亚急性甲状腺炎患者甲状腺激素水平与超声及核素显像特点相关性研究

目的探讨亚急性甲状腺炎患者的甲状腺激素指标与超声及核素显像特点的相关性。方法回顾性分析2014年10月至2016年4月沈阳医学院附属中心医院收治的58例临床可疑亚急性甲状腺炎患者的临床资料。所有患者均进行超声及核素检查(甲状腺131I摄取率及甲状腺静态显像),同时测定血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(s TSH)水平。结果超声联合甲状腺核素静态显像诊断亚急性甲状腺炎的灵敏度、特异性及准确率分别为97.7%、92.8%及96.6%,较单独超声或单独甲状腺静态显像诊断效能高,差异有统计学意义(χ2=8.046,P<0.05)。FT3、FT4、s TSH水平分别为(8.36±5.30)pmol/L、(15.96±10.07)pmol/L、(2.66±3.67)m U/ml,甲状腺131I摄取率(24 h)为(12.41%±11.41%),甲状腺静态显像评分值为(1.07±0.89)分。FT3与FT4水平呈正相关(r=0.277,P<0.05),FT3、FT4与s TSH水平呈负相关(r=-0.553,P<0.05;r=-0.308,P<0.05);甲状腺131I摄取率与甲状腺静态显像评分值之间呈正相关(r=0.437,P<0.05)。结论超声联合131I摄取率及甲状腺静态显像可明显提高亚急性甲状腺炎的检出率;核素检查可能反映亚急性甲状腺炎不同时期细胞功能水平,有助于对患者病情状态的准确评估。     

核素显像对甲状腺结节的诊断价值

本文应用^99mTc洗脱液为显像剂，对90例甲状腺结节患者进行了核素显像，并全部与术后病理结果进行了对照分析，以观察各类甲状腺结节在显像图中的不同表现。     

彩色多普勒超声与99mTC核素SPECT显像鉴别良恶性甲状腺结节的价值分析

目的 分析高频彩超与核素显像检查甲状腺良恶性结节的影像特征,比较两者的优缺点,探讨两者联合应用的诊断价值.方法 对68个甲状腺结节的彩超与核素检查结果对照病理进行回顾性分析.结果 两种影像学检查方法都可以显示甲状腺的形态、位置、大小.68个结节,超声全部查出,核素扫描只能显示54个.超声对甲状腺结节的大小、结构及血流清晰的显示独具优势,尤其是小于1cm的结节、钙化及颈部淋巴结超声显示清晰,而核素则无法显示.核素显像可以反应甲状腺摄锝功能,通过“冷热温凉”的特性来判断结节的性质,特别是利用血流灌注显像或亲肿瘤显像可进一步区分结节的良恶性,本组病例超声诊断符合率86.7％;14例做了动态血流灌注显像,其诊断符合率为75％;38例“冷凉”结节均做了亲肿瘤显像,其诊断符合率为90.9％;二者结合诊断符合率提高为92.3％.超声难以显示甲状腺功能状态.超声表现的囊、实性结节和核素显示的“冷热温凉”特性之间无统计学意义.结论 彩超与核素两种影像学检查方法各有特点、优势和不足,结合使用可进一步提高甲状腺良恶性结节鉴别的准确率.     

超声与核素显像诊断甲状腺结节的对比研究

目的：探讨超声和核素显像法诊断甲状腺结节的价值。材料和方法：对比研究超声和核素显像诊断经手术病理证实的１００例甲状腺结节。结果：核素显像中,冷（凉）、温、热结节分别占７５％、１９％、６％;冷（凉）、温结节中甲状腺癌分别为８％和１１％,热结节中未见恶性存在。超声检查诊断甲状腺结节良恶性的敏感性６２５％、特异性９６７％、准确性９４％、阳性预测值６２５％、阴性预测值９６７％、假阴性３／８和假阳性３例。结论：甲状腺扫描能反映结节摄取９９ｍＴｃＯ４－功能,据此可判断肿瘤性质,但存在一定困难;超声对甲状腺结节具有定性诊断价值,但对恶性结节诊断时存在假阴性和假阳性。     

