~(131)I SPECT/CT评价分化型甲状腺癌患者~(131)I清甲后的甲状舌管残留
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摘要
目的评价~(131)I SPECT/CT判断DTC患者清甲治疗时甲状舌管的存在情况及其对~(131)I治疗的影响。方法回顾性分析127例以~(131)I清甲为目的 DTC术后患者,男29例,女98例,平均年龄39. 7±12. 8岁,~(131)I治疗前停用左甲状腺素钠3周以上,测得刺激后血清TSH、Tg和TgAb水平,完成颈部~(99)Tc~mO_4~-显像,治疗剂量为(384. 0±64. 3)×10~7Bq(103. 90±17. 37mCi)。服~(131)I后72～96小时内完成颈胸部SPECT/CT融合显像。结果 127例患者中,SPECT/CT显示有甲状舌管残留58例,无甲状舌管残留69例。有或无甲状舌管残留人群的刺激后Tg分别为5.31 pmol/L(3.05～14.26 pmol/L和3.58pmol/L(2.15～7.10 pmol/L),~(131)I治疗剂量分别为(389.0±64.3)×10~7Bq(105.17±17.37 mCi)和(381.2±64.8)×10~7Bq(102. 90±17. 51 mCi)。有或无甲状舌管残留人群在年龄、性别、病理类型、刺激后Tg-Ab和~(131)I治疗剂量等方面均无明显差异,但前者的刺激后Tg要明显高于后者(Z=2.435,P=0.015)。~(99m)TcO4~-显像示甲状舌管残留者42例,无甲状舌管残留者85例;以SPECT/CT结果为诊断标准,则~(99)Tc~mO_4~-显像诊断甲状舌管的敏感性、特异性和准确性分别为67. 2%、95.7%和82. 7%。结论甲状舌管残留在DTC术后接受~(131)I清甲治疗的人群中较常见,~(131)I SPECT/CT显像有助于判断甲状舌管的残留情况、指导诊疗策略的正确制定。
Objective To investigate the clinical value of thyroglossal tract thyroid tissue using SPECT/CT fusion imaging in DTC patients. Methods 127 patients(29 males and 98 females) underwent the first ~(131)I ablation were included in our study. The average age of patients was 39.7 ± 12. 8. All patients were prepared with thyroid hormone withdrawal for at least three weeks and measured the levels of serum TSH,Tg and TgAb. These patients underwent 99 Tcm0_4~-neck planar imaging. 72-96 hours after the oral therapeutic 131 I,and131 I dose was(384. 0 ± 64. 3) x 10~7 Bq(103. 90 ± 17. 37 mCi). All patients undertook 131 I SPECT/CT regional fusion imaging. Results Of all 127 patients,thyroglossal tract thyroid tissue was present on the images of SPECT/CT fusion imaging for 58 patients. 69 patients did not have thyroglossal tract on SPECT/CT.Based on the results of SPECT/CT, the stimulated serum Tg of patients with or without thyroglossal tract were 5.31 pmol/L(3.05-14. 26 pmol/L) and 3.58 pmol/L(2.15-7.10 pmol/L). The doses of ~(131)I were(389.0 ±64.3) ×10~7 Bq(105. 17 ± 17. 37 mCi) and(381. 0 ±64. 8) x 10~7 Bq(102. 90 ± 17. 51 mCi).There weren' t significant differences of age, gender, pathology and stimulated TgAb and dose of ~(131)I,however,the level of stimulated Tg was higher in patients with thyroglossal tract than that of the patients without thyroglossal tract. According to the results of SPECT/CT, the sensitivity, specificity and accuracy of99 Tcm04-imaging were 67.2% 、95. 7% and 82. 7%, respectively. Conclusion Thyroglossal tract thyroid tissue is present in nearly one half of our study population.~(131)I regional SPECT/CT fusion imaging can provide valuable information to evaluate the present of thyroglossal tract and guide the treatment.
Objective To investigate the clinical value of thyroglossal tract thyroid tissue using SPECT/CT fusion imaging in DTC patients. Methods 127 patients(29 males and 98 females) underwent the first ~(131)I ablation were included in our study. The average age of patients was 39.7 ± 12. 8. All patients were prepared with thyroid hormone withdrawal for at least three weeks and measured the levels of serum TSH,Tg and TgAb. These patients underwent 99 Tcm0_4~-neck planar imaging. 72-96 hours after the oral therapeutic 131 I,and131 I dose was(384. 0 ± 64. 3) x 10~7 Bq(103. 90 ± 17. 37 mCi). All patients undertook 131 I SPECT/CT regional fusion imaging. Results Of all 127 patients,thyroglossal tract thyroid tissue was present on the images of SPECT/CT fusion imaging for 58 patients. 69 patients did not have thyroglossal tract on SPECT/CT.Based on the results of SPECT/CT, the stimulated serum Tg of patients with or without thyroglossal tract were 5.31 pmol/L(3.05-14. 26 pmol/L) and 3.58 pmol/L(2.15-7.10 pmol/L). The doses of ~(131)I were(389.0 ±64.3) ×10~7 Bq(105. 17 ± 17. 37 mCi) and(381. 0 ±64. 8) x 10~7 Bq(102. 90 ± 17. 51 mCi).There weren' t significant differences of age, gender, pathology and stimulated TgAb and dose of ~(131)I,however,the level of stimulated Tg was higher in patients with thyroglossal tract than that of the patients without thyroglossal tract. According to the results of SPECT/CT, the sensitivity, specificity and accuracy of99 Tcm04-imaging were 67.2% 、95. 7% and 82. 7%, respectively. Conclusion Thyroglossal tract thyroid tissue is present in nearly one half of our study population.~(131)I regional SPECT/CT fusion imaging can provide valuable information to evaluate the present of thyroglossal tract and guide the treatment.
