Search Results (298)

Treatment of severely injured patients is challenging, and timely reading of whole-body computed tomography (WBCT) images therefore crucial. Artificial intelligence is increasingly used to prioritize and detect acute injuries in this context. Algorithms focusing on the cervical spine and compression fractures have been deployed successfully. However, tools for whole spine assessment and the entirety of fracture morphologies are lacking. We aimed to investigate the capabilities of an algorithm to detect spine fractures on WBCTs and factors contributing to the difficulties in its development. A version 1.0 (v1) of the algorithm was previously trained with 454 cervical spine fractures using a U-Net via four-fold cross-validation to segment spine fractures and the spine via a multi-task loss. Further training expanded towards whole spine assessment with additional annotated fractures (Cohort 1) of the cervical (n = 50), thoracic (n = 30), and lumbar spine (n = 20), resulting in version 2.0 (v2). Baseline was set to reach the highest sensitivity at a maximum of five false positives per case. Version 1.0 was tested on Cohort 1 and both versions were compared on prospectively collected real-world data (Cohort 2, n = 712 WBCTs). An additional systematic review served to compare the algorithmic performance against the state-of-the-art. Version 1.0 showed promising performance not only for the cervical but also the thoracic and lumbar spine due to generalization (sensitivities ranging between 60% and 87%). Version 2.0 also achieved decent sensitivities for Cohort 2 (sensitivities ranging between 77% and 85%) but generated an abundance of false positives. Various reasons led to false positive results; for Version 2.0, the trabecular structure itself provoked false alerts. Variances in training and test data (image quality, dose, reconstructions), heterogeneity of fractures and anatomies, plus the size of training sets explain some difficulties during algorithm development. Only five other groups described their work on whole-spine fracture detection, encountered similar difficulties, and have also failed to develop a clinically deployable tool. Spine fracture detection on WBCT is feasible, but multiple factors hinder the development of commercially available AI tools. Expansion and the improved design of training cohorts are necessary for further development and simulation of real-life conditions. Full article

