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1.
The aim of this study was to investigate the possible role of technetium-99m methoxyisobutylisonitrile (MIBI) scan in planning post-surgical therapy and follow-up in patients with differentiated thyroid carcinoma (DTC). Four groups of DTC patients were considered: Group 1 comprised 122 patients with high serum thyroglobulin (s-Tg) levels and negative high-dose iodine-131 scan during follow-up who had previously undergone total thyroidectomy and 131I treatment. Group 2 consisted of 27 patients who had previously undergone total thyroidectomy and 131I treatment but were now considered disease-free; this group was considered as controls. Group 3 comprised 49 patients studied after total thyroidectomy but prior to 131I scan. Finally, group 4 consisted of 21 patients who had previously undergone partial thyroidectomy alone. MIBI scan, neck ultrasonography (US), and s-Tg measurements during suppressive hormonal therapy (SHT) were obtained in all patients. Neck and chest computed tomography (CT) or magnetic resonance imaging (MRI) was also performed in group 1 patients. In group 1, MIBI scan and US were very sensitive in detecting cervical lymph node metastases (93.54% and 89.24%, respectively). Furthermore, MIBI scan and US played a complementary role in several patients, yielding a global sensitivity of 97.84%. In contrast, CT/MRI sensitivity for cervical lymph node metastases was very low (43.01%). MIBI scan also showed a higher sensitivity than CT/MRI in detecting mediastinal lymph node metastases (100% vs 57.89%). Regarding distant metastases, MIBI scan provided results similar to those of conventional imaging (CT, MRI, 99mTc-methylene diphosphonate bone scan). In group 2, no false-positive cases were observed with MIBI scan (100% specificity). In group 3, MIBI scan correctly identified all the 131I-positive metastatic foci, except in two patients with micronodular pulmonary metastases that were visualised with 131I scan. In contrast, both MIBI scan and US showed low sensitivity (46.15% and 61.53%, respectively) compared with 131I scan in detecting thyroid remnants. s-Tg was increased in all patients with distant metastases but only in 56% of those with lymph node metastases. Furthermore, s-Tg was increased in 21.42% of patients with thyroid remnants alone (false-positive results). In group 4, MIBI scan was the only examination capable of detecting at an early stage a mediastinal lymph node metastasis in one patient. We conclude that the integrated MIBI scan/neck US protocol: (a) can be proposed as a first-line diagnostic procedure in the follow-up of DTC patients with high s-Tg levels and negative high-dose 131I scan, and (b) may be helpful in the follow-up of DTC patients who undergo partial thyroidectomy alone. Moreover, the combined MIBI scan/neck US/s-Tg protocol appears to be highly sensitive in identifying patients with metastatic disease after total thyroidectomy and prior to 1311 scan; consequently, it may play a prognostic role in distinguishing high-risk from low-risk DTC patients. However, due to the low sensitivity of MIBI scan and neck US in detecting thyroid remnants, this diagnostic approach cannot be used as a predictor of 131I scan results. Lastly, because of the high sensitivity of MIBI scan and neck US in revealing both functioning and non-functioning metastases, this integrated protocol might be helpful in the follow-up of high-risk DTC patients, particularly for the early detection of lymph node metastases in patients with undetectable s-Tg during SHT. 相似文献
2.
Zhi-Yi Ye Hui Wang Hong-Liang Fu Jia-Ning Li Ren-Jian Zou Zhen-Hui Gu Jing-Chuan Wu 《Clinical imaging》2009,33(3):221-225
ObjectiveThyroid carcinoma is the most common malignant endocrine tumor, which comprises 1% in all human tumors. As for differentiated thyroid carcinoma (DTC), lymph nodes are the most common metastatic site for which the major treatment is 131I therapy. This retrospective study aimed to investigate the therapeutic effect and analyze the influence factors on 131I treatment of DTC with lymph node metastases.MethodsCollecting clinical data of 66 DTC patients with lymph node metastases at the Department of Nuclear Medicine, Xin Hua Hospital from January 1996 to January 2006. Investigating the therapeutic effect firstly and then dividing 66 patients into an eliminated group and an uneliminated group according to the evaluation criteria of the therapeutic effect. Finally, observing the differences between the two groups. The significant differences in the following 10 influence factors were determined: gender, age, pathological type, the periods from the thyroidectomy to the first 131I therapy, when the metastases were found, the history of resection of the lymph node metastases, the uptake of 18F-FDG in the lymph node metastases, remnant thyroid, multiple metastases, and the cumulative dose of 131I. This retrospective study was analyzed by Student t test, χ2 test, and Fisher's exact test.ResultsOf all 66 patients with lymph node metastatic DTC treated by 131I therapy, 31 patients (46.97%) had complete elimination. Twenty-seven patients were improved or controlled, and the overall effective rate reached 87.88%. The elimination rate of lymph node metastases in patients with resection was significantly higher than in those without resection (χ2=5.561, P=.018<0.05). The elimination rate of lymph node metastases in patients with 18F-FDG uptake was significantly higher than in those without 18F-FDG uptake (χ2=4.014, P=.045<.05). There was no significant difference in the elimination rate among the patients with various values in the other eight factors.Conclusions131I Therapy is an effective treatment of lymph node metastatic DTC. The history of resection of the lymph node metastases and the uptake of 18F-FDG in the lymph node metastases were the influence factors on the therapeutic effect, whereas the other eight factors were probably not. 相似文献
3.
