Acknowledging gray areas: 2015 vs. 2009 American Thyroid Association differentiated thyroid cancer guidelines on ablating putatively low-intermediate-risk patients

Purpose

Typically formulated by investigators from “world centres of excellence,” differentiated thyroid carcinoma (DTC) management guidelines may have more limited applicability in settings of less expert care and fewer resources. Arguably the world’s leading DTC guidelines are those of the American Thyroid Association, revised in 2009 (“ATA 2009”) and 2015 (“ATA 2015”). To further explore the issue of “real-world applicability” of DTC guidelines, we retrospectively compared indications for ablation using ATA 2015 versus ATA 2009 in a two-centre cohort of ablated T1–2, M0 DTC patients (N?=?336). Based on TNM status and histology, these patients were low–intermediate risk, but many ultimately had other characteristics suggesting elevated or uncertain risk.

Methods

Working by consensus, two experienced nuclear medicine physicians considered patient and treatment characteristics to classify each case as having “no indication,” a “possible indication,” or a “clear indication” for ablation according to ATA 2009 or ATA 2015. The physicians also identified reasons for classification changes between ATA 2015 versus ATA 2009. Classification was unblinded, but the physicians had cared for only 138/336 patients, and the charts encompassed September 2010–October 2013, several years before the classification was performed.

Results

One hundred of 336 patients (29.8 %) changed classification regarding indication for ablation using ATA 2015 versus ATA 2009. Most reclassified patients (70/100) moved from “no indication” or “clear indication” to “possible indication.” Reflecting this phenomenon, “possible indication” became the largest category according to the ATA 2015 classification (141/336, 42.0 %, versus 96/336, 28.6 %, according to ATA 2009). Many reclassifications were attributable to multiple clinicopathological characteristics, most commonly, stimulated thyroglobulin or anti-thyroglobulin antibody levels, multifocality, bilateral involvement, or capsular/nodal invasion.

Conclusions

Regarding indications for ablation, ATA 2015 appears to better “acknowledge grey areas,” i.e., patients with ambiguous or unavailable data requiring individualised, nuanced decision-making, than does ATA 2009.

     

Long-term outcomes and prognostic factors in patients treated with intraoperatively planned prostate brachytherapy

PurposeEvaluate outcomes and prognostic factors in men with localized prostate cancer.Methods and MaterialsA total of 3760 patients have undergone prostate seed implantation at our institution. This review is of our initial 304 consecutive patients treated before January 30, 2001. A total of 124 patients were treated with ¹²⁵I implant monotherapy and 180 with ¹⁰³Pd implant combined with 45-Gy external beam radiation therapy.ResultsThe median followup was 10.3 years. A 10-year biochemical control for low risk (LR) was 98% , intermediate risk (IR) 94%, high risk (HR) 78%, and HR with one HR factor 88% (p < 0.001); cause-specific survival was 99%, 98%, and 84% for LR, IR, and HR, respectively (p < 0.001); No significant difference in outcome was seen for LR and IR patients (p > 0.3). On multivariate analysis, only pretreatment PSA, Gleason score, and T-stage were significant for biochemical control. Most biochemical failures occurred within 5 years (93%).ConclusionsWith a minimum followup of 10 years, results are excellent and do not differ for LR or IR prostate cancer patients. HR patients are a very heterogeneous group, and excellent results can still be achieved for HR patients with only one HR feature.     

Total thyroidectomy and adjuvant radioiodine treatment independently decrease locoregional recurrence risk in childhood and adolescent differentiated thyroid cancer.

We sought to assess whether extensive surgical treatment, postsurgical radioiodine therapy, or both decrease the risk of locoregional recurrence (LR) after curative primary treatment in children and adolescents diagnosed with differentiated thyroid cancer (DTC) at age 相似文献   

SPECT/CT in the Treatment of Differentiated Thyroid Cancer

Single-photon emission computed tomography with integrated computed tomography (SPECT/CT) systems has been applied in a wide range of clinical circumstances, and differentiated thyroid cancer (DTC) is one of the most important indications of SPECT/CT imaging. In the treatment of DTC, SPECT/CT images have been reported to have many advantages over conventional planar whole-body scintigraphy based on its precise localization and characterization of abnormal foci of radioactive iodine (RAI) accumulation, influencing the staging, risk stratification, and clinical management as well as reader confidence. On the other hand, SPECT/CT has limitations including additional radiation exposure from the CT component, additional imaging time, and cost-related issues. Each SPECT/CT image acquired at different time points throughout the management of DTC may have a different clinical meaning and significance. This review article addresses the clinical usefulness of RAI SPECT/CT images acquired during the pre-ablation period, post-therapy period, and long-term follow-up period, respectively.     

