CNSM-06 WHEN BRAIN LESIONS AREN’T WHAT THEY SEEM: THE POWER OF COMBINING MRI AND RADIOACTIVE IODINE SCINTIGRAPHY FOR THYROID CANCER IN A RESOURCE-LIMITED SETTING Article Swipe

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Peter Afolami , Augustine Adeolu , Mutiu Jimoh , Olumayowa Kolade ·

YOU? · · 2025 · Open Access · · DOI: https://doi.org/10.1093/noajnl/vdaf213.020

Background and Aims Accurate imaging is essential for the diagnosis, staging, and treatment planning of cancer. Magnetic Resonance Imaging (MRI) provides high-resolution anatomical detail and is preferred for evaluating intracranial lesions, while radioactive iodine (RAI) scintigraphy remains the cornerstone of functional imaging (and therapy) in well-differentiated thyroid cancer (WDTC). These modalities offer complementary insights, which are particularly valuable in resource-limited settings where hybrid imaging may be unavailable. This case report demonstrates the utility of combining MRI and RAI scintigraphy to improve diagnostic accuracy in a patient with suspected intracranial metastases from follicular thyroid cancer (FTC). Methods We retrospectively reviewed the clinical records and imaging findings (MRI and RAI scintigraphy) of a 51-year-old Nigerian woman with advanced FTC. Independent and integrated image interpretation was performed, followed by histopathological correlation. Results The patient presented with progressive right-sided exophthalmos and underwent brain MRI, which revealed a right sphenoid wing mass extending into the orbit. Initial postoperative histology suggested polymorphous low-grade adenocarcinoma, but immunohistochemistry favoured metastatic FTC. Two additional enhancing intracranial lesions were interpreted as likely benign epidermoid cysts. However, whole-body RAI scintigraphy subsequently demonstrated abnormal cranial uptake spatially congruent with the locations of these lesions, raising suspicion for metastatic disease. Surgical excision and histology confirmed the diagnosis of metastatic FTC. Conclusions Accurate staging is critical in advanced thyroid cancer, particularly when intracranial metastases are present, as these represent a contraindication to radioactive iodine therapy (RAIT) without prior surgical resection. In this case, RAI scintigraphy proved vital in reclassifying lesions initially presumed benign, thereby preventing potential complications such as cerebral edema, increased intracranial pressure, and seizures following RAIT. This case underscores the importance of combining functional and anatomical imaging to enhance diagnostic precision, especially in resource-constrained settings where hybrid imaging technologies are limited but can be effectively simulated through multimodal integration.

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Medicine Radiology Thyroid cancer Scintigraphy Thyroid Magnetic resonance imaging Nuclear medicine Cancer Contraindication Medical imaging Context (archaeology) Neuroimaging Anaplastic thyroid cancer Overdiagnosis Surgical oncology

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Type: article
Language: en
Landing Page: https://doi.org/10.1093/noajnl/vdaf213.020
OA Status: gold
OpenAlex ID: https://openalex.org/W7104440620

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DOI: https://doi.org/10.1093/noajnl/vdaf213.020

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Title: CNSM-06 WHEN BRAIN LESIONS AREN’T WHAT THEY SEEM: THE POWER OF COMBINING MRI AND RADIOACTIVE IODINE SCINTIGRAPHY FOR THYROID CANCER IN A RESOURCE-LIMITED SETTING

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Language: en

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Publication year: 2025

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Publication date: 2025-11-01

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Authors: Peter Afolami, Augustine Adeolu, Mutiu Jimoh, Olumayowa Kolade

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Landing page: https://doi.org/10.1093/noajnl/vdaf213.020

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Concepts: Medicine, Radiology, Thyroid cancer, Scintigraphy, Thyroid, Magnetic resonance imaging, Nuclear medicine, Cancer, Contraindication, Medical imaging, Context (archaeology), Neuroimaging, Anaplastic thyroid cancer, Overdiagnosis, Surgical oncology

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abstract_inverted_index.Independent	118
abstract_inverted_index.cornerstone	39
abstract_inverted_index.effectively	293
abstract_inverted_index.interpreted	170
abstract_inverted_index.progressive	134
abstract_inverted_index.radioactive	33, 229
abstract_inverted_index.right-sided	135
abstract_inverted_index.underscores	267
abstract_inverted_index.correlation.	128
abstract_inverted_index.demonstrated	181
abstract_inverted_index.demonstrates	71
abstract_inverted_index.exophthalmos	136
abstract_inverted_index.integration.	297
abstract_inverted_index.intracranial	30, 89, 167, 219, 259
abstract_inverted_index.particularly	57, 217
abstract_inverted_index.polymorphous	156
abstract_inverted_index.scintigraphy	36, 79, 179, 241
abstract_inverted_index.subsequently	180
abstract_inverted_index.technologies	287
abstract_inverted_index.unavailable.	67
abstract_inverted_index.complementary	53
abstract_inverted_index.complications	253
abstract_inverted_index.postoperative	153
abstract_inverted_index.reclassifying	245
abstract_inverted_index.scintigraphy)	109
abstract_inverted_index.interpretation	122
abstract_inverted_index.adenocarcinoma,	158
abstract_inverted_index.high-resolution	22
abstract_inverted_index.retrospectively	98
abstract_inverted_index.contraindication	227
abstract_inverted_index.resource-limited	60
abstract_inverted_index.histopathological	127
abstract_inverted_index.well-differentiated	46
abstract_inverted_index.immunohistochemistry	160
abstract_inverted_index.resource-constrained	282
cited_by_percentile_year
countries_distinct_count	0
institutions_distinct_count	4
citation_normalized_percentile.value	0.79168311
citation_normalized_percentile.is_in_top_1_percent	False
citation_normalized_percentile.is_in_top_10_percent	False