Cholestatic syndromes in infancy and childhood

Of 33 children with various cholestatic syndromes who were studies with sonography, 19 also had 131I rose bengal scintigraphy, and 12 also had 99mTc sulfur colloid scintigraphy. Patients were categorized into intra- or extrahepatic etiologies for their cholestasis. Of 19 children in the extrahepatic category, 17 had abnormal sonographic studies; two with biliary atresia appeared normal. All 14 patients in the intrahepatic category had normal sonographic studies. Rose bengal was most useful when demonstrating biliary patency. Some cases of biliary atresia with normal sonography and lack of rose bengal excretion into the intestinal tract could not be separated from cases of neonatal hepatitis using a similar combination of studies. Radiocolloid studies were less valuable than other examinations except when demonstrating diffuse hepatic reticuloendothelial dysfunction as found in two cases of congenital syphilitic hepatitis.     

The investigation of neonatal obstructive jaundice using 123I rose bengal

With the development of new surgical techniques the outlook for infants with biliary atresia has improved significantly. It has therefore become increasingly important to identify these patients quickly in order to allow prompt surgical intervention. Differentiation of biliary atresia from other causes of jaundice, in particular idiopathic neonatal hepatitis, is often difficult as there is considerable clinical and histological overlap of the two conditions. Demonstration of biliary patency using radiopharmaceuticals is a well established technique. 131I rose bengal and the 99Tcm-labelled iminodiacetic acid derivatives have both been used, but are not completely satisfactory, and controversy still exists as to which is the most suitable agent. Nine infants with prolonged jaundice have been studied using 123I-labelled rose bengal. All infants with biliary atresia and neonatal hepatitis were correctly identified. The results indicate that 123I rose bengal provides a reliable tracer for assessing biliary patency and is the agent of choice in the investigation of neonatal obstructive jaundice.     

Pharmacokinetics of hepatobiliary imaging agents in rats: concise communication.

The distribution and elimination kinetics of Tc-99m pyridoxlidene glutamate (Tc-99m PG), of Tc-99m N-(2,6-dimethyl-phenylcarbamoylmethyl) iminodiacetic acid (Tc-99m HIDA), and of I-131 rose bengal in blood were quantitated after i.v. injection in rats. This was performed by use of a unique indwelling catheter that externalizes the systemic circulation, permitting continuous monitoring of blood radioactivity. The blood activity-time curves of Tc-99m PG and Tc-99m HIDA are described by the sum of three exponential functions. Only two exponentials are required in the case of I-131 rose bengal. The rank order for the rates of loss from blood was Tc-99m HIDA less than Tc-99m PG less than I-131 rose bengal. Bile was collected after administration of Tc-99m HIDA and Tc-99m PG. The total excretion of radioactivity over a 70-min period amounted to 95.7% and 42.8% of the dose of Tc-99m HIDA and Tc-99m PG, respectively. A linear compartmental kinetic model was developed to account for the disappearance from blood and the biliary excretion of these radiopharmaceuticals in rats.     

Catabolism and protein binding of Tc-99m pyridoxylideneglutamate.

Various Tc-99m-labeled compounds have been suggested as replacements for [I-131] rose bengal for imaging of the hepatobiliary system. Among such compounds are Schiff's bases, which are tin-free Tc-chelates easily prepared by 30-min autoclaving of an equimolar mixture of pyridoxal and an amino acid at pH 8.5. We have compared the properties of several Schiff's bases, including Tc-99m pyridoxylideneglutamate (Tc PyG) with [I-131] rose bengal. Under conditions described, Tc-PyG can be prepared free of Tc-pyridoxal and with less than 2% TcO4- radiochemical impurity. Blood clearance and biliary excretion were studied in three animal models, and in normal human volunteers. In all animal models, Tc-PyG initially cleared from the blood more rapidly than rose bengal, but a significant amount of Tc-PyG was excreted in the urine, this in contrast to [I-131] rose bengal which was almost completely excreted through the biliary system. Species differences were observed in the degree of urinary versus biliary clearance of Tc-PyG, with significantly greater urinary excretion in dogs than in monkeys and rabbits. Replacing glutamate with other amino acids did not significantly increase the blood clearance rate or decrease urinary excretion, so that Tc-PyG appears to be at least as good as any of the others studied. Tc-PyG was only 20% bound to plasma proteins, and electrophoretic and chromatographic studies did not reveal any in vivo changes of Tc-PyG before excretion in urine or bile.     