分化型甲状腺癌放射性碘治疗敏感性及其影响因素的研究进展

放射性碘（RAI）治疗是分化型甲状腺癌（DTC）的主要治疗方法之一,其治疗效果主要与肿瘤病灶对RAI 的摄取能力及肿瘤细胞对射线的敏感性有关。对RAI 治疗反应评估为疗效不满意的患者,可以通过上述2个方向来改善其对RAI 治疗的敏感性。笔者通过分析近年来影响DTC患者RAI治疗的相关信号通路及分子机制,总结了影响RAI摄取的包括钠碘同向转运体（NIS）表达及质膜定位的相关机制,以及影响RAI放射敏感性的DNA损伤修复等机制,以期为DTC患者内照射增敏治疗的基础及临床研究提供参考。     

Brain metastasis from differentiated thyroid cancer in patients treated with radioiodine for bone and lung lesions

Brain metastasis of differentiated thyroid cancer (DTC) often is detected during treatment of other remote lesions. We examined the prevalence, risk factors and treatment outcome of this disease encountered during nuclear medicine practice. Of the 167 patients with metastasis to lung or bone treated 1-14 times with radioactive iodine (RAI), 9 (5.4%) also had lesions in the brain. Five were males and 4 females, aged 49-84, out of the original population of 49 males and 118 females aged 10-84 (mean 54.7) years. Three of them underwent removal of their brain tumors, 5 received conventional external beam irradiation, and 2 had stereotactic radiosurgery with supervoltage X-ray. None of the brain lesions showed significant uptake of RAI despite demonstrable accumulation in most extracerebral lesions. Seven patients died 4-23 (mean 9.4) months after the discovery of cerebral metastasis, brain damage being the primary or at least a contributing cause. The 8th and 9th patients remained relatively well for more than 42 and 3 months, respectively, without any evidence of intracranial recurrence. Our results confirmed that the brain is a major site of secondary metastasis from DTC. No statistically significant demographic risk factor was detected. Any suspicious neurological symptoms in the course of RAI treatment warrant cerebral computed tomography. As for therapy, from our initial experience, radiosurgery seemed promising as an effective and less invasive alternative to surgical removal.     

Factors Associated with Dose Determination of Radioactive Iodine Therapy for Differentiated Thyroid Cancer

Radioactive iodine (RAI) therapy for differentiated thyroid cancer has been successfully used for more than 70 years. However, there is still plenty of controversy surrounding the use and doses of radioiodine. There is insufficient evidence to answer the questions. Recent American Thyroid Association (ATA) guidelines seem to favor low-dose RAI, based on recent clinical trials and meta-analyses. However, long-term follow-up data remains limited, and there are additional factors we should consider that might affect the efficacy of RAI therapy. Therefore, until sufficient data are available, it is necessary to remain cautious about determining RAI doses by considering multiple patient-specific variables.     