彩色多普勒超声对甲亢患者甲状腺血流分级与功能指标的关系研究

目的探讨彩色多普勒超声观察甲亢患者的血流分级与甲状腺功能指标之间的关系。方法将我院经过临床和实验室检查确诊为甲亢的患者78例,在做碘~(131)I治疗前进行甲状腺彩色多普勒超声检查和甲状腺血清学功能检测,根据彩色多普勒超声独立血流显像,将甲状腺实质血流分布情况分为1级和2级,分析甲状腺血流分级与甲状腺功能指标的游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)、抗甲状腺球蛋白体(Anti-TG)、抗甲状腺过氧化酶抗体(Anti-TPO)和促甲状腺素受体抗体(TRAb)有无相关性。结果甲亢的彩色多普勒超声血流分级与甲状腺功能指标中的FT3、FT4、TRAb有相关性,2级血流分布者较1级血流分布者表现出更高的FT3、FT4、TRAb水平。结论彩色多普勒超声血流分级与甲状腺功能指标之间存在一定的相关性,并可以作为甲亢患者诊断和治疗效果观察的一种影像学手段。     

131I治疗自主功能亢进性甲状腺腺瘤的疗效观察

自主功能亢进性甲状腺腺瘤又称甲状腺毒性腺瘤 ,与Graves病不同。13 1I治疗本病具有安全、有效、简便、无痛苦的特点。笔者自 1996年以来采用13 1I治疗甲状腺毒性腺瘤 43例 ,现报道如下。一、资料与方法1 临床资料。对 1996年 1月～ 2 0 0 2年 1月经FT3 、FT4 、TSH测定、甲状腺核素显像、B超等检查确诊为单发性甲状腺毒性腺瘤的 43例患者行13 1I治疗 ,其中男 15例 ,女 2 8例 ,年龄 3 8～ 75(55 3±9 5)岁。患者FT3 6 9～ 18 3 (10 6± 3 1)pmol L(正常参考值 3 5～ 6 5pmol L) ,FT42 7 1～ 74 8(45 2± 11 6)pmol L(正常参考值 …     

甲状腺上动脉流速与甲状腺素及腺体增生关系的超声研究

目的: 探讨各种甲状腺功能状态下甲状腺上动脉血流改变的原因.材料和方法: 回顾性分析30例甲状腺功能亢进,18例原发性甲状腺功能减低(13例桥本氏病),8例亚临床甲状腺功能减低,12例单独性甲状腺肿大但功能正常,20例正常人FT3,FT4,TSH和甲状腺大小与甲状腺上动脉血流Vmax的相关性.结果: 甲状腺功能亢进组和桥本氏病甲状腺功能减低组、亚临床甲状腺功能减低组的甲状腺上动脉血流Vmax均较甲状腺功能正常组增高;伴肿大者增高更为明显.甲状腺功能亢进组中甲状腺上动脉血流Vmax与甲状腺素FT3、FT4呈正相关.桥本氏病甲状腺功能减低组、亚临床甲状腺功能减低组甲状腺上动脉血流Vmax与甲状腺体积呈正相关.单纯性甲状腺肿但功能正常者甲状腺上动脉血流Vmax与激素、甲状腺体积不相关.各组甲状腺上动脉血流RI与正常组相比无差异.结论: 甲状腺功能亢进者血流Vmax增加主要与甲状腺素相关,桥本氏病甲状腺功能减低组、亚临床甲状腺功能减低组甲状腺上动脉血流Vmax增加主要与增生相关.     

~(111)In-pentetreotide 生长抑素受体显像对非摄碘甲状腺癌复发的诊断作用

目的：采用１１１　 Ｉｎｐｅｎｔｅｔｒｅｏｔｉｄｅ 生长抑素受体显像（ Ｓ Ｒ Ｓ）对碘扫描阴性的甲状腺滤胞状或乳头状癌患者进行研究,以评价其诊断价值。方法：已行根治术并接受放射性碘治疗的高分化甲状腺癌患者 １６ 例（２３～８４ 岁）,其中 １５ 例甲状 腺球蛋白升高被怀疑癌复发,已有 ４ 例证实为肺转移或纵膈病变。１６ 例中的 ５ 例显像前已停用替代治疗,１１ 例正在接受替代治疗。碘显像均呈阴性。所有患者在静脉注射 １３７～２００ Ｍ Ｂｑ １１１　 Ｉｎｐｅｎｔｅｔｒｅｏｔｉｄｅ后,分别于 １、４ 和 ２４ 小时用低能高分辨准直器的 γ照相机进行显像。图像判定标准：在 ４ 小时和 ２４ 小时图像上如果怀疑病变处核素摄取和对比随时间呈递增或保持不变,视为阳性;如果是一过性摄取或强度和对比随时间逐渐下降,视为非特异摄取。复发诊断标准：当 Ｃ Ｔ 可疑病变处出现阳性摄取,考虑为真阳性;如 Ｃ Ｔ 未提示的部位出现核素摄取,视为假阳性（经病理证实）。结果：１６ 例中,３ 例 Ｓ Ｒ Ｓ阳性（占 １９％ ）,１ 例假阳性（占６％ ）,１２ 例假阴性（占７５％ ）。有５ 例只在２４小时图像中出现纵膈或肺部少量核素摄取。 Ｓ Ｒ Ｓ阳性的患者甲状腺球蛋白水平都升     