[¹⁸F]-PSMA PET/CT is a high-impact modality for the staging and restaging of prostate cancer, but its wide anatomic coverage and tracer biology generate frequent incidental findings on both PET and the accompanying low-dose CT (LDCT). This narrative review is restricted in scope to fluorine-18 PSMA tracers because tracer-specific biodistribution and pitfall profiles shape what is perceived as incidentaloma: how confidently lesions can be categorized, and how often borderline findings trigger downstream testing, particularly for skeletal foci with [¹⁸F]-PSMA-1007. Specifically, [¹⁸F]-PSMA-1007 shows substantially higher rates of focal unspecific bone uptake than [⁶⁸Ga]-PSMA-11—reported in multicenter studies as affecting up to 40–50% of patients—which directly inflates the pool of potential incidentalomas and creates a tracer-specific false-positive problem with no parallel in gallium-68 practice. Additionally, [¹⁸F]-DCFPyL has different urinary clearance kinetics that affect bladder and ureteral uptake patterns, altering what qualifies as physiologic versus incidental in the pelvis. These differences mean that the threshold for Category B versus C classification—and the appropriate cascade-resistant language—must be tuned to the specific tracer in use. A framework built on [⁶⁸Ga]-PSMA-11 data would systematically underestimate bone pitfall frequency in [¹⁸F]-PSMA-1007 practice and could therefore paradoxically increase rather than reduce cascades if applied uncritically across tracers. These biodistribution differences have direct and concrete consequences for reporting behaviour and downstream management. In [¹⁸F]-PSMA-1007 practice, a focal bone uptake without a CT correlate in a mechanically plausible location—such as an anterior rib or vertebral endplate—should trigger Category B language in the report conclusion: the finding is documented in the body with explicit safety netting (“most consistent with unspecific uptake; no routine workup unless interval growth, new pain, or aggressive CT morphology”), and no referral to bone scintigraphy or MRI is generated. Without tracer-specific awareness, the same finding would typically prompt a reflex bone scan or whole-body MRI referral, delaying definitive prostate cancer management by weeks and adding imaging costs without diagnostic gain. By contrast, in [⁶⁸Ga]-PSMA-11 practice, an equivalent focal bone uptake without a CT correlate carries a higher prior probability of true metastatic disease given the lower background rate of unspecific uptake and should more often be reported at Category B with a lower threshold for escalation or more cautious language. For [¹⁸F]-DCFPyL, the higher urinary activity in the pelvis means that ureteral segments can mimic lymph node disease; recognizing this as a physiologic variant (Category C) rather than an equivocal nodal finding (Category B) avoids unnecessary pelvic MRI referrals that would otherwise be triggered by an uncontextualized report. In practical terms, the tracer-specific calibration of the overlay therefore changes not only the category assigned but also the specific safety-netting language and the escalation trigger, which directly modifies the downstream management pathway for each affected finding type. The scanned population—predominantly older men with a high prevalence of degenerative, inflammatory, and vascular abnormalities—creates substantial background noise that can drive low-value diagnostic cascades if incidental findings are communicated without actionability context. We integrate society-endorsed frameworks (EANM/SNMMI procedure guideline 2.0; E-PSMA; PSMA-RADS; and PROMISE/miTNM with miPSMA score) and propose a cascade-aware overlay for incidental findings that can be appended to existing PSMA reporting standards rather than replacing them. The A/B/C actionability overlay is a structured expert-consensus framework informed by existing evidence-based guidelines for specific finding types and by tracer-specific cohort data; it has not yet been prospectively validated as a standalone tool, and its current level of evidence is therefore analogous to a structured expert recommendation rather than an evidence-based clinical guideline. We operationalize a three-tier actionability scheme across PET- and CT-dominant findings, provide cascade-resistant language for conclusions, and clarify why SUVmax-only “probability scales” for lymph nodes are not recommended in routine reports. Three practical tables summarize PET incidental findings, lymph node reporting frameworks, and LDCT incidental findings, and two structured report templates are provided (concise and extended), with the extended version explicitly labelling actionability tiers and escalation triggers. Finally, we outline concrete AI use cases for standardization and triage while emphasizing governance to avoid the amplification of false positives and paradoxical growth of cascades. Full article

Whole-body dynamic positron emission tomography/computed tomography (WBD-PET/CT) has transformed medical imaging, enabling the fusion between (i) detailed anatomical maps of the human body and (ii) quantitative multi-parametric functional maps of specific biochemical and physiological processes across the human body beyond the semi-quantitative limitations of static PET/CT imaging. Latest developments in systems hardware, particularly with the introduction of long-axial-field-of-view (LAFOV) and Time-of-Flight (TOF) PET scanners and low-dose CT scanners, and in data analysis, primarily with direct parametric PET image reconstruction and Artificial Intelligence, offer unprecedented opportunities towards the wide clinical adoption of the superior quantitative accuracy and precision of WBD-PET/CT imaging overcoming current challenges, such as data acquisition complexity and long scan durations. This review aims to summarize the latest developments, current challenges, and emerging opportunities in WBD-PET/CT, emphasizing its potential to broaden the diagnostic and theranostic role of PET/CT in clinical practice. Full article

A 74-year-old woman with a history of non-small cell lung cancer underwent 18F-FDG PET/CT to rule out recurrence of the disease. The whole-body scan revealed a nodule in the left upper lobe of the lung that could not be unequivocally distinguished as either malignant or inflammatory. A segmental minimal activity (MA) PET/CT was performed for clarification, as it offers additional metabolic information without significantly increasing radiation exposure. Based on the MA-PET/CT scan and clinical findings, the nodule was classified as inflammatory. To the best of our knowledge, the use of MA-PET/CT in cases of suspected lung cancer recurrence has rarely been reported so far. Full article

