Predictive value of scintigraphic (semi-)quantitative thyroid parameters on radioiodine therapy outcome in hyperthyroid cats.

Objectives The outcome of radioiodine therapy in hyperthyroid cats is suspected to be influenced by multiple factors. The degree of activity of the thyroid gland, represented by uptake of sodium pertechnetate or tracer activities of radioiodine by the thyroid gland on thyroid scintigraphy, has been suggested in the literature as one of those. Thyroid gland pertechnetate uptake can be represented by (semi-)quantitative factors such as the thyroid to salivary gland (T/S) ratio, the thyroid to background (T/B) ratio and the percentage technetium uptake by the thyroid glands (%TcU). The aim of this study was to investigate a possible relationship between these thyroid scan parameters and radioiodine therapy outcome. Methods Sodium pertechnetate thyroid scans of 75 hyperthyroid cats were retrospectively evaluated and statistical analysis was performed with and without correction for injected radioiodine activity. Three different background regions of interest (ROIs) were used to calculate the T/B ratio and %TcU: 'neck', 'circle' and 'copy ROI'. Results Higher T/S ratios were found to be significantly related to a persistent hyperthyroid outcome in both analyses. For the T/S ratio, a threshold value of 5.4 was determined, with a sensitivity of 73% and a specificity of 59%. An increased risk for persistent hyperthyroidism compared with a final euthyroid outcome with an increased T/Bcircle ratio was only found to be significant without correction for the activity of radioiodine administered. For the %TcU no statistical significance was reached. Regarding a low total thyroxine outcome, no significant relationships with any of the investigated parameters were found. Conclusions and relevance The findings of this study suggest that semi-quantification of thyroid gland uptake is best performed using the T/S ratio. A T/S ratio ⩾5.4 is a possible indicator for an increased risk of persistent hyperthyroidism.

Repeatability of Contrast-Enhanced Ultrasonography of the Kidneys in Healthy Cats.

Contrast-enhanced ultrasound can be used to image and quantify tissue perfusion. It holds great potential for the use in the diagnosis of various diffuse renal diseases in both human and veterinary medicine. Nevertheless, the technique is known to have an inherent relatively high variability, related to various factors associated with the patient, the contrast agent and machine settings. Therefore, the aim of this study was to assess week-to-week intra- and inter-cat variation of several perfusion parameters obtained with CEUS of both kidneys of 12 healthy cats. Repeatability was determined by calculating the coefficient of variation (CV). The contrast-enhanced ultrasound parameters with the lowest variation for the renal cortex were time-to-peak (CV 6.0%), rise time (CV 13%), fall time (CV 19%) and mean transit time (24%). Intensity-related parameters and parameters related to the slope of the time-intensity curve had a CV of >35%. Lower repeatability was present for perfusion parameters derived from the renal medulla compared with the renal cortex. Normalization to the inter-lobar artery does not cause a reduction in variation. In conclusion, time-related parameters for the cortex show a reasonable repeatability; whereas poor repeatability is present for intensity-related parameters and parameters related to in- and outflow of contrast agent. Poor repeatability is also present for all perfusion parameters for the renal medulla, except for time to peak, which has a good repeatability.

Week-to-week variation of scintigraphic (semi-)quantitative thyroid variables in 14 healthy experimental cats.

Although scintigraphy is an important tool for the assessment of thyroid function in cats, time variation of commonly used thyroid variables has not been investigated to this day. The aim of this study was to investigate whether a week-to-week variation of scintigraphic variables exists in healthy cats of a magnitude that is clinically relevant, as this could lead to misinterpretation of results. Fourteen adult, healthy, experimental cats were included in the study. At 3 time points, with 7-day intervals, the cats underwent a thyroid pertechnetate scan and blood samples were collected. The scintigraphic variables calculated were the thyroid to salivary gland ratio (T/S), thyroid to background ratio (T/B), percentage technetium uptake in the thyroid glands (%TcUT) and additionally percentage technetium uptake in the salivary glands (%TcUSG). Two thyroid hormones, total thyroxine (TT4) and thyroid stimulating hormone (TSH), were included in the analysis. All scintigraphic variables, with the exception of the %TcUT and T/Bneck ratio, were within the normal reference ranges reported in literature. No clinically relevant week-to-week variation was observed for any of the variables included in this study.