基于切伦科夫效应的裸鼠甲状腺131I多模态显像

目的 采用切伦科夫发光断层成像(CLT)和γ显像进行裸鼠甲状腺摄取131I的多模态成像,探索CLT与γ显像之间的相关性.方法 先对4只裸鼠[体质量(21±3)g]尾静脉注射1.67×107 Bq 131I,在注药后0.5、3、12及24h均分别行CLT和γ显像.采用基于漫射方程(DE)的切伦科夫光源重建方法重建裸鼠体内131I的生物分布及在不同采集时间点甲状腺摄取131I的切伦科夫光的功率.对采集的γ显像图像勾画ROI,获得γ计数的平均值,对CLT 1311的切伦科夫光的功率和γ显像获取的γ计数行直线相关分析.结果 甲状腺摄取131I的切伦科夫光的功率在0.5、3、12和24h分别为7.80×10-3、1.62×10-12、2.20×10 - 12和2.68×10-12 W.甲状腺摄取131I的切伦科夫光的功率随放射性药物注射时间的延长而逐渐增加.γ显像结果表明131I在裸鼠腹部的摄取逐渐降低,而在甲状腺的摄取越来越高,CLT与γ显像结果具有较好的相关性(r2 =0.7620,P＜O.05).结论 CLT具有临床甲状腺成像、甲状腺疾病诊断和疗效判断的潜力.     

过量碘摄入对甲状腺功能影响的探讨

过量碘摄入可以引起甲状腺细胞形态的改变,继而引起甲状腺功能紊乱,从而导致各种甲状腺疾病。将与碘属同族元素的核素引入体内进行甲状腺显像对于诊断甲状腺疾病有重要意义,而阐述过量碘对甲状腺功能的影响,对于指导甲状腺核素显像前的准备有重要的临床价值。     

Graves病药物治疗后TSH增高伴摄99Tcm增强患者131I治疗

目的：探讨甲状腺功能亢进症（甲亢）抗甲状腺药物（ATD）治疗后促甲状腺激素（TSH）增高伴摄99Tcm增强患者131I治疗的可能性和必要性。方法：27例经临床ATD治疗后TSH增高伴摄99Tcm增强患者分3组，治疗组15例，及时进行131I治疗；随访观察组12例，仅作随访观察，均随访年，结果：治疗组15例中9例血清游离三碘甲状腺原氨酸（FT3），游离甲状腺激素（FT4），TSH水平及甲状腺显像均恢复正常。有2例5－6个月复查甲亢复发，第2次治疗后恢复正常，1例为早发甲低，甲低发生率为6．7％，随访观察组12例在1－4个月内均复发为典型甲亢，复发率100％，结论：甲亢ATD治疗后TSH增高伴摄99Tcm增强患者宜及时进行131I治疗。     

99Tcm-PPM及99Tcm-MIBI肺显像诊断原发性肺癌

目的 探讨99Tcm－培普利欧霉素（PPM）及99Tcm-甲氧基异丁基异腈（MIBI）肺显像诊断原发性肺癌的临床价值。方法 对28例临床诊断肺肿瘤患者进行99Tcm-PPM ey 99T0-MIBI肺肿瘤显像并进行比较。结果 肺癌与良性病变对99T -PPMey 99T-MIBI观的摄取差异有显著性（P＜0．01）,以肺癌晚期显像摄取比值（T／NT,X－S）作为判断良恶性阈值,99Tcm-PPM及99Tcm-MIBI对肺癌诊断的灵敏度,准确性分别为90％,89．3％,和80％,82．1％,两者结合显像阳性率为95％,病灶对放射性药物的摄取与肿瘤大小无明显相关（P＞0．05）,结论 99Tcm-PPM ey 99T-MIBI肺显像对肺癌的诊断,鉴别诊断有一定的临床价值。两者联合应用可提高肺癌的阳性检出率,单独使用99Tcm-PPM优于99Tcm-MIBI。     