Prostate cancer (PCa) is predominantly an acinar adenocarcinoma arising from the prostatic glandular epithelium, with tumor grade assessed using the International Society of Urological Pathology (ISUP) Grade Group classification, reflecting the degree of glandular differentiation and underlying molecular heterogeneity. PCa exhibits wide clinical behavior heterogeneity, ranging from indolent disease to aggressive forms with poor outcomes. Accurate prognostic assessment is, therefore, essential for guiding treatment selection and monitoring disease progression. This review examines recent advances in imaging and non-imaging biomarkers that contribute to improved risk stratification, treatment planning, and disease monitoring. Particular attention is given to multiparametric magnetic resonance imaging (mpMRI), whole-body magnetic resonance imaging (WB-MRI), positron emission tomography/computed tomography (PET/CT), positron emission tomography/magnetic resonance imaging (PET/MRI), computed tomography (CT), and transrectal ultrasound (TRUS), evaluated for their capacity not only to detect disease but also to predict recurrence, progression, and survival outcomes. In parallel, the prognostic role of non-imaging biomarkers is discussed, including the prostate-specific antigen (PSA), histopathological grading, biochemical and inflammatory biomarkers, as well as genomic classifiers and circulating tumor DNA (ctDNA). Emerging approaches such as radiomics, liquid-biopsy-derived molecular profiles, and artificial intelligence (AI)-based multimodal integration are highlighted for their potential to enhance individualized decision making. This review underscores the importance of combining imaging and molecular information to refine prognostic models and accelerate the translation of precision medicine in PCa. Full article

Background/Objectives: Pancreatic cancer (PC) should be diagnosed in its early stages. Therefore, it is necessary to identify high-risk individuals of PC. Methods: Between 2001 and 2017, 1542 PC cases were diagnosed at two tertial care institutions. Of these, 117 cases had undergone abdominal contrast-enhanced computed tomography (CE-CT) 1–10 years before PC diagnosis and were classified as the PC group. Meanwhile, 43,102 cases underwent abdominal CE-CT for close examination of non-pancreatic diseases in the same period, of which 1170 were randomly selected. Of these, 117 cases were matched to the PC group with the propensity score and designated the non-PC group. Pancreatic volumetry was performed using the 3D image analysis system for abdominal CE-CT in both groups and various measurements were compared. In PC group, CE-CT taken 1–10 years before the onset of PC was analyzed. Results: After propensity score matching, baseline characteristics did not significantly differ between the two groups. The whole pancreatic volume/body surface area (BSA) (p = 0.014), volume of main pancreatic duct (MPD) plus cystic lesion/BSA (p < 0.001), volume of pancreatic parenchyma/BSA (p = 0.002), ratio of cross-sectional areas (p = 0.033), and MPD diameter/BSA (p < 0.001) significantly differed between the two groups. In subgroup analysis of patients without cystic lesions, the whole pancreatic volume/BSA, volume of MPD/BSA, volume of pancreatic parenchyma/BSA, ratio of cross-sectional areas, and MPD diameter/BSA significantly differed between the two groups. Conclusions: Pancreatic volumetry could identify patients at high risk of PC. Full article

Introduction: Idiopathic rhinitis (IR) is one of the most common causes of chronic nasal discharge in dogs. It is a diagnosis of exclusion requiring a comprehensive diagnostic work-up to rule out other differentials. To investigate a possible allergic etiology, allergen-specific IgE antibody superclasses were evaluated. Methods: Dogs with chronic nasal discharge underwent blood testing, whole-body CT, and detailed evaluation of the nasal cavity. Dogs with systemic diseases or corticosteroid treatment within two weeks prior to presentation were excluded. Results: A total of 46 dogs were included: 13 IR, 10 malignant tumors, six benign tumors, eight other inflammatory nasal diseases, and nine controls. All IR dogs were non-brachycephalic and of various breeds. No correlation was found between sinusitis, turbinate destruction, culture-based bacteriology, or IgE positivity. A similarly high number of positive IgE results was observed across all groups. Regarding treatment and follow-up, compared to dogs with other nasal diseases, compliance among IR dog owners was comparably poor. Conclusions: Allergen-specific IgE may be elevated in dogs with IR; however, they are neither diagnostic nor predictive. As owners often perceive the disease as a harmless cold, awareness must be raised about the nasal functions in dogs and possible consequences of untreated nasal discharge. Full article