分化型甲状腺癌131I治疗后TgAb由阳转阴时间与临床转归的关系

目的 探究131I治疗前甲状腺球蛋白抗体（TgAb）阳性（≥40 IU/ml）的分化型甲状腺癌（DTC）患者131I治疗后TgAb转阴时间与临床转归的关系,并分析影响的因素。 方法 回顾性分析2014年1月至2019年1月在青岛大学附属医院行甲状腺全切术及131I治疗前TgAb阳性的126例DTC患者的临床资料,其中男性15例、女性111例,年龄11~74（42.1±11.5）岁。将患者按末次随访时的治疗反应分为疗效满意组和疗效不满意组。采用卡方检验、独立样本t检验、Mann-Whitney U检验分析2组间年龄、性别、原发灶最大径、肿瘤是否多灶、是否合并桥本甲状腺炎、术前甲状腺过氧化物酶抗体（TPOAb）水平、TgAb水平（术前及首次131I治疗前）、首次131I治疗后（1、6、12个月）TgAb水平的下降率、TgAb转阴时间、131I治疗总剂量、肿瘤分期、淋巴结分期、淋巴结转移率、首次131I治疗前复发危险分层的差异,对差异有统计学意义的变量进一步行Logistic回归分析,明确影响患者临床转归的独立危险因素。通过受试者工作特征（ROC）曲线确定预测患者临床转归的最佳临界值。 结果 疗效满意组患者共109例,疗效不满意组患者共17例。2组间首次131I治疗后12个月TgAb水平下降率[89.84%（82.81%,94.70%）对83.01%（74.99%,91.08%）,Z=?2.168,P=0.030]、TgAb转阴时间[（25.06±17.96）个月对（45.41±22.11）个月,t=?4.206,P<0.001]、131I治疗总剂量[3 700（3 700,3 700） MBq对5 550（3 700,10 545） MBq,Z=?4.388,P<0.001]的差异有统计学意义;而Logistic回归分析结果显示,TgAb转阴时间（OR=1.036,P=0.034）及131I治疗总剂量（OR=1.033,P=0.001）为预测临床转归的独立危险因素。ROC曲线分析结果显示,当TgAb转阴时间临界值为31.5个月（曲线下面积为0.766,95%CI:0.650~0.881,P<0.001）时,其预测临床转归的灵敏度及特异度最高,分别为78.00%和70.60%。 结论 对于131I治疗前TgAb阳性的DTC患者,其TgAb转阴时间和131I治疗总剂量是预测患者临床转归的独立危险因素。TgAb在首次131I治疗后31.5个月内转阴的患者更易获得满意疗效,且疗效满意组患者所需的131I治疗总剂量比疗效不满意组更低。     

Response Prediction of Altered Thyroglobulin Levels After Radioactive Iodine Therapy Aided by Recombinant Human Thyrotropin in Patients with Differentiated Thyroid Cancer

Purpose

Thyroglobulin (Tg) may be released from damaged residual thyroid tissues after radioactive iodine (RAI) therapy in patients with differentiated thyroid carcinoma (DTC). We investigated whether altered levels of serum Tg after recombinant human thyrotropin (rhTSH)-aided RAI therapy could be a prognostic marker in patients with DTC.

Methods

We evaluated 68 patients who underwent RAI therapy after total thyroidectomy. Serum Tg levels were measured just before RAI administration (D0Tg) and 7 days after RAI therapy (D7Tg). Patients with a D0Tg level greater than 2.0 ng/mL were excluded to more precisely evaluate the injury effect of RAI in small remnant tissues. The ratioTg was defined as the D7Tg level divided by that on D0Tg. The therapeutic responses were classified as acceptable or non-acceptable. Finally, we investigated which clinicopathologic parameters were associated with therapeutic response.

Results

At the follow-up examination, an acceptable response was observed in 50 patients (73.5%). Univariate analysis revealed significant differences in N stage (P?=?0.003) and ratioTg (acceptable vs. non-acceptable responses, 21.9?±?33.6 vs. 3.8?±?6.5; P?=?0.006). In multivariate analysis, only ratioTg significantly predicted an acceptable response (odds ratio 1.104; 95% confidence interval 1.005–1.213; P?=?0.040). A ratioTg above 3.5 predicted an acceptable response with a sensitivity of 66.0%, specificity of 83.3%, and accuracy of 70.6% (area under the curve?=?0.718; P?=?0.006).

Conclusions

Altered levels of serum Tg after RAI therapy, calculated as the ratioTg (D7Tg/D0Tg), significantly predicted an acceptable response in patients with DTC.

