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分化型甲状腺癌(differentiated thyroid carcinoma,DTC)包括乳头状癌和滤泡状癌,占甲状腺恶性肿瘤的80%以上,其侵袭性较低,预后常较好[1],但仍有1%~7%的乳头状癌和5%~20%的滤泡状癌在初诊时就已发生远处转移[2]。DTC最常见的远处转移部位是肺,DTC肺转移常较隐匿,缺乏特异性的临床症状,有研究结果表明131I治疗DTC肺转移的缓解率达47%[3],因此早期发现肺转移病灶有利于调整131I剂量,改善预后。
有研究结果表明术后诊断性131I全身显像有助于发现残留甲状腺以及转移灶,但因其可造成“顿抑现象”而限制了应用[4]。为避免“顿抑现象”,近年来99TcmO4-显像被广泛应用于131I治疗前。既往研究大多集中于99TcmO4-显像对于术后残留甲状腺的诊断[5-6],而对于转移灶的研究则较少,一些个案显示仅有少数转移灶可摄取99TcmO4- [7-8]。而近期一些对照性研究结果显示99TcmO4-全身显像联合局部断层融合显像对于转移灶的发现有一定意义[9-10],但其中肺转移灶的病例数较少。因此我们主要探讨99TcmO4-全身显像联合颈胸SPECT/CT在DTC术后肺转移灶检出中的应用,旨在提高肺转移灶的检出率。
99TcmO4-全身显像联合颈胸SPECT/CT在DTC患者术后肺转移灶显影中的应用
Effectiveness of 99Tcm-pertechnetate whole body scan with neck and chest SPECT/CT for the detection of post-surgical pulmonary metastasis in differentiated thyroid carcinoma patients
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摘要:
目的探讨99TcmO4-全身显像联合颈胸SPECT/CT在分化型甲状腺癌(DTC)术后肺转移灶检出中的应用。 方法回顾性分析2013年1月至2016年1月收治的34例DTC肺转移患者在术后131I治疗前的99TcmO4-全身显像联合颈胸SPECT/CT中肺转移灶的检出情况,计算99TcmO4-全身显像联合颈胸SPECT/CT检出肺转移灶的灵敏度、阳性预测值,并评估其对治疗决策的影响。 结果34例肺转移患者中,2例表现为阳性(放射性浓聚+结构异常),10例表现为可疑阳性(仅有典型肺转移CT表现),22例表现为可疑阴性,若将可疑阳性与阳性均视为阳性发现,则99TcmO4-全身显像联合颈胸SPECT/CT发现肺转移灶的灵敏度为35.3%(12/34),阳性预测值为100%(12/12),11例患者在后续的131I治疗中增加了剂量。 结论99TcmO4-全身显像联合颈胸SPECT/CT能发现部分无99TcmO4-浓聚的肺转移灶,提高了肺转移灶的检出率;指导临床调整131I治疗剂量,改善预后。 -
关键词:
- 甲状腺肿瘤 /
- 肿瘤转移 /
- 99m锝高锝酸钠 /
- 单光子发射计算机体层摄影术
Abstract:ObjectiveTo evaluate the effectiveness of 99Tcm-pertechnetate whole body scan with neck and chest SPECT/CT for detecting post-surgical pulmonary metastasis in differentiated thyroid carcinoma(DTC) patients. MethodsA total of 34 DTC patients were evaluated retrospectively. The patients underwent 99Tcm-pertechnetate whole body scan with neck and chest SPECT/CT after surgery and before 131I treatment. The sensitivity and positive predictive value of this imaging in detecting pulmonary metastasis were calculated. Moreover, its impact on formulating therapeutic schedule was analyzed. ResultsTwo of the 34 patients were defined as positive, which was manifested as an anatomical finding from CT with increased radiotracer uptake. Ten patients were equivocal positive, which was manifested as typical abnormal anatomical localization of lung metastasis without radiotracer uptake. The remaining 22 patients were considered as equivocal negative. Considering positive and equivocal results as positive findings, the sensitivity of the 99Tcm-pertechnetate whole body scan with neck and chest SPECT/CT in detecting pulmonary metastasis was 35.3%(12/34), and its positive predictive value was 100%(12/12). Consequently, 11 of 34 patients received increased radioactive dosage in the subsequent 131I treatment. ConclusionsMost pulmonary metastasis of DTC manifested as no radiotracer uptake in 99Tcm-pertechnetate planar imaging, and bigger lesions tended to show positive pertechnetate uptake. 99Tcm-pertechnetate whole body scan with neck and chest SPECT/CT could detect several pulmonary metastasis lesions which showed no pertechnetate uptake. Thus, this process can increase the positive detection rate of pulmonary metastasis lesions and adjust the treatment program of some patients. -
图 1 甲状腺乳头状癌肺转移患者99TcmO4- SPECT/CT显像图 患者女性,47岁。图中,A:平面显像图像示右肺下叶见放射性浓聚影;B、C、D:肺部局部断层图及断层融合显像横断面、矢状面、冠状面图像示右肺下叶基底段见一结节影,伴显像剂浓聚;99TcmO4-:99m锝高锝酸钠;SPECT/CT:单光子发射计算机体层摄影术。
Figure 1. 99Tcm-pertechnetate SPECT/CT images of a differentiated thyroid cancer patient diagnosed with pulmonary metastasis(female, 47 years old)
图 2 甲状腺乳头状癌肺转移患者局部99TcmO4- SPECT/CT显像图及治疗后局部131I SPECT/CT显像图 患者女性,47岁(与图 1为同一患者)。图中,A:99TcmO4- SPECT/CT显像示右肺下叶基底段结节(直径约1.8 cm)伴显像剂浓聚(白色细箭头所示);B:99TcmO4- SPECT/CT显像示左肺上叶前段结节(直径约0.4 cm)不伴显像剂浓聚(白色粗箭头所示);C:治疗后131I SPECT/CT显像示右肺下叶基底段结节伴显像剂浓聚(绿色细箭头所示);D:治疗后131I SPECT/CT显像示左肺上叶前段结节伴显像剂浓聚(绿色粗箭头所示)。99TcmO4-:99m锝高锝酸钠;SPECT/CT:单光子发射计算机体层摄影术。
Figure 2. 99Tcm-pertechnetate SPECT/CT images and post-treatment 131I SPECT/CT images of the same patient in Fig. 1
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