光动力疗法建立大鼠视网膜静脉阻塞模型

目的建立SD大鼠视网膜静脉阻塞模型。方法成年雄性SD大鼠20只,双眼均用。经大鼠尾静脉注入孟加拉红3 min后,采用波长532 nm的绿激光,对距离视乳头1～3 PD内的视网膜静脉段进行激光照射,形成一段约1 PD的静脉血栓模型。随后眼底和视网膜荧光血管造影（fundus fluorescein angiography,FFA）连续3周观察模型的建立情况。并用光镜和透射电镜观察视网膜组织和血管结构。结果用激光联合孟加拉红的方法成功建立SD大鼠视网膜静脉阻塞的模型。FFA观察可见血流中断,远端血管纡曲扩张、视网膜出血等。光镜显示视网膜组织各层结构基本正常以及血管完全阻塞。电镜观察证实血管完全阻塞是由于血栓的形成。结论利用激光联合孟加拉红的方法可以成功建立大鼠视网膜静脉阻塞的模型。此方法对视网膜组织结构无明显损伤,为下一步研究视网膜静脉阻塞的治疗奠定了实验基础。     

Effect of altered thyroid status on the transport of hepatobiliary radiopharmaceuticals

The effect of induced hypothyroidism (by feeding an antithyroid drug-propylthiouracil) on the transport and clearance of the routinely used hepatobiliary radiopharmaceuticals--radioiodinated iodine-131 (131I) rose bengal and technetium-99m-N-(4-n-butylphenylcarbamoylmethyl) iminodiacetate, was studied in the rats. Hypothyroidism was associated with depressed growth and retarded clearance of these radiotracers from the in vivo system. Treatment of the hypothyroid rats with thyroxine (2-5 micrograms/100 g b.w. day) for 6 wk, restored these parameters towards normal values. These data suggest that delayed clearance of these hepatobiliary tracers could be related to reduced metabolic rate accompanied with the hypotonia and hypomotility of intestine normally observed in the hypothyroid state.     

Serial scintigraphy of choledochal cysts using 131I-rose bengal and 131I-bromsulphalein.

Nine cases of congenital choledochal cysts are reported which were correctly diagnosed by 131I-rose bengal or 131I-bromsulphalein (BSP) serial scintigraphy. They were classified by scintigraphic patterns into two types depending on whether biliary obstruction was complete or incomplete. All but two showed incomplete obstruction. The correct diagnosis may be difficult to make by scintigraphy if complete biliary obstruction is present. In such cases the clinical findings and other diagnostic studies, such as angiography or ultrasound, should be carefully considered. Serial scintigraphy with 131I-rose bengal or 131I-BSP is nontraumatic, safe, and provides increased diagnostic accuracy. It is the examination of choice when choledochal cysts are suspected clinically.     

Triple radioisotope technique in etiologic evaluation of space-occupying lesions of the liver.

The findings from 43 patients with histologically proven focal liver disease examined by triple isotope tracer study are presented. The method consisted in a three step technique, the first step being an isotope scan after injection of 99mTc-sulfur colloid and 131I rose bengal. As a second step dynamic hepatic scintiangiography was carried out with 99mTc human serum albumin in order to assess the vascularity of a lesion detected on the initial scan. Thirdly, the patient was administered 67Ga to evaluate further the pathologic process. According to our results this triple radioisotope technique provides the clinician with valuable information on the possible etiology of focal liver disease.     

