治疗剂量131 I-SPECT／CT断层融合显像诊断分化型甲状腺癌转移灶的价值

摘要

Objective To compare 131 I whole body scan(Rx-WBS)and SPECT/CT imaging after131 I therapy for detecting metastatic lesions from differentiated thyroid carcinoma in patients with thyroglobulin elevation but negative iodine scintigraphy.Methods This study re-viewed 49 patients with thyroglobulin elevation but negative iodine scintigraphy from differentiated thyroid carcinoma[1 1 men and 39 women, 2 follicular and 47 papillary thyroid cancer,age 12~73(46 ±17)years]who underwent Rx-WBS and SPECT/CT imaging after 131 I therapy (7 days after administration).The dosage of 131 I were 7400MBq.Investigated the utility of post-therapeutic SPECT/CT imaging for detecting metastatic lesions.Results In the visual analysis,Rx-WBS show the lesions of 16 patients(32.7%):Thyroid remnants in 1 patient,distant metastasis in 15 patients(30.6%),Including the lymph node metastases in 1 1 patients (3 cases for multiple lesions),lung metastasis in 1 patient,and bone metastasis in 1 patient,2 cases of suspicious lesions.Through 131 I-SPECT/CT fusion image,All of the above Positive lesions were detected;6 cases with metastatic lesions were new found(42% detection rate of metastases).Conclusions Rx-WBS can increase the detection of metastases in patient with DTC with thyroglobulin elevation but negative iodine scintigraphy.Delayed post-therapeutic SPECT/CT fusion imaging showed a higher detection rate than Rx-WBS.%目的：评价治疗剂量的131 I-SPECT/CT断层融合显像检测血清甲状腺球蛋白升高（Tg＋）而诊断剂量131 I全身显像阴性（Dx-WBS-）的分化型甲状腺癌（DTC）转移灶的价值。方法回顾性分析49例血清Tg＋DxWBS-的DTC患者（滤泡状2例，乳头状47例），给予盲法大剂量131 I（7400MBq）治疗后第7天行131 I-全身显像（Rx-WBS）和头颈部、胸部131 I-SPECT/CT断层融合显像，在病灶水平分析131 I-SPECT/CT断层融合图像对 DTC 定位和定性诊断情况。结果治疗剂量131 I 全身显像显示阳性病例16例（32．7％），其中甲状腺残留1例，转移灶15例（30．6％）。经过131 I-SPECT/CT断层融合显像均检测出上述转移灶，同时新发现6例患者的转移灶，转移灶检出率42．9％。结论 Rx-WBS可检测出部分Tg＋DxWBS-的DTC患者的转移灶；对Tg＋DxWBS-的DTC患者常规行头颈部、胸部131 I-SPECT/CT断层融合图像可提高Tg＋DxWBS-的DTC患者的转移灶的诊断准确率。