     

Treating the patient with differentiated thyroid cancer with thyroglobulin-positive iodine-131 diagnostic scan-negative metastases: including comments on the role of serum thyroglobulin monitoring in tumor surveillance

Differentiated thyroid cancer (DTC) patients, especially the 10% to 15% at high risk of cancer-related death, should have long-term monitoring for detection of recurrence or metastasis. Conventional radiologic and ultrasonographic imaging is useful for localization of recurrent or persistent disease. For patients who have had ablation of residual thyroid tissue, measurement of serum thyroglobulin (Tg) levels and radioactive iodine (RAI) imaging provide highly sensitive tools for early detection. Serum Tg is reliable only in the absence of Tg autoantibodies. Sensitivity increases with TSH stimulation, either by withdrawal of thyroxine (T4) therapy, or administration of recombinant TSH (rTSH). In some patients, serum Tg levels are positive but the RAI whole body scan (WBS) is negative. In these patients, either the recurrent tumor is too small and below the sensitivity of the diagnostic scan, or there is a dissociation between Tg synthesis and the iodine-trapping mechanism. Recent literature suggests that empiric high-dose RAI therapy of Tg-positive diagnostic scan-negative patients may result in a high rate of visualization of uptake in posttherapy scans (PTS). Evidence for subsequent improvement of parameters of disease activity has also been presented. Almost all such reported cases had micrometastases that were not visualized by conventional imaging. In our experience, aggressive macrometastases with negative diagnostic WBS do not show significant uptake after therapeutic doses of RAI. The small size of micrometastases in the first group of patients and a possible defect of the iodine-trapping mechanism in the second group may explain this apparent discrepancy. Based on presently available information, a generalized recommendation for RAI therapy of Tg-positive, diagnostic scan-negative patients should await further studies. Meanwhile, in some high-risk patients, in the absence of alternative therapies, empiric RAI therapy is justified.     

Retrospective Application of the 2015 American Thyroid Association Guidelines for Ultrasound Classification,Biopsy Indications,and Follow-up Imaging of Thyroid Nodules: Can Improved Reporting Decrease Testing?

IntroductionThyroid ultrasound has been widely used to determine which nodules need further investigation. The goal of this study is to determine if using an ultrasonographic features checklist based on 2015 American Thyroid Association (ATA) guidelines can improve reporting and decrease unnecessary further testing.MethodsIn this retrospective study, ultrasonographic images of all nodules biopsied at our institution in 2014 and 2015 were reviewed by radiologists blinded to fine needle aspiration (FNA) biopsy result using a checklist. The checklist was prepared based on 2015 ATA guidelines. The ultrasonographic characteristics of thyroid nodules were compared with the result of biopsy to determine positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity for predicting malignancy. Radiologists also made an overall recommendation on need for FNA.ResultsA total of 425 thyroid nodule ultrasound scans were reviewed by radiologists. Biopsy results of 31 nodules were malignant and 394 were non-malignant. Malignant nodules showed higher frequency of solid composition, hypoechoechogenicity, and cervical lymph node involvement compared to benign nodules. Solid nodule composition had the highest PPV (13%) and NPV (94.7%). Extra-thyroid extension had the highest specificity (90.1%). Lesion vascularity had the highest sensitivity (83.8%), followed by hypoechogenicity (65.6%). Overall, the checklist had a positive predictive value of 9%, negative predictive value of 97.5%, sensitivity of 96.8%, and specificity of 11.14%. Radiologists determined that 10% of the nodules were very low-risk and did not require FNA.ConclusionUsing a checklist based on 2015 ATA guideline thyroid nodule ultrasonographic features is a sensitive tool with high NPV to predict benign thyroid nodule, thereby preventing unnecessary FNAs.     