The management of differentiated thyroid cancer using 123I for imaging to assess the need for 131I therapy

BACKGROUND: Follow-up of 131I whole-body scanning after 131I ablation is associated with potential stunning. Previous studies have suggested that, for scanning, 123I is more sensitive than 131I in identifying thyroid tissue, but its specificity when positive is less certain. AIM: The use of 123I as an imaging agent in place of serial 131I imaging has been evaluated in the surveillance and treatment of differentiated thyroid carcinoma. RESULTS: A total of 186 studies in 136 patients with differentiated thyroid carcinoma were evaluated after total or near total thyroidectomy followed by 131I ablation. In 125 studies 123I scanning was negative and no 131I therapy was given; four patients were positive on 123I scanning but for other reasons no 131I therapy was given. In 48/49 patients a positive 123I scan was followed by positive 131I therapeutic uptake. Only one patient failed to show positive uptake of I when first treated and she subsequently demonstrated uptake on a second therapy. CONCLUSION: High-dose 123I imaging is the correct predictor of the 131I post-therapy scan findings in most cases, at an administered activity that avoids stunning. As a diagnostic agent it is preferable to 131I in differentiated thyroid carcinoma.     

Triple radioisotope technique in etiologic evaluation of space-occupying lesions of the liver

The findings from 43 patients with histologically proven focal liver disease examined by triple isotope tracer study are presented.The method consisted in a three step technique, the first step being an isotope scan after injection of ^99mTc-sulfur colloid and ¹³¹I rose bengal. As a second step dynamic hepatic scintiangiography was carried out with ^99mTc human serum albumin in order to assess the vascularity of a lesion detected on the initial scan. Thirdly, the patient was administered ⁶⁷Ga to evaluate further the pathologic process.According to our results this triple radioisotope technique provides the clinician with valuable information on the possible etiology of focal liver disease.     

99mTc-sestamibi and 131I whole-body scintigraphy and initial serum thyroglobulin in the management of differentiated thyroid carcinoma.

99mTc-sestamibi whole-body scanning has been used in the postoperative assessment of differentiated thyroid carcinoma together with 131I whole-body scanning and serum thyroglobulin (Tg) estimation. This study compared 99mTc-sestamibi whole-body scanning with 131I whole-body scanning in the context of initial serum Tg levels of patients after total or near-total thyroidectomy who were taken off thyroxine suppression therapy and who had no 131I ablation before surgery. METHODS: A prospective study of 360 patients was undertaken. 99mTc-sestamibi whole-body scintigraphy was performed at least 5 wk after thyroidectomy and was followed by 131I whole-body scanning. The patients had no thyroxine suppression for 5 wk, and Tg was measured thereafter. Radiologic studies (chest radiography, CT, MRI, sonography, and bone scanning) and histopathologic examinations were performed to clarify the presence of metastases with positive uptake on either 99mTc-sestamibi scans or 131I whole-body scans. Positive scans were defined as those with the presence of thyroid remnants, lymph node disease, or metastases. RESULTS: Two hundred fifty-nine (71.9%) of the 360 patients had initial serum Tg levels < 30 ng/mL (group 1), whereas 101 (28.1%) had initial serum Tg levels > or = 30 ng/mL (group 2). Of the 259 group 1 patients, 82 had positive 99mTc-sestamibi scans and 113 had positive 131I scans; 71.7% of patients with positive 1311 scans also had positive 99mTc-sestamibi scans, and 98.8% of patients with positive 99mTc-sestamibi scans also had positive 131I scans. Of the 101 group 2 patients, 81 had positive 99mTc-sestamibi scans and 97 had positive 131I scans; 83.5% of patients with positive 131I scans also had positive 99mTc-sestamibi scans, and all patients with positive 99mTc-sestamibi scans also had positive 131I scans. Of those with initial serum Tg levels > or = 30 ng/mL (group 2), 27.2% had thyroid remnants and 68.8% had lymph node disease or metastases. 131I scanning detects more thyroid remnants and lung metastases than does 99mTc-sestamibi scanning. CONCLUSION: Our findings suggest that, compared with 131I scanning, 99mTc-sestamibi scanning is less sensitive in detecting thyroid remnants and lung metastases but appears to be more useful in the detection of lymph node disease before initial 131I treatment.     