目的探讨手术联合131I对分化型甲状腺癌的治疗效果。方法将160例分化型甲状腺癌(DTC)患者根据术后是否接受131I治疗分为观察组与对照组各80例。观察组给予手术+放射性131I治疗,对照组给予手术+优甲乐治疗,观察两组治疗情况。结果观察组首次"清甲"成功率为71.3%,甲状腺全切者首次"清甲"成功率显著高于次全切者(P<0.01)。术后131I治疗对颈部淋巴结转移患者总有效率为95.3%,肺转移患者为82.6%,骨转移患者为64.3%。服用131I后1周内不良反应发生率为38.8%(31/80),其中甲状腺全切者不良反应发生率显著低于次全切者(P<0.05)。随访至今,观察组复发转移发生率与患者存活率均显著优于对照组(P<0.05)。结论手术+131I治疗DTC可在术后有效清除残留甲状腺组织及残留的微小癌,同时可对颈部淋巴结转移及肺转移灶进行治疗,可降低复发及转移率,远期效果较好。 相似文献
4.
Fabio Pomerri Anna Rita Cervino Faise Al Bunni Laura Evangelista Pier Carlo Muzzio 《La Radiologia medica》2014,119(2):97-102
Purpose
18F-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) has proved effective in detecting recurrent or metastatic differentiated thyroid carcinoma (DTC) in the follow-up of operated DTC patients with high thyroglobulin (Tg) levels and negative findings on radioiodine whole-body scan. The aim of this retrospective study was to assess the impact of PET/CT on the planning of appropriate treatment for known recurrent disease in operated DTC patients.Materials and methods
The study concerned 44 consecutive DTC patients (36 papillary, 8 follicular), who underwent total thyroidectomy and thyroid remnant ablation with 131I and PET/CT. All patients had proven or strongly suspected recurrent disease judging from neck ultrasound (US) and fine-needle aspiration cytology, and detectable basal Tg levels.Results
PET/CT findings were positive in 25/44 patients (56.81 %) and negative in 19. A positive PET/CT result predicted resectable tumour recurrences in 19/25 patients, but also detected additional tumour sites that prompted changes to the treatment plan in 6/25 patients (24 %). A negative PET/CT result led to clinical monitoring for 11/19 patients (57.89 %).Conclusions
PET/CT can help select patients, who might benefit from a tailored therapy by improving the detection of local recurrences not apparent on neck US or metastases. 相似文献5.