分化型甲状腺癌术后首次血清刺激性Tg水平对远处转移的预测价值

目的 探讨分化型甲状腺癌（DTC）患者术后首次血清预先刺激性甲状腺球蛋白（ps-Tg）水平对远处转移的预测价值。 方法 收集2016年8月至2017年8月首次行131I治疗的113例DTC患者的临床资料,其中男性32例、女性81例,年龄15~68（44.85±12.01）岁。将患者分为无远处转移（M0）组和远处转移（M1）组。所有患者在未服或停服左旋甲状腺素4周后,行甲状腺功能与抗体水平等检测,行131I治疗后全身显像（Rx-WBS）和局部SPECT/CT断层融合显像。采用χ2检验、独立样本t检验和Mann-Whitney秩和检验对比2组患者的基本资料;采用Mann-Whitney秩和检验比较2组之间ps-Tg水平的差异;非参数法建立ps-Tg水平的受试者工作特征（ROC）曲线,获得最佳诊断界值点（DCP）。 结果 M0组（85例）与M1组（28例）的病理类型、颈部淋巴转移情况及131I治疗剂量均存在差异,且差异有统计学意义（χ2=12.588、12.588、12.581,P=0.003、0.003、0.002）;而性别、年龄、肿瘤分期、手术至首次检测ps-Tg的时间、促甲状腺激素和甲状腺球蛋白抗体水平的差异均无统计学意义。2组患者ps-Tg水平的M（P25~P75）分别为1.95（0.70~6.98） ng/mL和95.05（6.98~278.47） ng/mL,且差异有统计学意义（U=417.5,P=0.000）。ps-Tg水平ROC曲线下面积为0.825（95%CI:0.713~0.936）,灵敏度、特异度和准确率分别为71.4%、91.8% 和86.7%,DCP为28.80 ng/mL。 结论 DTC术后首次血清ps-Tg水平对预测DTC远处转移有重要价值。     

Uphill sprint vs. intermittent running in young soccer players: acute physiological responses

Purpose

This study aimed to compare the acute effects of uphill repeated sprinting “with long recovery” (RS) and uphill intermittent running (IR) training on heart rate (HR) and blood lactate (BL) responses.

Methods

Thirteen young male soccer players randomly performed in two separate occasions, on a slope (10 %), an RS and an IR session. RS consisted of three sets of eight maximal uphill 20-m sprints with long (90 s) recovery between sprints, and 8 min passive rest between sets, whereas IR consisted of 24 repetitions of 22-m sub-maximal (95 % of maximum speed achieved in an incremental test) uphill runs interspersed by a 15-s downhill walking recovery, lasting for a total duration of 8 min.

Results

The mean HR, expressed as the percentage of HR_MAX, was significantly higher in IR than in RS (86.1 ± 3.1 vs. 77.0 ± 4.5 %, respectively, p < 0.05). Conversely, BL measured after 3 min was significantly higher in RS (5.9 ± 1.1 mmol L^?1) than in IR (2.9 ± 1.2 mmol L^?1, p < 0.05).

Conclusions

The differences found between RS and IR may be attributed to the different work/recovery ratios and speed characteristics. Therefore, uphill IR seems more suitable when the target is to tax the aerobic system, while RS may be more suitable when the focus is on stimulating the speed without increasing the metabolic demand.     

What influences early hypothyroidism after radioiodine treatment for Graves' hyperthyroidism?

OBJECTIVE: The objective of this study was to evaluate the factors influencing the occurrence of early hypothyroidism after radioiodine treatment of Graves' hyperthyroidism. MATERIAL AND METHODS: Of 147 patients with Graves' disease (GD) treated with radioactive I-131 (RAI) in our thyroid clinic between July 2003 and December 2004, 84 were followed at 2 and 4 to 5 months after treatment. The age range was 12 to 75 years and the dosage range in these patients was 7.4 to 29.9 mCi. Twenty-four were males and 60 were females. Factors possibly contributing to post-RAI hypothyroidism are: dosage of I-131, age, gender, size of the gland, initial serum free T4, free T3, thyroid-stimulating hormone (TSH) levels, pretreatment with antithyroid drugs, radioactive iodine uptake, and duration of disease. RESULTS: All patients had low TSH, elevated FT4, and elevated radioactive iodine uptake (RAIU) at 4 and/or 24 hours. Of the 84 patients followed, 46% of the males and 62% of the females became hypothyroid at 4 to 5 months (57% of the total). Twenty-one patients remained hyperthyroid and 14 patients became euthyroid. Multivariate analysis of these 84 patients showed no statistically significant single contributing factor for the development of early hypothyroidism. CONCLUSION: The early onset of hypothyroidism after RAI in GD is very common (57%) and unpredictable. Thus, after RAI treatment, all patients must be closely monitored for the development of this disorder.     