A comparative study of 99mTc and 131I in thyroid scanning

Thyroid scans performed with both 99mTc pertechnetate (99mTcO4) and (131I) were compared in 46 patients with palpable thyroid nodules to determine whether 131I scanning is any longer a necessary procedure. A discrepancy between the two types of scan existed in only three cases, in one of which the thyroid nodule showed uptake of 99mTcO4 but not of 131I. Subsequent surgery revealed a thyroid malignancy in this patient. In each of the other two discrepancies a nodule "cold" on 99mTcO4 scanning was apparently functioning on 131I scanning, and was found to be benign at surgery. As the convenience and lower radiation absorbed dose of 99mTcO4 patients compared with 131I make it a better scanning agent, it is recommended that 99mTcO4 scans of the thyroid be first nodules. If these nodules prove to be functioning equally with paranodular tissue, a 131I scan should also be performed to help exclude a possible thyroid malignancy.     

131I rose bengal: Its use in the evaluation of infantile jaundice

One-hundred ten ¹³¹I-rose bengal studies (RBI) were performed in infants suspected of having biliary atresia. Fecal RBI excretion of less than 10% was observed in 72 of 73 cases of extrahepatic biliary atresia, but also in 10 of 37 cases of intrahepatic cholestasis of various origins.One-hundred twenty-two RBI tests were performed in children operated on for extrahepatic biliary atresia and 71 tests were performed between postsurgical weeks 3 and 8, and 51 tests were done later.Prognostically, early tests show that fecal RBI excretion of more than 15% was observed in 2 of 34 cases who were later completely jaundice-free and in only 1 of 37 cases where no bile flow restoration occurred.     

Upper retropharyngeal node involvement in differentiated thyroid carcinoma demonstrated by 131I scintigraphy

We report four patients with papillary thyroid cancer who had upper retropharyngeal node involvement demonstrated by 131I scintigraphy. Three patients presented with a thyroid nodule and enlarged jugular nodes. Total thyroidectomy was performed with node dissection. Pathology demonstrated papillary carcinoma with several metastatic nodes. 131I scanning 4 weeks after surgery demonstrated increased uptake in an upper retropharyngeal node. In one patient, thyroidectomy had been performed 21 years previously. Increased thyroglobulin level led to 131I scanning, which showed focal retropharyngeal uptake. All four patients had asymmetrical uptake at mouth level with focal uptake close to the sagittal plane. A lateral projection showed focal uptake between the base of the skull and the mandibular angle, behind the region of the mouth and nose. CT in all cases and MRI in one case confirmed the presence of an enlarged node. The mass was removed surgically in two patients and pathology confirmed the papillary nature of the metastatic node. Two patients were treated by 131I. Focal uptake of 131I in the region of the mouth is ambiguous, since salivary uptake of 131I is a common finding on scintigraphy. In cases of asymmetrical uptake in the region of the mouth, a lateral projection of the head therefore allows the correct diagnosis.     

Radioiodine whole-body scans, thyroglobulin levels, 99mTc-MIBI scans and computed tomography: results in patients with lung metastases from differentiated thyroid cancer