Inter- and intraobserver variability of (semi-)quantitative parameters commonly used in feline thyroid scintigraphy.

The aim of this study was to assess inter- and intraobserver variability of commonly used semi-quantitative and quantitative parameters in feline thyroid scintigraphy: thyroid to salivary gland ratio (T/S), thyroid to background ratio (T/B) and the percentage technetium pertechnetate uptake for the thyroid glands (%TcUT). These parameters are being used to diagnose thyroid disease and to assess its severity, but may be influenced by operator related factors when processing the images. Additionally, inter- and intraobserver variability of the percentage technetium pertechnetate uptake for the salivary glands was determined (%TcUSG). The study included technetium pertechnetate scans of 100 hyperthyroid cats. Variability within and between three observers was determined using a random effects model and variance components were estimated by the restricted maximum likelihood procedure. The %TcU for the thyroid and salivary glands, as well as the T/S ratio, showed little to no difference in inter- and intraobserver variability, whereas this was clearly present for the T/B ratio. Overall, the T/S ratio and %TcUSG showed a good repeatability and reproducibility with low inter- and intraobserver variabilities. Inter- and intraobserver variability was higher for the %TcUT, however variations were still considered to be acceptable. On the contrary, inter- and intraobserver variability was clearly larger for the T/B ratio. These findings suggest the preferential use of the T/S ratio or %TcU, especially in facilities with a less experienced staff.

Effect of thyroid volume on radioiodine therapy outcome in hyperthyroid cats.

Radioiodine therapy is commonly used in hyperthyroid cats and has a high success rate, ranging from 85-95%. As in humans, thyroid volume has been reported to influence radioiodine therapy outcome in hyperthyroid cats. The purpose of this study was to relate total thyroid volume, calculated by a newly constructed formula for feline patients (0.438 × length × width²), to the outcome of radioiodine therapy. To search for a correlation between total thyroid volume and therapy outcome, 167 hyperthyroid cats were included. Patients were categorised according to the administered radioiodine dose and therapy outcome. Our analysis did not show a significant relationship between an increasing total thyroid volume and the odds for a final low total thyroxine concentration (TT4; P = 0.3930) or a final hyperthyroid outcome (P = 0.0901). A significant relationship was found for an increase in the odds for a final low TT4 outcome with an increase in the number of foci detected on the pertechnetate thyroid scan (P = 0.0238). This was not true for a final hyperthyroid outcome (P = 0.7435). The number of detected foci was also significantly associated with the total thyroid volume (P = 0.0006). Findings indicated that the presence of multiple affected foci influences therapy outcome towards a low TT4 outcome. Bilateral hyperthyroidism and its potential effect on a final low TT4 outcome should therefore be addressed when informing owners of the possible outcomes of radioiodine therapy for their cat.

Scintigraphic thyroid volume calculation in hyperthyroid cats.

A successful, euthyroid outcome after radioiodine therapy in hyperthyroid cats ranges from 83% to 95%. Thyroid volume has been reported as one of the factors influencing radioiodine therapy outcome in man and cats. The goal of this study was to describe the most reliable and practically applicable formula to determine thyroid volume using scintigraphy. The volume of each thyroid lobe of 32 hyperthyroid cats was determined by ultrasound and scintigraphy. The ultrasonographically determined volume (ellipsoid formula) for each thyroid lobe was compared with the scintigraphic volume that was calculated using eight different formulas: F1 [(π/6) × L × H × W], F2 [(π /2) × L × W(2)], F3 [0.33 × (area cm(2))(3/2)], F4 [1.08 × (π /6) × L × W(2)], F5 (area × H), F6 (0.27 × area × L), F7 (π × L × W(2)) and F8 [π × (4/3) × W(3)]. F1, F3, F4 and F6 did not differ statistically from the volumes measured on ultrasound, while F2, F5, F7 and F8 did. Subjective shape assessment of the thyroid lobes, assigned as cylindrical or spherical, and the use of corresponding formulas, did not appear to be useful.