Among thyroid malignancies, medullary thyroid carcinoma (MTC) has some very specific features. Production
and secretion of large amounts of peptides occur in malignant transformed C cells with few exceptions, leading to high serum
levels of calcitonin (Ctn) and carcinoembryonic antigen (CEA), that act after thyroidectomy as tumour markers warning
for the presence of persistent or metastatic MTC. The availability of those serum biomarkers with an excellent sensitivity
challenges medical imaging to localise the recurrent cancer tissue, since surgery is a major therapeutic option.
The aims of this article are (i) to review literature evidence about the efficacy and tolerance of radiopharmaceuticals for 3
targets of PET/CT imaging (glucose metabolism, bioamines metabolism and somatostatin receptors) and also bone scintigraphy
which is recommended in the Guidelines of European Society for Medical Oncology (ESMO; (ii) to compare the
availability and the costs in relation with those radiopharmaceuticals, (iii) and to discuss a possible sequence of those examinations,
in order to optimise spending and to minimise the overall radiation dose.
In this context of recurrent MTC suspected on rising tumour markers levels after thyroidectomy, this survey of literature
confirms that FDOPA is the best radiopharmaceutical for PET/CT with significant diagnostic performance if Ctn
>150pg/mL; an early image acquisition starting during the first 15 min is advised. In negative cases, FDG should be the
next PET radiopharmaceutical, in particular if Ctn and CEA levels are rapidly rising, and PET with a somatostatin analogue
labelled with gallium-68 when neither FDOPA nor FDG PET are conclusive. Bone scintigraphy could complement
FDG-PET/CT if FDOPA is not available.