OBJECTIVES: The correlation between a 131I whole-body scan (WBS), a 99mTc sestamibi (99mTc-MIBI) WBS, a computed tomography (CT) scan and the value of routine follow-up for 131I WBS and thyroglobulin (Tg) levels in patients with lung metastases from differentiated thyroid cancer was assessed. METHOD: Pulmonary metastases were detected in 32 patients out of 583 with differentiated thyroid cancer (DTC) who were admitted to our clinic between 1985 and 2004 (age range, 22-79 years; mean, 58 +/- 19 years; 15 women and 17 men). Pulmonary metastases were diagnosed by considering the 131I WBS, increased Tg levels and/or other positive radiological findings. Papillary carcinoma was diagnosed in 15/32 patients and follicular carcinoma in 13/32. A mixed type found in 4/32 patients was classified histopathologically. A total of 3.7-53.65 GBq (100-1450 mCi) 131I was given to each patient. The duration of follow-up ranged from 36 to 240 months. A 131I WBS, the determination of Tg levels and/or a CT scan were carried out in the assessment of a diagnosis and follow-up of patients with lung metastases. A 99mTc-MIBI WBS was performed on 19 patients who were chosen at random from the 583. RESULTS: Nineteen of 32 patients had lung metastases before they received the first 131I treatment. Six of the 32 had distant-organ metastases other than in the lungs. Four of these six patients had only lung and bone metastases. Pulmonary metastases were observed on the 131I WBS patients 31/32 (96.8%) whereas no pulmonary metastases, were detected on the CT scans in 3/32 patients. The last diagnostic whole-body scan (DWBS) was normal in 13/32 patients. At the first examination, the Tg levels in 27/32 (84.4%) patients were below 30 ng . ml(-1). At the final examination, 20/32 (62.5%) patients had Tg levels higher than 30 ng . ml(-1), while Tg levels were lower than 30 ng . ml(-1) in 12/32 patients. Tg levels decreased in 21/32 and increased in 3/32 patients. The 131I WBS continued to be abnormal in 2/3 patients with increased Tg levels but became normal in one patient whose CT scan still showed macro-nodular lesions. Tg levels did not change significantly in 8/32 patients. The 131I WBS became normal in 5/8 patients, while the CT scans for 4/5 showed micro-nodules. Metastases were detected in 12/19 patients who underwent 99mTc-MIBI whole-body scanning: 18/19 showed metastases on the 131I WBSs and 17/19 on the CT scans. Of the seven patients without a sign of metastasis on the 99mTc-MIBI WBS, one was negative in terms of metastasis on the 131I WBS and one on the CT scan. Fibrosis was observed on the CT scans of 2/32 patients. One patient developed dedifferentiation, as determined by the negative 131I WBS and positive CT scan. CONCLUSION: 131I whole-body scanning and the determination of Tg levels are the most important procedures for the evaluation of lung metastases in differentiated thyroid cancer. Computed tomography is a useful addition to 131I whole-body scanning. MIBI imaging alone may not be enough to detect lung metastases from differentiated thyroid cancer.     

Tear clearance measurement in patients with dry eye syndrome using quantitative lacrimal scintigraphy

OBJECTIVE: The aim of this study was to evaluate the tear clearance in patients with dry eye syndrome using quantitative lacrimal scintigraphy. MATERIALS AND METHODS: We investigated 21 patients (42 eyes; 18 women, 3 men; mean age, 63.19 +/- 13.33 years) with dry eye syndrome. Additionally, for the sake of comparison, 12 normal subjects of the same age group (24 eyes; 10 women, 2 men; mean age, 68.25 +/- 2.63 years) were included. Lacrimal scintigraphy, Schirmer-1 test, BUT, and rose bengal ocular surface vital staining were performed in these cases. RESULTS: According to the results of lacrimal scintigraphy, the mean value of T 1/2 was 4.16 +/- 1.22 minutes and the mean value of RI was 14.15% +/- 2.30% in normal subjects. However, in patients with dry eye syndrome, these values were 20.59 +/- 1.97 minutes and 55.64% +/- 6.90%, respectively. Consistent with the results of ophthalmologic tests, the mean Schirmer-1 value was 12.46 +/- 2.10 mm, the mean value of BUT was 14.36 +/- 3.40 seconds, and the mean staining value of the rose bengal was 1.98 +/- 0.80 in normal subjects, whereas these values were 1.36 +/- 0.49 mm, 5.46 +/- 1.33 seconds, 6.62 +/- 0.86, respectively, in patients with dry eye syndrome. When we compared the results of lacrimal scintigraphy and the results of ophthalmologic tests, an inverse correlation was noted between both the T1/2 and RI values and both the Schirmer-1 and BUT values in all subjects (p < 0.001). However, there was a greater positive correlation between the rose bengal ocular surface staining value and both the T1/2 and RI values in all cases (p < 0.001). CONCLUSION: In the current study, it was concluded that although the lacrimal drainage system was normal, tear clearance was significantly delayed in dry eye patients. With this study, we have shown that quantitative lacrimal scintigraphy, which is an objective, practical, and noninvasive method, appears to be useful for the assessment of the tear clearance in patients with dry eye syndrome.     

