/L in northwestern, 208.02 µg/L in eastern, 216.07 µg/L in north Adriatic and 366.43 µg/L in central Dalmatia region). There were 10.08% of samples with UIC < 100 mcg/L while 38.24% of samples had UIC > 300 mcg/L. Age-matched Tvol medians in schoolchildren from all regions of Croatia were at the upper limits of reference values, but in north Adriatic and central Dalmatia exceeded the 97th percentile. BSA-matched Tvol was within the reference range in all regions. CONCLUSIONS:Our results demonstrate sufficient (more than adequate) iodine intake in schoolchildren of Croatia, and excessive iodine intake in central Dalmatia region. Total thyroid volumes in schoolchildren of Croatia were within the normal range, however borderline enlarged age-matched thyroid glands were observed in coastal areas.

Autoimmune thyroid disease (AITD) is the most common organ-specific autoimmune disorder clinically presented as Hashimoto thyroiditis (HT) and Graves’ disease (GD). The pathogenesis of AITD is caused by an inappropriate immune response related to genetic, non-genetic, and environmental factors. Pregnancy is one of the factors that have a great influence on the function of the thyroid gland because of the increased metabolic demand and the effects of hormones related to pregnancy. During pregnancy, an adaptation of the maternal immune system occurs, especially of the innate immune system engaged in maintaining adaptive immunity in the tolerant state, preventing the rejection of the fetus. Pregnancy-related hormonal changes (estrogen, progesterone, hCG) may modulate the activity of innate immune cells, potentially worsening the course of AITD during pregnancy. This especially applies to NK cells, which are associated with exacerbation of HD and GD. On the other hand, previous thyroid disorders can affect fertility and cause adverse outcomes of pregnancy, such as placental abruption, spontaneous abortion, and premature delivery. Additionally, it can cause fetal growth retardation and may contribute to impaired neuropsychological development of the fetus. Therefore, maintaining the thyroid equilibrium in women of reproductive age and in pregnant women is of the highest importance.

Karcinom štitnjače koji se obično prezentira kao čvor u štitnjači čini tek 1 % svih malignoma, no s druge strane čvorove u štitnjači nalazimo u više od polovice svjetske populacije. Navedena statistika svakako nije zanemariva te se nameće potreba za postojanjem stanadardiziranog usmjerenog dijagnostičkog i terapijskog pristupa kojim bi se riješio problem prekomjernog dijagnosticiranja, a da se pri tome ne propusti prepoznati pacijente kojima je medicinska intervencija uistinu potrebna. Nakon otkrivanja čvora u štitnjači dijagnostički se proces sastoji od pretraga koje služe za procjenu funkcionalnog statusa (hormonalni status, scintigrafija), pretraga koje prikazuju izgled i građu štitnjače i čvora ili čvorova (ultrazvuk) te pretraga koje opisuju staničnu građu čvora i promjena nađenih u štitnjači (citološka analiza). Procjena i liječenje ovih pacijenata više se ne temelje na univerzalnom, već na personaliziranom pristupu koji zagovara pažljivu i racionalnu procjenu svake lezije unutar zadanog kliničkog konteksta kako bi se što preciznije utvrdila vjerojatnost zloćudne etiologije i reducirala primjena nepotrebnih dijagnostičkih i terapijskih postupaka. Udio malignih čvorova je malen, svega 5 %, što znači da tek maleni broj čvorova u štitnjači uistinu zahtijeva intenzivnu obradu i kirurško liječenje, dok se, u pravilu, u većine pacijenata s benignim čvorovima nakon odgovarajuće početne evalvacije postupa konzervativno te se učestalost naknadnih kontrola može svesti na minimum.