引文
[1] KIM D W, JUNG S L, BAEK J H, et al. The prevalence and features of thyroid pyramidal lobe, accessory thyroid, and ectopic thyroid as assessed by computed tomography:a multicenter study[J].Thyroid,2013,23(1):84-91.
[2] LEE S W, LEE J, LEE H J, et al. Enhanced scintigraphic visualization of thyroglossal duct remnant during hypothyroidism after total thyroidectomy:prevalence and clinical implication in patients with differentiated thyroid cancer[J]. Thyroid, 2007, 17(4):341-346.
[3]程旭,李永军,徐兆强,等.SPECT/CT显像对~(131)I治疗分化型甲状腺癌患者的临床意义[J].标记免疫分析与临床,2017,24(5):481-485.
[4]程旭,李永军,徐兆强,等.~(131)I SPECT/CT断层融合显像评价分化型甲状腺癌远处转移的临床研究[J].肿瘤影像学杂志,2017,26(5):371-374.
[5]程旭,李永军,徐兆强,等. SPECT/CT诊断分化型甲状腺癌~(131)I清甲治疗后淋巴结转移及ROC分析[J].医学影像学杂志,2017,27(1):36-39.
[6] BARBER T W,CHERK M H.TOPLISS D J,et al. The prevalence of thyroglossal tract thyroid tissue on SPECT/CT following(131):I ablation therapy after total thyroidectomy for thyroid cancer[J]. Clin Endocrinol(Oxf),2014,81(2):266-270.
[7] ALTAY C, ERDO G AN N, KARASU S, et al. CT and MRI findings of developmental abnormalities and ectopia varieties of the thyroid gland[J]. Diagn Interv Radiol,2012,18(4):335-343.
[8] LEE S W. SPECT/CT in the Treatment of Differentiated Thyroid Cancer[J]. Nucl Med Mol Imaging,2017,51(4):297-303.
[9] SOOD A, KUMAR R. The ectopic thyroid gland and the role of nuclear medicine techniques in its diagnosis and management[J].Hell J Nucl Med,2008,11(3):168-171.
[10] JUNG J S,LEE S M,KIM S J,et al. Prediction of the success of thyroid remnant ablation using preablative 99mTc pertechnetate scintigraphy and postablative dual 1311 scintigraphy[J]. Nucl Med Commun,2015,36(1):38-44.
[2] LEE S W, LEE J, LEE H J, et al. Enhanced scintigraphic visualization of thyroglossal duct remnant during hypothyroidism after total thyroidectomy:prevalence and clinical implication in patients with differentiated thyroid cancer[J]. Thyroid, 2007, 17(4):341-346.
[3]程旭,李永军,徐兆强,等.SPECT/CT显像对~(131)I治疗分化型甲状腺癌患者的临床意义[J].标记免疫分析与临床,2017,24(5):481-485.
[4]程旭,李永军,徐兆强,等.~(131)I SPECT/CT断层融合显像评价分化型甲状腺癌远处转移的临床研究[J].肿瘤影像学杂志,2017,26(5):371-374.
[5]程旭,李永军,徐兆强,等. SPECT/CT诊断分化型甲状腺癌~(131)I清甲治疗后淋巴结转移及ROC分析[J].医学影像学杂志,2017,27(1):36-39.
[6] BARBER T W,CHERK M H.TOPLISS D J,et al. The prevalence of thyroglossal tract thyroid tissue on SPECT/CT following(131):I ablation therapy after total thyroidectomy for thyroid cancer[J]. Clin Endocrinol(Oxf),2014,81(2):266-270.
[7] ALTAY C, ERDO G AN N, KARASU S, et al. CT and MRI findings of developmental abnormalities and ectopia varieties of the thyroid gland[J]. Diagn Interv Radiol,2012,18(4):335-343.
[8] LEE S W. SPECT/CT in the Treatment of Differentiated Thyroid Cancer[J]. Nucl Med Mol Imaging,2017,51(4):297-303.
[9] SOOD A, KUMAR R. The ectopic thyroid gland and the role of nuclear medicine techniques in its diagnosis and management[J].Hell J Nucl Med,2008,11(3):168-171.
[10] JUNG J S,LEE S M,KIM S J,et al. Prediction of the success of thyroid remnant ablation using preablative 99mTc pertechnetate scintigraphy and postablative dual 1311 scintigraphy[J]. Nucl Med Commun,2015,36(1):38-44.