Absence of thyroid stunning after diagnostic whole-body scanning with 185 MBq 131I.

There has been recent controversy regarding the optimal protocol for imaging and ablation of post-thyroidectomy patients. Several authors have suggested that a scanning dose of 185-370 MBq (5-10 mCi) (131)I may be capable of producing a stunning effect on thyroid tissue that may interfere with the uptake and efficacy of the subsequent ablation dose of radioiodine. The purpose of this study was to determine whether a 185-MBq (5 mCi) diagnostic dose of (131)I produces a visually apparent stunning effect 72 h before (131)I ablation therapy. METHODS: One hundred twenty-two consecutive post-thyroidectomy patients for differentiated thyroid carcinoma received a 185-MBq (5 mCi) diagnostic dose of (131)I followed by a whole-body diagnostic scan at 72 h. On the same day the diagnostic scan was completed, the patient was admitted to the hospital and received an (131)I ablation therapy dose of 5550 MBq (150 mCi) in most cases. A postablation, whole-body scan was obtained at 72 h and compared with the previous diagnostic scan for any visual evidence of stunning. RESULTS: No cases of visually apparent thyroid stunning were observed on any of the postablation scans with regard to the number of (131)I foci identified or the relative intensity of (131)I uptake seen. CONCLUSION: Diagnostic whole-body scanning can be performed effectively with a 185-MBq (5 mCi) dose of (131)I 72 h before radioiodine ablation without concern for thyroid stunning.     

Radioiodine-131 treatment of thyrotoxicosis: dose required for and some factors affecting the early induction of hypothyroidism

The results of sodium iodide 131I treatment of thyrotoxicosis in 1,168 patients (302 males, 866 females; 58.5% diffuse and 41.5% multinodular toxic goitre) are presented. At the end of the 1st year post-treatment, 54.4% were hypothyroid, and the incidence of hypothyroidism after the 2nd year increased by 3% per year. When the results were analysed according to the calculated radiation dose the thyroid, it was found that the cumulative incidence of hypothyroidism from 6 months to 2 years post-treatment rose almost proportionally to the dose in cases of doses of 1,500-15,000 rad, but increased very little for higher doses; however, the long-term incidence of hypothyroidism was almost independent of the thyroid dose. Multivariate analysis showed that the results of 131I therapy at 6 months depended also on sex (treatment being more effective in women), the consistency of the thyroid gland and the year of treatment, with the same radiation dose giving a higher incidence of hypothyroidism in patients treated recently, in comparison to those treated early in the period studied. Of the patients treated in the period 1978-1982 (mean dose, 300 microCi/g), 93.5% were cured with a single dose of 131I, and 78% were hypothyroid at 6 months post-treatment.     

The value of simultaneous co-registration of 99mTc- MDP and 131Iodine in metastatic differentiated thyroid carcinoma