TSH alone is not sufficient to exclude all patients with a functioning thyroid nodule from undergoing testing to exclude thyroid cancer

PURPOSE: The purpose of the study was to analyze whether the thyroid-stimulating hormone (TSH) alone avoids tests to exclude malignancy in all patients with functional thyroid nodules (FTN). METHODS: Sixty-nine patients with FTN on (99m)Tc scintigraphy, radioiodine uptake test (RIU), (99m)Tc thyroid uptake, TSH assay, T3, and T4 obtained within 48 h were retrospectively identified out of 2,356 thyroid scans performed from January 2000 to April 2007. FTNs were classified as causing total, partial, or no inhibition of the thyroid as group 1, 2, or 3, respectively. RESULTS: TSH was subnormal in 21 of 69 (30.43%) patients. In group 1 (N = 23, 33.3%), TSH was subnormal, normal, and high in eight, nine, and six patients; in group 2 (N = 17, 24.6%), TSH was subnormal, normal, and high in four, six, and seven patients, and in group 3 (N = 29, 42%), TSH was subnormal, normal, and high in 9, 13, and 7 patients, respectively. TSH was significantly lower in group 1. In T3, T4, (99m)Tc thyroid uptake, and RIU, there were no differences between the three groups. CONCLUSIONS: Only 30.43% of patients had subnormal TSH. TSH alone cannot avoid tests to exclude malignancy in all patients with FTN. FTN existence can only be accurately assessed by thyroid scintigraphy. The current incidence of FTN may be unknown because scintigraphy is not routinely performed in all patients with thyroid nodules. Thyroid scintigraphy of patients with high TSH can detect diseases such as Hashimoto's thyroiditis and identify patients with FTN in whom no further diagnostic procedures would be needed in patients with normal TSH levels with nondiagnostic fine-needle aspiration results.     

Prediction of remission in Graves' disease treated with long-term carbimazole therapy: Evaluation of technetium-99m thyroid uptake and TSH concentrations as prognostic indicators

Computerized technetium-99m thyroid uptake and thyrotropin (TSH) estimation using a sensitive immunoradiometric assay were performed at presentation and following completion of an 18-month course of antithyroid drug therapy in 45 patients with Graves' disease. All patients had increased^99mTc thyroid uptake and subnormal TSH levels before the start of treatment. Twenty-two patients developed recurrent hyperthyroidism in a 3-year follow-up period. Of these 22 patients with relapse, 20 had had a persistently increased^99mTc thyroid uptake at the end of the course of carbimazole treatment, whereas TSH had remained subnormal in 18 of the 22. All 23 patients who remained in remission until the end of the 3-year follow-up had had normal^99mTc thyroid uptake following completion of antithyroid drug treatment. TSH levels had reverted to normal in 19 cases, but remained subnormal in four cases in this group at the end of treatment. The results suggest a high likelihood of relapse in patients who have persistently increased^99mTc thyroid uptake and subnormal TSH after a full course of carbimazole treatment. Patients whose^99mTc thyroid uptake and TSH levels have reverted to normal are likely to stay in long-term remission. Assessment of^99mTc thyroid uptake and TSH levels following completion of carbimazole therapy for Graves' disease offers useful information regarding long-term prognosis.     

High pre-therapy [99mTc]pertechnetate thyroid uptake, thyroid size and thyrostatic drugs: predictive factors of failure in [131I]iodide therapy in Graves' disease