Iwata M Kasagi K Misaki T Matsumoto K Iida Y Ishimori T Nakamoto Y Higashi T Saga T Konishi J 《European journal of nuclear medicine and molecular imaging》2004,31(4):491-498
The usefulness of fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in differentiated thyroid cancer (DTC) has been demonstrated by many investigators, but in only a small number of studies have FDG-PET images been compared with those obtained using other non-iodine tumour-seeking radiopharmaceuticals. In most of the studies, planar imaging was performed for comparison using thallium-201 chloride or technetium-99m 2-methoxyisobutylisonitrile (99mTc-MIBI). Furthermore, FDG-PET studies were not always performed in the hypothyroid state with increased levels of thyroid stimulating hormone (TSH), which are known to increase FDG uptake by DTC. The aim of this study was to compare the ability of FDG-PET to detect metastatic DTC with that of 99mTc-MIBI whole-body single-photon emission tomography (SPET) and post-therapeutic iodine-131 scintigraphy, evaluated under TSH stimulation. Nineteen patients (8 men, 11 women; age range, 38–72 years, mean 60 years; 17 thyroidectomised and 2 inoperable patients following 131I ablation of the remaining thyroid tissue; 16 papillary and 3 follicular carcinomas) with metastatic DTC underwent FDG-PET whole-body scan (WBS) and 99mTc-MIBI SPET WBS at an interval of less than 1 week, followed by 131I therapy. The SPET images were reconstructed using the maximum likelihood expectation maximisation (ML-EM) method. All patients were hypothyroid at the time of each scan. 131I WBS was performed 3–5 days after oral administration of the therapeutic dose. A total of 32 lesions [10 lymph node (LN), 15 lung, 6 bone, 1 muscle] were diagnosed as metastases, as confirmed by histopathology and/or other imaging modalities (X-ray, US, CT, MRI, bone, 201Tl and 131I scans). FDG-PET, 99mTc-MIBI SPET and post-therapeutic 131I scintigraphy respectively revealed a total of 26 (81.3%), 20 (62.5%) and 22 (68.8%) lesions. These techniques respectively demonstrated nine (90.0%), eight (80.0%) and six (60.0%) LN metastases, and eleven (73.3%), seven (46.7%) and ten (66.7%) lung metastases. They each demonstrated five of the six bone metastases (83.3%). FDG-PET and 99mTc-MIBI SPET were positive in 17 (78.3%) and 14 (63.6%) of the 22 131I-positive lesions, respectively, and also in nine (90.0%) and six (60.0%) of the ten 131I-negative lesions, respectively. Three of the five 131I-positive and FDG-PET-negative lesions were miliary type lung metastases with a maximal nodular diameter of less than 10 mm. Comparison of FDG-PET with 99mTc-MIBI SPET revealed concordant results in 24 lesions, and discordant results in eight lesions (seven with positive FDG-PET alone and one with positive 99mTc-MIBI SPET alone). In conclusion: (a) even using whole-body SPET, FDG PET is superior to 99mTc-MIBI in terms of ability to detect metastases of DTC; (b) the higher sensitivity of FDG-PET compared with the previous studies could partly be due to increased serum TSH. 相似文献
6.
Katja Brandt-Mainz Stefan P. Müller Rainer Görges Bernhard Saller Andreas Bockisch 《European journal of nuclear medicine and molecular imaging》2000,27(5):490-496
The early detection of metastases from medullary thyroid cancer (MTC) is important because the only curative therapy consists
in surgical removal of all tumour tissue. There is no single sensitive diagnostic imaging modality for the localization of
all metastases in patients with MTC. Therefore, in many cases several imaging modalities (e.g. ultrasonography, magnetic resonance
imaging, computerized tomography and scintigraphy using pentavalent technetium-99m dimercaptosuccinic acid, thallium-201 chloride,
indium-111 pentetreotide, anti-CEA antibodies or metaiodobenzylguanidine) must be performed consecutively in patients with
elevated calcitonin levels until the tumour is localized. In this prospective study, we investigated the value of fluorine-18
fluorodeoxyglucose positron emission tomography ([18F]FDG PET) in the follow-up of patients with MTC. [18F]FDG PET examinations of the neck and the chest were performed in 20 patients with elevated calcitonin levels or sonographic
abnormalities in the neck. Positive [18F]FDG findings were validated by histology, computerized tomography or selective venous catheterization. [18F]FDG PET detected tumour in 13/17 patients (nine cases were validated by histology, four by computerized tomography). Five
patients showed completely negative PET scans (of these cases, one was true-negative and four false-negative). One patient
with [18F]FDG accumulation in pulmonary lesions from silicosis and one patient with a neck lesion that was not subjected to histological
validation had to be excluded. Considering all validated localizations, [18F]FDG PET detected 12/14 tumour manifestations in the neck, 6/7 mediastinal metastases, 2/2 pulmonary metastases and 2/2 bone
metastases. In two patients with elevated calcitonin levels, no diagnostic modality was able to localize a tumour. The sensitivity
of [18F]FDG PET in the follow-up of MTC was 76% (95% confidence interval 53%–94%); this is encouraging. [18F]FDG PET promises to be a valuable diagnostic method, especially for the detection of lymph node metastases, surgical resection
of which can result in complete remission.
Received 16 September 1999 and in revised form 19 January 2000 相似文献
7.
Annika Eigtved Anders P. Andersson Karin Dahlstrøm Alan Rabøl Mikael Jensen Søren Holm Sven Sølvsten Sørensen Krzysztof T. Drzewiecki Liselotte Højgaard Lars Friberg 《European journal of nuclear medicine and molecular imaging》2000,27(1):70-75
Correct staging is crucial for the management and prognosis of patients with malignant melanoma. The aim of this prospective
study was to compare staging by whole-body positron emission tomography using fluorine-18 fluorodeoxyglucose (18F-FDG) with staging by conventional methods. Thirty-eight patients with malignant melanoma of clinical stage II (local recurrence,
in-transit and regional lymph node metastases) or III (metastases to other sites than in stage II) were included in the study.