This study analyzes whole-body vibration (WBV) exposure of an agricultural tractor operator during three different primary tillage systems: Standard Tillage (ST), Conservation Tillage Deep (CTD), and Conservation Tillage Shallow (CTS). Measurements were conducted in accordance with ISO 2631-1 and ISO 2631-4 along three orthogonal axes (x, y and z) at the operator’s seat. Descriptive and inferential statistical analyses indicate that while none of the mean vibration values exceeded the regulatory limit value of 1.15 m/s² defined in Directive 2002/44/EC, several measurements—particularly in the y-axis during ST (0.715 m/s²)—surpassed the exposure action value of 0.5 m/s². These findings suggest that prolonged daily exposure under similar operational conditions may pose long-term health risks for tractor operators. The highest mean WBV values were recorded in the x- and y-axes during CTS (0.354 m/s² and 0.446 m/s², respectively), whereas the z-axis exhibited the highest values during ST (0.426 m/s²). Conservation Tillage Deep (CTD) demonstrated the most favorable vibration profile in the vertical axis (0.344 m/s²), indicating its potential dual benefit for soil structure preservation and operator ergonomics. Although all measured values remained below the regulatory limit, the frequent exceedance of the action value underscores the importance of exposure time management, regular maintenance of suspension systems, and implement selection as practical mitigation strategies. This comparative assessment provides baseline WBV data for reduced-tillage systems on hydromorphic soils and offers axis-specific guidance for optimizing operator comfort in sustainable mechanization practices. Full article

We evaluated global radiotherapy practices in the management of early-stage (AJCC/UICC 8th edition stages I-II) glottic cancer (ESGC). A cross-sectional online survey was conducted in March 2025 across centers worldwide. Data was collected on clinical practices, including staging, CT simulation, target volumes delineation, organs-at-risk contouring, radiotherapy techniques, dose and fractionation schedules, treatment delivery techniques, and image guidance practices. A total of 181 responses were received, primarily from Asia (41.4%) and Europe (24.3%). Most respondents were from non-academic public centers (44.2%), with multidisciplinary team involvement reported by 84.5%. Head and neck CT scan was the most used staging modality (80.1%). Intensity-Modulated Radiation Therapy was the most common planning technique (82.9%). Hypofractionated radiotherapy schedules predominated for T1 (84%) and T2 (72.4%) disease. T1a was typically treated with whole-larynx target volume (72.4%). Use of ipsilateral involved vocal cord irradiation varied by geographical region (p = 0.015), being most common in North America (44.8%) and Europe (38.6%). Accelerated fractionation for T2 also differed significantly (p < 0.001), with the highest use reported in North America (41.4%). Daily Cone-Beam Computed Tomography was acquired by (58.2%). In total, 70% of respondents expressed interest in the results of a future phase III randomized trial comparing stereotactic body radiation therapy to conventional radiotherapy. Significant global variations in radiotherapy practices for ESGC were observed, likely reflecting disparities in access and differences in institutional protocols. The development and implementation of standardized, evidence-based global guidelines are essential to harmonize care, minimize toxicity, and improve outcomes for patients with ESGC. Full article

