分化型甲状腺癌术后^99Tc^m—MIBI显像与^131 I显像比较及其意义

目的：探讨分化型甲状腺癌（DTC）术后^99Tc^m—MIBI显像结果的意义。方法：300例DTC术后患者中随机选取69例行^99Tc^m-MIBI显像。2名有经验核医学医师盲法阅片。将^99Tc^mMIBI显像结果与治疗后^131I显像结果比较。另对经高分辨CT或治疗后^131 I显像诊断肺转移和无肺转移患者行半定量分析，比较靶本底比值（T／B）。结果：排除1例死于血管肉瘤者，余按照手术方式及^131 I治疗情况分为3组（A组：44例甲状腺癌术后拟^131I治疗组；B组：22例有再次^131I治疗指征组；C组：2例甲状腺大部切除组）。A组^99 Tc^m-MIBI显示残余甲状腺34．1％（15／44），转移灶30．0％（6／20）。B组^9^Tc ^m-MIBI显示复发及转移灶63．6％（7/11）。C组^99Tc^mMI—BI显示残余甲状腺100．0％（2／2），并为唯一一种发现颈部转移显像方法。5例患者同时存在多种性质转移灶：MI—BI＋I-，MIBI-I＋及MIBI＋I＋。肺转移与无肺转移患者T/B比值差异无统计学意义。结论：^99Tc^m -MIBI可发现分化好及失分化病灶，联合^131 I显像为DTC术后患者选择治疗方式提供重要信息，有临床应用价值。

Research on application of ^99Tcm-MIBI scan compared with ^131I whole-body scan to the postsurgical patients with DTC

OBJECTIVE： To evaluate the clinical utility of ^99Tc^m MIBI scintigraphy in the postsurgical patients with differentiated thyroid cancer （DTC）. METHODS： A prospective study of 69 patients randomized picked out from 300 DTC patients underwent ^99Tc^m -MIBI scan after thyroidectomy. Visual analysis of the scintigraphic images was performed by two experienced physicians without clinical findings and results of the other imaging. The result compared with posttherapy ^131I scan. In addition, ^99 Tc^m-MIBI uptake in lung was semi-quantitatively evaluated by calculating the target-to background （T/B） ratio. RESULTS： One patient who died of angiosarcoma was excluded. According to radioiodine therapy and surgery style, the patients were categorized into 3 groups for analysis. Group A （n= 44）： prepare for initial ^131 I treatment after thyroidectomy. Group B （n =22）： need further ^131I treatment. Group C （n= 2） ： underwent partial thyroidectomy alone. In group A, ^99Tc^m-MIBI scans detected thyroid remnants in 15 of 44 pa tients （34. 1%） and metastatic loci in 6 of 20 （30.0%） patients. In group B, ^99 Tc^m-MIBI scans detected recurrent and metastatic loci in 7 of 11 （63.6%）. In group C, ^99Tc^m- MIBI scan detected all the remnants （2/2,100.0%）, and to be the only examination detecting a cervical lymph node metastasis in one patient. Five patients had three type metastases： MIBI＋1-, MIBI-I＋ and MIBI＋I- metastases. T/B ratio showed no significant difference between non-metastatic and metastatic groups in lung which confirmed by high-resolution CT or posttherapy ^131I scan. CONCLUSIONS： ^99Tc^m-MIBI can reveal both functioning and non-functioning metastases, so ^99 Tc^m MIBI scan may be useful for choosing the best therapeutic approach. The combination of ^99Tc^m-MIBI with ^131 I offers the highest diagnostic yield.