The results of the PET scans were compared with those obtained by clinical examination, computed tomography, ultrasound, radiography,
and liver function tests and histology or clinical follow-up. With 18F-FDG PET we found for all foci a sensitivity of 97% and a specificity of 56%, compared with 62% and 22%, respectively, when
using routine methods. For intra-abdominal foci, the sensitivity and specificity were 100% for both 18F-FDG PET and routine methods. Corresponding figures for pulmonary/intrathoracic foci were 100% and 33%, respectively. Of
the patients included in this study, 34% would not have been staged correctly by conventional methods alone. We conclude from
this study that 18F-FDG PET is a sensitive method superior to conventional methods for detecting widespread metastases from malignant melanoma.
Mutilating surgery of no benefit can thereby be avoided. 18F-FDG PET is useful as a supplement to clinical examination in melanoma staging.
Received 26 May and in revised form 20 September 1999 相似文献
8.
Iodine-131 treatment and high-resolution CT: results in patients with lung metastases from differentiated thyroid carcinoma 总被引:12,自引:1,他引:11
Ilgan S Karacalioglu AO Pabuscu Y Atac GK Arslan N Ozturk E Gunalp B Ozguven MA 《European journal of nuclear medicine and molecular imaging》2004,31(6):825-830
Between 1984 and 2002, pulmonary metastases were detected in 42 (4%) out of 1,023 patients with differentiated thyroid carcinoma (DTC) in our department. The age at diagnosis ranged from 6 to 77 years. Lung metastases were diagnosed by both increased thyroglobulin (Tg) levels and positive uptake of iodine-131 on scans, and/or positive radiological findings. The primary tumours were histologically classified as papillary (30 patients), follicular (nine patients) and poorly differentiated (two tall cell, one insular carcinoma). The duration of follow-up ranged from 24 to 228 months. The end-results of the 131I therapy were evaluated. The treatment of choice was 131I therapy of metastases after total thyroidectomy plus lymph node dissection (if lymph node metastases were present). Applied single and total 131I activities were 1.8–10.4 GBq and 5.5–43.7 GBq, respectively. Lung metastases were present at the time of diagnosis in 30 patients and developed during the follow-up period in the remaining 12. Twelve patients with extensive metastases died of thyroid carcinoma and another died due to secondary malignancy (malignant mesothelioma). Ten patients with lung metastases remain completely free of disease and are probably cured, while another seven were stable at the time of study. Three- and five-year survival rates were 86% (36/42) and 76% (32/42), respectively. To define the diagnostic value of high-resolution computed tomography (HRCT) and identify the distinctive features of lung metastases from DTC, 22 patients were further examined with HRCT within 2 weeks of the initial diagnosis of lung metastases and the results were compared with chest X-ray findings. HRCT detected metastases in 10 out of 14 patients with a normal chest X-ray and confirmed metastases in all patients with positive (n=5) and suspicious (n=3) chest X-ray. HRCT did not show any abnormalities in four patients with positive lung uptake on 131I whole-body images. Stage of disease, existence of distance metastases other than to the lung, and HRCT characteristics were significant prognostic variables. Lung metastases from DTC can be cured with 131I therapy in a considerable number of patients, especially when they are not associated with other distant metastases; they should therefore be treated at an early stage. HRCT clearly improved diagnostic ability in the evaluation of lung metastases compared with chest X-ray and should be the primary method when radiological correlation is needed. The main, and new, finding of the study is that HRCT not only improves diagnostic ability but is also of prognostic value. 相似文献
9.
