Value of Oblique View in Nodular Thyroid Disease; Revisiting Fundamentals

Abdelhamid H Elgazzar 1, Saud Alenezi 1, Jehan M Alshammari 1, Mohammad Ghanem 1, Saqr Asa'ad 1

Affiliations

01 May 2015

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doi: 10.4103/1450-1147.153911

Abstract

Thyroid scintigraphy plays an important role in the anatomical and functional evaluation of thyroid nodules which carry the risk of malignancy. The presence of multiple nodules carries overall smaller risk of cancer than solitary nodule. Missing nodules, whether solitary or multiple, may mean delaying detection of possible cancer. Therefore, it is important to improve the delectability of thyroid scintigraphy using most optimal imaging techniques. For pinhole thyroid imaging, there is a recent trend to omit oblique projections by some laboratories. The objective of this study was to reevaluate the impact of oblique projections in the detection of thyroid nodules. A total of 92 cases with nodular thyroid disease on routine pinhole thyroid scintigraphy was reviewed retrospectively. Two nuclear medicine physicians recorded the number of nodules based on the anterior view only and another time with adding the oblique views. A total of 192 nodules was detected using the three views. Sixty nodules (31%) were only seen on the oblique views and were missed on the anterior projections. Oblique pinhole projections are mandatory for adequate thyroid scintigraphy since 31% of nodules are missed if only anterior projection was used for interpretation. Following proper techniques will avoid missing of detection of nodule that may harbor cancer.

Keywords: Radionuclide; oblique views; pinhole; thyroid nodules; thyroid scintigraphy.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1 Multiple projections of a Tc-99m pertechnetate thyroid study. The anterior image demonstrates normal gland with no definite nodules. The RAO image demonstrates a cold nodule at the posteromedial aspect of the right upper pole (arrow). RAO: Right anterior oblique

Figure 1 Multiple projections of a Tc-99m pertechnetate thyroid study. The anterior image demonstrates normal gland with no definite nodules. The RAO image demonstrates a cold nodule at the posteromedial aspect of the right upper pole (arrow). RAO: Right anterior oblique

Figure 2 Tc-99m pertechnetate pinhole thyroid study with multiple projections. The anterior image shows no definite evidence of discrete nodules. The LAO demonstrates a large cold nodule at the lateral aspect of the left upper pole (thick arrow). As well, there are two small cold nodules at the posterior aspect of the right lobe (thin arrows). LAO: Left anterior oblique

Figure 2 Tc-99m pertechnetate pinhole thyroid study with multiple projections. The anterior image shows no definite evidence of discrete nodules. The LAO demonstrates a large cold nodule at the lateral aspect of the left upper pole (thick arrow). As well, there are two small cold nodules at the posterior aspect of the right lobe (thin arrows). LAO: Left anterior oblique

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