BACKGROUND: The lack of anatomical details in standard (131)Iodine whole body scanning ((131)I WBS) interferes with the proper localization of metastatic differentiated thyroid carcinoma (DTC) lesions. In addition, nearby or overlapping variable physiological distribution of (131)I may affect the specificity of (131)I uptake, giving indeterminate results. The aim of this study was to demonstrate the clinical usefulness of simultaneous co-registration of (99m)Tc MDP bone scanning as an anatomical landmark with (131)I scanning in the evaluation of metastatic DTC. MATERIAL AND METHODS: Twenty-five patients (16 females and 9 males, mean age +/- SD = 52 +/- 13 years) with metastatic DTC (17 papillary, 8 follicular), were included. Whole body scanning using a 256 x 1024 matrix and an 8 cm/min scan rate were obtained 48 hours after oral administration of 185-370 MBq 131I and 2 hours after IV administration of 185-370 MBq (99m)Tc MDP using a dual head gamma camera equipped with high energy parallel hole collimators. Occasionally, additional simultaneous co-registration of localised detailed images was also performed using a 256 x 256 matrix size. The two planar images were fused with optional fusion of SPECT images. The data from standard (131)I scanning and fused (131)I/ (99m)Tc-MDP scanning were separately assessed by two nuclear medicine physicians. Fusion images were considered to improve image interpretation in comparison with standard (131)I scanning when they provided better localization of lesions. RESULTS: All lesions in the present study were validated by radiological images and clinical follow up for at least 12 months. Forty-eight metastatic lesions were confirmed as follows: 2 in the skull, 10 in the neck, 20 in the thorax, 12 in the pelvic-abdominal region and 4 in the extremities. Standard (131)I WBS showed 54 extra-thyroidal foci with 8 false positive lesions of which 2 were located in the scalp and 6 in the pelvic-abdominal region extra-skeleton (i.e. sensitivity 100%, specificity 86%). Out of the 48 validated lesions, 16 were indeterminately localized: 10 in the thorax (3 mediastinal nodal lesions, 5 vertebral lesions and 2 ribs) and 6 in the pelvic-abdominal region (2 upper sacral, 2 sacroiliac region and 2 ischial bone). Fusion images confirmed the precise localization of the pathological uptake in the validated 48 lesions (sensitivity 100%, specificity 100%). There were 2 (4%) indeterminate lesions in fused planar imaging that were clearly localized via fused SPECT images. CONCLUSIONS: Fusion images using simultaneous co-registration of (131)I and (99m)Tc MDP scanning is a simple and feasible technique that improves the anatomically limited interpretation of scintigraphy using (131)I alone in patients with metastatic differentiated thyroid carcinoma. The diagnostic advantage of this technique seems to be more apparent in the thoracic and pelvic- abdominal regions in contrast to the neck and extremities.     

~(131)I治疗甲状腺癌498例临床分析

目的探讨治疗分化型甲状腺癌的疗效。方法采用回顾性分析方法,将行甲状腺次全切除术或全切术并经病理确诊为甲状腺乳头状癌或滤泡状癌患者498例,于131I治疗前1个月禁食含碘食物、药物、优甲乐,使血清中TSH≥30 mU/L。采用131I一次口服,"清甲"、淋巴结转移、远处脏器转移剂量分别为3.7、5.55、7.4 GBq。131I治疗后7 d,行全身ECT扫描,若患者体内有核素浓集,4个月后再次服131I。结果 31～50岁发病人数占63.5%。行次全切、次全切+单侧颈廓清、全切、全切+单侧颈廓清、全切+双颈廓清术分别为85、62、251、72、28例。行1、2、3次手术者分别为451、39、8例。有、无颈部淋巴结转移者分别为419、79例。甲状腺内有一个癌结节者130例,一叶内有2个癌结节者59例,左右叶内各有1个及以上癌结节者309例。癌结节有、无局部侵犯者分别为139、359例。乳头状、滤泡状、乳头+滤泡状癌分别为464、25、9例。Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者分别为61、155、268、14例。有远处转移患者共14例。274例患者2次服131I后、130例患者3次服131I后、58例患者4次服131I后、20例患者5次服131I后、5例患者6次服131I后ECT扫描证实全身无核素浓集,其中3例肺转移患者6次服131I后ECT扫描证实全身无核素浓集,11例骨转移或肺转移患者服131I后ECT扫描证实仍有核素浓集。结论131I是分化型甲状腺癌术后治疗的有效方法。甲状腺残留多、有局部侵犯的患者,会增加服131I的次数。有远处转移的甲状腺癌患者仍有治愈可能,但是有肺、骨等远处转移的患者仍是治疗的难点。