(1) Background: Creutzfeldt–Jakob disease (CJD) is a progressive neurodegenerative disorder, characterized by cognitive decline, and motor and psychiatric symptoms; it primarily affects the central nervous system; however, peripheral nervous system involvement has rarely been described, particularly as an atypical presentation. (2) Methods: A 78-year-old Caucasian man, a retired farmer with no family history of neurological disease, presented with diarrhea followed by progressive lower limb weakness, which eventually evolved into encephalopathy and generalized areflexia. An initial diagnosis of inflammatory neuropathy was considered; the diagnostic assessment included blood and cerebrospinal fluid testing, a CT whole body scan, brain MRI, neuropsychological testing, electroencephalography, a nerve conduction study and electromyography. (3) Results: Neurophysiological studies demonstrated an acute asymmetrical sensorimotor, predominantly axonal polyneuropathy, initially suggestive of an axonal form of inflammatory polyradiculoneuritis. This pattern was confirmed on follow-up neurophysiological assessment performed three weeks later. Unexpectedly, the diagnostic course ultimately led to a diagnosis of sporadic Creutzfeldt–Jakob disease, confirmed by post-mortem neuropathological examination. Based on these findings, we conducted a literature review to summarize the current evidence on CJD-related neuropathy. (4) Conclusions: Our case emphasizes the importance of maintaining clinical suspicion for CJD even in patients presenting with progressive lower limb weakness and suggests that peripheral neuropathy may be concomitant or even precede the CNS manifestations. Careful consideration is required to avoid misdiagnosis of inflammatory neuropathy in the context of neurodegenerative diseases such as CJD. Full article

Objectives: The aim of this study was to determine differences in injury types and frequencies between piston-based and band-based automated chest compression devices in patients with non-traumatic out-of-hospital cardiac arrest (OHCA) at a German cardiac arrest center. Methods: This retrospective single-center study assessed resuscitation-related injuries in OHCA patients using protocol-based early whole-body CT scans at hospital admission. CT scans were reviewed independently by two reviewers blinded to the compression device used. Between May 2015 and September 2021, all patients resuscitated from non-traumatic OHCA, treated with a mechanical chest compression device, and showing stable return of spontaneous circulation (ROSC) until CT examination according to the institutional standard operating procedure for all OHCA patients were included. Patients were categorized by compression device type, and group differences were analyzed using the Chi-square test and Mann–Whitney U test. In addition, patient-level incidences of rib fracture types were calculated, and risk ratios with corresponding 95% confidence intervals were used to compare rib fracture patterns between groups. A p-value of <0.05 was considered statistically significant. Results: Among 71 patients, 32 received band-based and 39 piston-based treatment. Both groups were comparable in resuscitation duration, body constitution, and gender ratio, although the band-based group was older. Thoracic injuries predominated, with rib fractures representing the most frequent injury pattern (64/71, 90.1%). The median number of rib fractures per patient was 10 (IQR 8–12) in the band-based group and 9 (IQR 7–12) in the piston-based group. The band-based group had significantly more liver lacerations (5/32, 15.6% vs. 0/39, 0%; p = 0.01) and displaced rib fractures (117 vs. 87; p = 0.046; patient-level RR = 1.43, 95% CI 1.06–1.93). Conclusions: In this observational study of a CT-based cohort of OHCA patients with stable ROSC, the band-based device was associated with significantly higher frequencies of liver lacerations and displaced rib fractures than the piston-based device. These findings should be interpreted as hypothesis-generating and may support further evaluation of device-specific injury profiles in future studies. Full article

