Objective: Neck and thorax single photon emission computed tomography with computed tomography (SPECT-CT) improves the reliability of postablation 131 I whole-body scan (WBS) for differentiated thyroid cancer (DTC). The aim of this study was to assess the prognostic value for persistent or recurrent disease of postablation 131 I scintigraphy combining WBS and neck and thorax SPECT-CT with that of the previously known predictive factors. Methods: This is a single referral center prospective study with a median follow-up of 29 months. Postablation 131 I WBS and neck and thorax SPECT-CT were performed in 170 consecutive patients treated between 2006 and 2008. Stimulated serum thyroglobulin (Tg) and anti-thyroglobulin antibodies (TgAb) levels were measured. The impact on disease-free survival of age; gender; postablation 131 I scintigraphy; stimulated serum Tg level; T, N, and M status; and macroscopic lymph node involvement was assessed by univariate and multivariate analyses. Results: Persistent or recurrent disease was observed in 32 (19%) patients. In the whole group of patients, only positive WBS with SPECT-CT was related to an increased risk of persistent or recurrent disease (hazards ratio (HR)Z65.21, 95% confidence interval (CI)Z26.03-163.39, P!0.0001). In patients without TgAb (nZ146), both positive WBS with SPECT-CT (HRZ18.86, 95% CIZ5.02-70.85, P!0.0001) and serum Tg level R58 ng/ml (HRZ4.42, 95% CIZ1.18-16.53, PZ0.0271) were associated with an increased risk. Conclusion: In patients with DTC, the cross analysis of postablation 131 I scintigraphy with neck and thorax SPECT-CT and stimulated serum Tg level enables early assessment of the risk of persistent or recurrent disease.European Journal of Endocrinology 164 961-969