Amiloidoza srca nastaje uslijed nakupljanja nepravilno savijenih ili polimeriziranih bjelančevina, najčešće transtiretina ili lakih lanaca imunoglobulina u intersticiju miokarda. Bolest se još uvijek teško otkriva jer se na nju kao mogući uzrok zatajivanja srca rijetko pomišlja. Dijagnoza se postavlja na temelju kliničke slike, anamnestičkih podataka, nalaza srčanih biomarkera, promjena u elektrokardiogramu, ehokardiografskom nalazu i/ili magnetskoj rezonanciji, koji zajedno mogu upućivati na dijagnozu. Donedavno je biopsija miokarda bila jedina pouzdana dijagnostička metoda za dokaz ove bolesti. Nuklearna medicina nudi mogućnost neinvazivnog postavljanja dijagnoze, no samo u pacijenata koji zadovoljavaju određene kliničke kriterije. Koriste se radiofarmaci obilježeni gama i pozitronskim emiterima namijenjeni prikazu skeleta ili direktnoj vizualizaciji amiloidnih plakova koji se nakupljaju u miokardu zahvaćenom amiloidozom. Dijagnostička vrijednost scintigrafije ovisi o korištenju te metode u ispravnom kliničkom kontekstu te o poznavanju i postupanju prema dijagnostičkom algoritmu. Posljednjih se godina transtiretinska amiloidoza sve više prepoznaje kao uzrok zatajivanja srca, a razvijaju se i nove terapijske mogućnosti. Stoga je interes za dijagnostiku, posebno nuklearno-medicinske metode povećan, a provode se i brojna istraživanja, naročito u području PET/CT dijagnostike.

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.

Cilj: Cilj rada bio je procijeniti doprinos jednofotonske emisijske tomografije / kompjutorizirane tomografije somatostatinskih receptora (SR SPECT/CT) s 99mTc-EDDA/HYNIC-Tyr3-oktreotidom (99mTc-Tektrotyd) u dijagnostici i procjeni proširenosti bolesti kod pacijenata oboljelih od neuroendokrinih tumora (NET-ova). Ispitanici i metode: Retrospektivno je analizirano 120 SR SPECT/CT snimanja pacijenata s patohistološki dokazanim NET-om s obzirom na vizualizaciju primarnih lezija i metastaza. U 45 pacijenata učinjena je i pozitronska emisijska tomografija 18F-fluorodeoksiglukozom (18F-FDG PET/CT) te su nalazi uspoređeni s nalazima SR SPECT/CT-a i vrijednostima kromogranina A. Rezultati: Od 120 pacijenata 47 (39 %) je na SR SPECT/CT upućeno nakon odstranjenja primarne lezije. Od preostala 73 pacijenta (61 %), u 56 (77 %) primarni je tumor bio vidljiv SR SPECT/CT-om, a u 9 (12 %) poznata lezija nije akumulirala radiofarmak. U 8 (11 %) pacijenata s NET-om nepoznatog primarnog sijela nalaz je bio negativan. Od 68 (57 %) pacijenta s dokazanim metastazama, u njih 57 (84 %) bile su vidljive SR SPECT/CT-om, a u 11 (16 %) nisu akumulirale radiofarmak. Od 45 (38 %) pacijenata kojima je učinjen i 18F-FDG PET/CT, u 27 (60 %) detekcija primarnih lezija i metastaza bila je sukladna nalazu SR SPECT/CT-a. Osjetljivost SR SPECT/CT-a bila je 77 % za primarne lezije i 84 % za metastaze, a 18F-FDG PET/CT-a 75 % za primarne lezije i 76 % za metastaze. Vrijednosti kromogranina A nisu pokazale statistički signifikantnu korelaciju s nalazima slikovne dijagnostike. Zaključci: SR SPECT/CT ima visoku osjetljivost za detekciju NET-ova. Osim toga, potvrđena je komplementarnost s 18F-FDG PET/CT-om te kod pacijenata s negativnim nalazom SR SPECT/CT-a treba učiniti 18F-FDG PET/CT i obrnuto.