In this experiment, we used a late 17th century embalming protocol for the long-term preservation (7.2 years) of an infant-sized piglet in order to evaluate the success of this technique over a period of several years. According to the description of the French anatomist Penicher (published in 1699), an 8.8 kg female piglet corpse was treated with a broad spectrum of herbs, seeds, leaves, flowers and dried berries, along with an alcohol-based fluid following subtotal exenteration and a reduction in peripheral muscle mass. The further process of this dry embalming technique was monitored by visual, tactile and olfactory evaluation of the embalmed body, along with a record of the body weight. Repeatedly taking samples from the skin and soft tissues provided insight into eventual changes on a histomorphological level and two whole-body CT scans complemented the evaluation of the internal changes within the corpse, which was eventually examined at autopsy. On the macroscopic level, we recorded slight signs of autolysis and very mild putrefaction within the first few weeks and a very well preserved and stable body over the subsequent years of evaluation. In parallel, we noted a gradual loss of fluid, as shown by a reduction in the body weight. This occurred faster in the first year (reduction in body weight by ca. 25%) than in the following ca. 4 years (with another ca. 25% loss of body weight). The CT scans showed stable osseous and soft tissue structures, while the few remaining internal organs that had been left inside the body after initial evisceration (such as kidneys and internal genitalia) had already completely disappeared after approx. 1 year. On the histological level, the histoanatomy of skin, subcutis and muscle remained intact over the entire observation period. A loss of epidermal cell nuclei was not noted before day 1772 and there were only slight signs of adipocire formation of fat tissue at the end point of observation (day 2634). In summary, we can confirm that excellent body preservation of external skin and soft tissue was maintained over a considerably long period (in this case, 7.2 years) using the applied protocol of dry embalming, but a complete loss of residual internal organs/structures beyond skin, subcutaneous fat tissue and muscle. Previous observations of the excellent preservation of an infant mummy that underwent the dry embalming procedure are very plausible. Full article

Background: Extracranial metastasis (EM) from glioblastoma (GB), IDH-wildtype (WHO CNS 2021 grade 4) is rare and often under-recognized, yet it has immediate implications for staging and management. We report a case series integrating advanced neuroimaging, whole-body imaging, and pathology/biomarkers to characterize imaging–pathology correlates of EM and highlight practical clinical triggers that should prompt systemic evaluation. Case presentation: We report three patients with adult-type, IDH-wildtype GB who developed EM confirmed by cytology/histology and/or concordant multimodality imaging. Brain MRI (1.5T/3T) demonstrated aggressive primary tumors with qualitative elevation of DSC-perfusion and frequent tumor–surface contact (dural, ependymal/leptomeningeal contact). Intratumoral susceptibility signal reached grade 3 where assessed. All patients underwent surgical resection followed by temozolomide-based chemoradiation; two received fotemustine and bevacizumab, and one underwent re-irradiation. EM presented with clinical triggers including severe axial/back pain, palpable cervical masses, and/or cytopenias. Initial EM sites were bone marrow/vertebrae (n = 1) and cervical lymph nodes (n = 2); staging revealed additional osseous disease in both nodal cases and a small pulmonary nodule in one. Nodal and osseous lesions were FDG-avid on 18F-FDG PET/CT. OLIG2-positive cytology confirmed cervical nodal metastases, and bone marrow aspiration with GFAP/OLIG2 positivity confirmed medullary infiltration. All tumors shared a molecular profile of TERT-promoter mutation, ATRX wild-type, TP53 mutation, and MGMT-promoter methylation. Despite attempts at second- and third-line therapies, disease progression was rapid, and all patients succumbed within 8–16 months of diagnosis. Discussion: This series underscores that EM can occur despite MGMT-promoter methylation and supports the concept of heterogeneous metastatic phenotypes in GB. Our cases reinforce that new axial/back pain or hematologic abnormalities may signal osseous or marrow involvement, and necrotic cervical lymphadenopathy in GB patients warrants dedicated imaging and tissue confirmation with glial markers. Integrating brain MRI features (high perfusion, surface contact, susceptibility burden) with FDG-PET/CT and targeted cytology/pathology can expedite diagnosis and inform multidisciplinary care. Conclusions: EM can arise despite MGMT-promoter methylation in IDH-wildtype GBM. Imaging red flags (high perfusion, surface contact, necrotic/FDG-avid cervical nodes) and clinical cues (axial pain, cytopenias, neck masses) should prompt early systemic staging (CT/PET-CT) and targeted tissue confirmation to advance management. Full article