In vitro differentiation characteristics of human skin fibroblasts: correlations with radiotherapy-induced breast fibrosis in patients

PURPOSE: To determine whether there is an association between dermal fibroblast differentiation characteristics in vitro and breast fibrosis developing in patients following radiotherapy for breast cancer. MATERIALS AND METHODS: Three hundred and eighty-five patients had been characterized for the degree of breast fibrosis and the level of clinical risk factors for fibrosis as established by logistic regression. Early-passage fibroblasts from 79 patients with a high (HR) or low (LR) level of risk factors were studied in vitro. The percentage differentiated cells (%DC) 7 days after 0 and 8 Gy was scored, and unirradiated colonies were scored for the ratio of early:late fibroblast differentiation stages (E:L ratio). RESULTS: %DC: For the 0 Gy data there was a significant interpatient variation (CoV = 55%, p = 0.0001). HR patients with breast fibrosis had a higher %DC compared with patients without (p = 0.017). E:L ratio: for HR patients there was a significant interpatient variation (82%, p = 0.0030) and a lower E:L ratio for patients with fibrosis compared with those without (p = 0.086), but for LR patients this relationship was reversed (p = 0.079) CONCLUSIONS: There was a true interpatient variation in the in vitro parameters of fibroblast differentiation but insufficient correlation with observed fibrosis after radiotherapy for use as a predictive test.     

Comparison of Thyroid Risk Categorization Systems and Fine-Needle Aspiration Recommendations in a Multi-Institutional Thyroid Ultrasound Registry

ObjectivesThe aim of this study was to compare how often fine-needle aspiration (FNA) would be recommended for nodules in unselected, low-risk adult patients referred for sonographic evaluation of thyroid nodules by ACR Thyroid Imaging Reporting and Data System (TI-RADS), the American Thyroid Association guidelines (ATA), Korean Thyroid Imaging Reporting and Data System (K-TIRADS), European Thyroid Imaging Reporting and Data System (EU-TIRADS), and Artificial Intelligence Thyroid Imaging Reporting and Data System (AI-TIRADS).MethodsSeven practices prospectively submitted thyroid ultrasound reports on adult patients to the ACR Thyroid Imaging Research Registry between October 2018 and March 2020. Data were collected about the sonographic features of each nodule using a structured reporting template with fields for the five ACR TI-RADS ultrasound categories plus maximum nodule size. The nodules were also retrospectively categorized according to criteria from ACR TI-RADS, the ATA, K-TIRADS, EU-TIRADS, and AI-TIRADS to compare FNA recommendation rates.ResultsFor 27,933 nodules in 12,208 patients, ACR TI-RADS recommended FNA for 8,128 nodules (29.1%, 95% confidence interval [CI] 0.286-0.296). The ATA guidelines, EU-TIRADS, K-TIRADS, and AI-TIRADS would have recommended FNA for 16,385 (58.7%, 95% CI 0.581-0.592), 10,854 (38.9%, 95% CI 0.383-0.394), 15,917 (57.0%, 95% CI 0.564-0.576), and 7,342 (26.3%, 95% CI 0.258-0.268) nodules, respectively. Recommendation for FNA on TR3 and TR4 nodules was lowest for ACR TI-RADS at 18% and 30%, respectively. ACR TI-RADS categorized more nodules as TR2, which does not require FNA. At the high suspicion level, the FNA rate was similar for all guidelines at 68.7% to 75.5%.ConclusionACR TI-RADS recommends 25% to 50% fewer biopsies compared with ATA, EU-TIRADS, and K-TIRADS because of differences in size thresholds and criteria for risk levels.     

Low-level Irradiation

Purpose : To determine whether there is an association between dermal fibroblast differentiation characteristics in vitro and breast fibrosis developing in patients following radiotherapy for breast cancer. Materials and methods : Three hundred and eighty-five patients had been characterized for the degree of breast fibrosis and the level of clinical risk factors for fibrosis as established by logistic regression. Early-passage fibroblasts from 79 patients with a high (HR) or low (LR) level of risk factors were studied in vitro. The percentage differentiated cells (%DC) 7 days after 0 and 8 Gy was scored, and unirradiated colonies were scored for the ratio of early:late fibroblast differentiation stages (E:L ratio). Results : %DC: For the 0 Gy data there was a significant interpatient variation (CoV=55%, p=0.0001). HR patients with breast fibrosis had a higher %DC compared with patients without (p =0.017). E:L ratio: for HR patients there was a significant interpatient variation (82%, p =0.0030) and a lower E:L ratio for patients with fibrosis compared with those without (p =0.086), but for LR patients this relationship was reversed (p =0.079) Conclusions : There was a true interpatient variation in the in vitro parameters of fibroblast differentiation but insufficient correlation with observed fibrosis after radiotherapy for use as a predictive test.     