Molecular imaging with 99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI, MIBI) has been used in the assessment of thyroid nodules (TNs) for more than two decades. Many studies showed that MIBI imaging is a suitable tool to rule-out malignancy when negative. However, relatively low specificity and accuracy have been described, thus, limiting its acceptance in clinical practice. Additionally, different technologies, protocols, and interpretation criteria are adopted accounting for heterogeneous data reported in the literature. Therefore, the present study was undertaken to assess the clinical use and methodology of MIBI imaging in patients with nodular thyroid disease in Europe. A questionnaire was sent to 12 European centers of Nuclear Medicine. The questionnaire encompassed ultrasound (US) and fine-needle aspiration cytology (FNAC) procedures and their evaluation as well scintigraphy imaging indications, technical procedures, and interpretation criteria of MIBI imaging. The survey showed a good agreement of different centers in approaching TNs by TSH measurement, US evaluation and 99mTc-pertechnetate thyroid scintigraphy. MIBI imaging is mainly used to assess TNs with inconclusive/indeterminate cytological findings and selection of target nodule(s) for FNAC in patients with multi-nodular goiter. Technical procedures adopted in different centers are globally comparable and the recorded differences are unlikely to impact clinical results. However, as the main result of the present study, substantial differences were found in interpretation criteria adopted in different centers. Our survey supports the urgent need of standardized interpretation criteria of thyroid MIBI imaging in order to improve its diagnostic performance and make results comparable in clinical practice.

Objectives Thyroglobulin is routinely used as a tumor marker in follow up of patients with thyroid carcinoma, but is also elevated in patients with toxic nodular goiter. The aim of this study was to evaluate the role of thyroglobulin measurement prior to and after the radioiodine therapy (RIT) in patients with toxic nodular goiter and to compare the results with the therapy outcome. Patients and methods In 109 patients with toxic nodular goiter (102 females, 7 males, aged 45–85 years), 61 with multinodular toxic goiter and 48 with toxic adenoma, thyroglobulin level was measured before RIT and during the first 12 months after the treatment and compared to therapy outcome, defined as euthyroid, hypothyroid and persistent hyperthyroidism. Results In patients with euthyroid and hypothyroid outcome, a significant fall of thyroglobulin level was noted during the first 12 months after RIT, more prominent in the latter group. In patients with persistent hyperthyroidism, the initial thyroglobulin level was higher than in other two groups and no significant decrease was noted by the end of the first year after therapy, especially in patients with multinodular toxic goiter. Conclusions The significant fall of thyroglobulin after RIT observed in patients in whom euthyroidism and hypothyroidism was achieved indicates that thyroglobulin values can be related to the treatment outcome. In patients with high initial thyroglobulin levels (above 400 ng/l), and possible unfavorable RIT outcome, higher radioiodine activities or other treatment options might be considered. Video abstract: http:/links.lww.com/NMC/A163

Thyroid cancer (TC) is the most common endocrine cancer today. The rising incidence of the differentiated papillary type cannot be entirely explained by early and meticulous diagnosis, since a proportion of large tumors has also been reported. In this review, we present the results of numerous investigations focused on possible factors causing increased TC incidence, such as chromosomal and genetic alterations, iodine intake, TSH level, autoimmune thyroid disease, gender, estrogen, obesity, lifestyle changes, and environmental pollutants. Up to now, only childhood exposure to ionizing radiation has been fully recognized as a risk factor. There is also a possibility that yet undiscovered carcinogens, especially during intrauterine life or early childhood, might be responsible for increased TC incidence as well as epigenetic changes. Therefore, more studies are necessary in order to further investigate the potential risk factors for TC and their mechanisms of action.

Sažetak.Cilj: Cilj studije je prikazati ulogu oslikavanja 99m Tc metoksiizobutilizonitrilom ( 99m Tc-MIBI) pomoću planarnog oslikavanja i jednofotonske emisijske tomografije "niskodoznom" kompjutoriziranom tomografijom (engl.single photon emission computerized tomographycomputerized tomography, SPECT-CT), u obradi čvorova štitne žlijezde koji su afunkcionalni na oslikavanju 99m Tc-pertehnetatom i potvrđeni ultrazvučnim pregledom.Ispitanici i metode: Retrospektivno su pregledani nalazi pacijenata kojima je učinjeno oslikavanje štitne žlijezde 99m Tc-MIBI-jem i citološka punkcija u periodu od 2008.do 2018., te su uspoređeni s patohistološkim nalazom (engl.pathohistological diagnosis, PHD).Studije su snimljene gamakamerom s kolimatorom visoke rezolucije na dva načina: planarno i tomografski (SPECT-CT