Lumbar oblique radiography plays a crucial role in diagnosing spinal disorders, particularly spondylolysis and spondylolisthesis. Achieving optimal projection angles remains challenging due to variability in positioning techniques and subjective quality assessment. This study presents a deep learning framework for automatic angle estimation in lumbar oblique X-ray images using a two-stage object detection approach. Training data consisted of synthetic X-ray images generated from CT datasets with known projection angles (20° to 60°), annotated with three classes: L2–L4 vertebral levels, vertebral bodies, and pedicles. Two detection models were compared: Model1, a three-class whole-image detector, and Model2, a single-class pedicle detector applied to vertebral body crops from Model1. The Vertebral–Pedicle Ratio (VPR) was used to estimate projection angle via separate linear regression for negative-angle (n-group) and positive-angle (p-group) projections. Five-fold cross-validation showed Model2 achieved higher detection performance (macro mean AP@0.5 = 0.913, mean DSC = 0.825) than Model1 (macro mean AP@0.5 = 0.762, mean DSC = 0.791). Pooled regression yielded R²_n = 0.832 and R²_p = 0.870. Angle estimation with Model2 achieved MAE = 5.42° (SD 1.08°), substantially lower than Model1 (MAE = 9.57°, SD 1.64°), while Model1 offered faster throughput (18.3 FPS vs. 2.9 FPS). Two-stage pedicle detection using VPR-based linear regression provides clinically acceptable angle estimation accuracy in lumbar oblique radiography. Automated angle verification enables real-time positioning feedback during imaging, post-imaging image quality documentation in PACS, and retrospective auditing of facility positioning protocols. These comprehensive implementations are expected to standardize lumbar oblique radiography. Full article

Background and aim: Recent preclinical studies have confirmed that inhibiting the MAP kinase pathway can induce the re-differentiation of radioiodine (RAI)-refractory (RAIR) follicular cell thyroid cancers (TCs). The aim of this trial is to investigate whether the combination of kinase inhibitors (KIs) with myo-inositol (MI) can induce or potentiate the re-uptake of RAI in cancer cells. Overview and methods: This is an open label, non-pharmacological, multicenter, randomized pilot study. Patients will be divided into two groups: (1) a control group in which patients are treated with KIs (subgroup a: trametinib plus dabrafenib; subgroup b: lenvatinib); (2) a group in which patients (divided into the two subgroups) are treated with the same KIs in addition to MI. After 30 days of MI treatment, all patients, treated with levothyroxine (L-T4) at a semi-suppressive dosage as per clinical practice, will be stimulated with recombinant human TSH (rhTSH) (days 31 and 32). On day 35, the patients will be subjected to whole-body scintigraphy, with hybrid imaging where possible (SPECT/CT), after the administration of diagnostic activity (185–222 MBq of 123-I in accordance with the SNMMI/EANM guidelines. Blood samples will be collected before starting MI therapy (day 0); after 30 days of MI therapy; and then on days 31, 32, 33, 34, and 35 after MI therapy. Quality of life (QoL) will be assessed at the beginning of the MI treatment and at the end of its administration. The primary endpoint is the restoration of 123-I uptake in RAIR-TC patients already on KI therapy alone and on KI therapy plus MI. The restoration of 123-I uptake in target lesions will be evaluated. Conclusions: MI may have a synergistic effect at the cellular level, and the possible increase in the re-differentiation of RAIR-TC in patients treated with KIs plus MI may have great clinical relevance. The re-uptake of RAI will be evaluated as the primary endpoint, and Tg values and QoL will be evaluated as the secondary endpoints. The main limitation of this study is that we do not investigate any clinical effects. We will have to postpone the clinical analysis to a later date after the administration of RAI for therapeutic purposes. Full article