131I治疗分化型甲状腺癌术后患者体内剂量测定方法的临床应用进展

根据分化型甲状腺癌（DTC)患者术后不同危险度分层结果，部分患者可能需要进一步行131I治疗，但131I可对周围人群产生辐射，因此正确评估患者体内的辐射剂量，对辐射防护个体化及131I治疗流程的优化至关重要。DTC患者术后131I治疗期间辐射剂量的测量方法主要分为体内和体外测量两大类，体外测量包括尿液测量法和血液剂量测定法；体内测量主要包括局部测量法和全身测量法，笔者就辐射剂量相关测定方法及其临床应用进行综述。     

Value of 131I SPECT/CT for the evaluation of differentiated thyroid cancer: a systematic review of the literature

Purpose

In the present study, we performed a systematic review of the current literature to assess the incremental value of ¹³¹I single photon emission computed tomography (SPECT)/CT for the management of patients with differentiated thyroid cancer (DTC).

Methods

The search of PubMed/MEDLINE and EMBASE databases to identify studies and reference lists for articles was conducted using the terms “SPECT or SPECT/CT or SPECT-CT or single photon emission computed tomography/computed tomography and thyroid carcinoma or thyroid cancer.” Studies reporting the clinical value of ¹³¹I SPECT/CT were selected. All studies included were assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2). Two independent reviewers selected the studies, summarized and tabulated the data, and pooled estimates were obtained. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

Results

A total of 14 studies involving 1,066 patients met the inclusion criteria. Data obtained included the impact of ¹³¹I SPECT/CT on staging or risk classification (three studies), diagnostic accuracy (six studies), and follow-up (five studies).

Conclusion

Integrated SPECT/CT is a useful tool for the diagnosis, staging, risk stratification, and follow-up of DTC. The impact of ¹³¹I SPECT/CT on the management of patients with thyroid cancer was evaluated.     

Correlation between thoracic aorta 18F-natrium fluoride uptake and cardiovascular risk

AIM: To investigating the relationship between thoracic and cardiac ¹⁸F-Natrium-Fluoride (18F-NaF) uptake, as a marker of ongoing calcification and cardiovascular risk factors.METHODS: Seventy-eight patients (44 females, mean age 63, range 44-83) underwent whole body 18F-NaF positron emission tomography/computed tomography. Cardiovascular risk (CVR) was used to divide these patients in three categories: Low (LR), medium (MR) and high risk (HR). 18F-NaF uptake was measured by manually drawing volumes of interest on the ascending aorta, on the aortic arch, on the descending aorta and on the myocardium; average standardized uptake value was normalized for blood-pool, to obtain target-to-background ratio (TBR). Values from the three aortic segments were then averaged to obtain an index of the whole thoracic aorta.RESULTS: A significant difference in whole thoracic aorta TBR was detected between HR and LR (1.84 ± 0.76 vs 1.07 ± 0.3, P < 0.001), but also between MR and HR-LR (1.4 ± 0.4, P < 0.02 and P < 0.01, respectively). Significance of this TBR stratification strongly varied among thoracic aorta subsegments and the lowest P values were reached in the descending aorta (P < 0.01). Myocardial uptake provided an effective CVR classes stratification (P < 0.001).Correlation between TBR and CVR was appreciable when the whole thoracic aorta was considered (R = 0.67), but it peaked when correlating the descending thoracic segment (R = 0.75), in comparison with the aortic arch and the ascending segment (R = 0.55 and 0.53, respectively).CONCLUSION: Fluoride uptake within the thoracic aorta wall effectively depicts patients’ risk class and correlates with cardiovascular risk. Descending aorta is the most effective in CVR determination.