BACKGROUND AND OBJECTIVE: Several factors may interfere with the success rate of radioiodine therapy (RIT) in Graves' disease. Our aim was to evaluate, retrospectively, some of these factors in the outcome of RIT. METHODS: Patient gender, age at diagnosis, ophthalmopathy, disease duration, thyroid size, drug used as clinical treatment, thionamide withdrawal period during RIT preparation, FT4, TSH and [99mTc]pertechnetate thyroid uptake prior to RIT were studied as potential interference factors for RIT success. Eighty-two Graves' disease patients were submitted to RIT after thionamide treatment failure. Prior to RIT, 67 patients were receiving methimazole and 15 propylthiouracil. Thirty-three patients received thionamides during RIT; in 49 patients the medication was withdrawn for 2-30 days. [99mTc]pertechnetate thyroid uptake was determined before RIT. Fixed doses of 370 MBq of [131I]iodide were administered to all patients. RESULTS: Eleven patients became euthyroid; 40 became hypothyroid and 31 remained hyperthyroid. There was no association between outcome and age at diagnosis, gender, ophthalmopathy, pre-RIT FT4, TSH, antithyroid antibodies or thyrostatic drug. Multiple logistic regression showed higher probability of treatment success in patients with thyroid mass <53 g (odds ratio (OR)=8.9), with pre-RIT thyroid uptake <12.5% (OR=4.1) and in patients who withdrew thionamide before RIT (OR=4.9). CONCLUSIONS: Fixed doses of 370 MBq of radioiodine seem to be practical and effective for treating Graves' disease patients with [99mTc]pertechnetate uptake <12.5% and thyroid mass <53 g. This treatment is clearly not recommended for patients with large goitre. In contrast to what could be expected, patients with a high pre-RIT thyroid uptake presented a higher rate of RIT failure.     

^99mTc-MIBI甲状腺显像半定量分析鉴别甲状腺结节的价值

目的评价99mTc-MIBI甲状腺显像半定量分析法鉴别甲状腺结节的价值.材料和方法36例Na99mTcO4甲状腺显像为单发"冷结节"患者,行99mTc-MIBI甲状腺双时相显像,分别计算15和120min甲状腺结节摄取比值(ER、DR),以良性结节组的DR均值+标准差(0.90+0.21)为诊断恶性病变的阈值.结果手术证实良性病变22例,ER与DR值分别为0.89±0.33、0.90±0.21,恶性病变14例,ER和DR值分别为1.16±0.51、1.34±0.64,ER值两组间比较无差异(p＞0.05),DR两组间比较有显著性差异(p＜0.01).99mTc-MIBI甲状腺显像DR值诊断良恶性病变的灵敏度85.7%,特异性86.4%,阳性预测值80.0%,阴性预测值90.5%.结论99mTc-MIBI甲状腺显像半定量分析能较好的鉴别甲状腺结节的性质,DR比ED更有价值.     

Imaging with 99mTc ECDG targeted at the multifunctional glucose transport system: feasibility study with rodents

PURPOSE: To evaluate the feasibility of technetium 99m ((99m)Tc) ethylenedicysteine-deoxyglucose (ECDG) imaging in tumor-bearing rodents. MATERIALS AND METHODS: ECDG was synthesized by means of reacting ethylenedicysteine with glucosamine, with carbodiimide as the coupling agent. Hexokinase assays were performed at an ultraviolet wavelength of 340 nm. To determine whether blood glucose level could be altered, ECDG or glucosamine was injected into six rats. In a separate study, ECDG followed by insulin was administered to three rats. To determine biodistribution, lung tumor cells were intramuscularly injected into the hind legs of 18 nude mice. The animals were then injected with (99m)Tc ECDG or fluorine 18 ((18)F) fluorodeoxyglucose (FDG) (0.037-0.074 MBq per mouse). Radioactivity was measured in tissue excised from the animals. Scintigraphy was performed in three groups: in group 1 to demonstrate that different-sized tumors could be imaged after (99m)Tc ECDG administration, in group 2 to ascertain whether tumor uptake of (99m)Tc ECDG was perfusion related, and in group 3 to demonstrate that tumor uptake of (99m)Tc ECDG occurred by means of a glucose-mediated process. RESULTS: ECDG was positive for phosphorylation at hexokinase assay. Blood glucose level increased with ECDG injection and decreased with insulin administration. Tumor-to-brain tissue and tumor-to-muscle tissue ratios of (99m)Tc ECDG uptake were higher than those of (18)F FDG uptake. Scintigraphic results demonstrated the feasibility of (99m)Tc ECDG imaging. CONCLUSION: There are similarities between (99m)Tc ECDG uptake and (18)F FDG uptake in tumors, and study findings supported the potential use of (99m)Tc ECDG as a functional imaging agent.     

甲状腺癌的影像学研究进展

X射线、CT、MRI、超声及核素显像是目前甲状腺癌主要的影像学诊断方法。通过复习近年来的文献,对各种方法做了比较后认为:每种影像学检查方法均有各自的优点,同时也存在各自的局限性,因此临床要根据患者的实际情况有目的地选择检查方法。