Markus Dietlein Klemens Scheidhauer Eberhard Voth Peter Theissen Harald Schicha 《European journal of nuclear medicine and molecular imaging》1997,24(11):1342-1348
Metastases of differentiated thyroid cancer may show different uptake patterns for fluorine-18 fluorodeoxyglucose and [131I]NaI. FDG positron emission tomography (PET), iodine-131 whole-body scintigraphy (131I WBS) and magnetic resonance imaging were performed in 58 unselected patients, and spiral computed tomography (CT) of the
lung in 25 patients. Thirty-eight patients presented with papillary carcinomas, 15 patients with follicular carcinomas and
five patients with variants of follicular carcinoma. Primary tumour stage (pT) was pT1 in 3, pT2 in 19, pT3 in 11 and pT4
in 25 cases. For the detection of metastases, FDG PET was found to have a sensitivity of 50%, 131I WBS a sensitivity of 61%, and the two methods combined a sensitivity of 86%. When FDG PET was limited to patients with elevated
thyroglobulin (Tg) levels and negative 131I WBS, the sensitivity of this algorithm was 82%. Of the 21 patients with lymph node metastases, seven presented with FDG
uptake but no iodine uptake. In four of them, a second FDG hot spot appeared in a lymph node metastasis of normal size. Five
of the seven patients underwent surgery. None of the eight patients with pulmonary metastases smaller than 1 cm exhibited
FDG uptake, while five of them had iodine uptake. All had positive results on spiral CT. In conclusion, FDG PET cannot be
substituted for 131I WBS. If the Tg level is elevated and 131I WBS is negative, FDG PET can be used to detect lymph node metastases and complements anatomical imaging. A spiral CT of
the lung is useful to exclude pulmonary metastases before planning a dissection of iodine-negative lymph node metastases.
Received 2 May and in revised form 8 July 1997 相似文献
10.
Caleo O Maurea S Klain M Salvatore B Storto G Mancini M Pace L Salvatore M 《La Radiologia medica》2008,113(2):278-288
PURPOSE: The aim of this study was to compare the results of ultrasound (US), whole-body scintigraphy with iodine-131 (I-131 WBS) and positron emission tomography with fluorine-18 deoxyglucose (FDG-PET) in the follow-up of patients after thyroidectomy for differentiated thyroid carcinoma (DTC). MATERIALS AND METHODS: Thirteen patients (3 men, 10 women) were evaluated by neck US, I-131 WBS and FDG-PET. In each patient six anatomical regions (right and left thyroid bed, right and left cervical region, right and left supraclavicular region) were investigated, for a total of 78 regions. Distant metastases were investigated by I-131 WBS and FDG-PET and considered separately in the analysis. Imaging findings were compared with the reference standards, such as fine-needle aspiration cytology (2), biopsy (4) or clinical-radiological studies (7). RESULTS: US, FDG-PET and I-131 WBS showed concordant negative results in most (70, 90%) of the anatomical sites considered. In one patient with left cervical lymph node metastasis, the imaging techniques showed concordant positive results (1%). In the remaining 7 regions (9%), the imaging results were discordant; in particular, tumour lesions, nodal metastases (4) and thyroid bed recurrences (3) were detected by US only (3), by US and I-131 WBS (1) and by FDG-PET only (3). With regard to distant metastases, FDG-PET and I-131 WBS yielded concordant negative results in the majority (77%) of patients (9); in one patient only were the two imaging techniques concordant in their positive result. In the last three patients, the results were discordant; in particular, distant metastases were detected by I-131 WBS only in two patients and by FDG-PET only in one patient. CONCLUSIONS: Our work indicates a fundamental role for US in evaluation of the neck after surgery for DTC. WBS is useful to determine differentiation of tumour lesions, to identify thyroid remnants and to look for distant metastases. FDG-PET has an important role in cases of dedifferentiated thyroid carcinoma in which WBS and thyroglobulin measurements are unable to detect tumour lesions. 相似文献
11.
Wu HS Hseu HH Lin WY Wang SJ Liu YC 《European journal of nuclear medicine and molecular imaging》2005,32(2):167-173
Purpose In an attempt to obviate the necessity for hospitalisation, the ablative dose of 131I in the treatment of thyroid cancer is divided into two or three fractions at weekly intervals in some hospitals with no special bed for 131I treatment. Thyroid stunning has been observed in patients receiving a 131I dose between 74 and 370 MBq (2–10 mCi). However, the influence of 131I uptake after administration of a higher dose, such as 1,110–1,850 MBq of 131I, has never been reported. In this study, we evaluated the degree of reduction in 131I uptake after patients received 1,480 MBq of 131I and evaluated the clinical value of fractionated ablative doses of 131I.Methods Thirty-five patients with functional thyroid cancer received a total of 4,440 MBq (120 mCi) of 131I which was divided into three fractions administered at weekly intervals. In all patients two 131I whole-body scans were performed. The first scan was performed directly prior to the second dose of 131I (7 days after the first administration of 131I), and the second scan was performed 7 days after the second administration of 131I and directly prior to the third administration. Regions of interest including the neck and lungs were drawn to calculate the uptake of 131I in the thyroid remnant and possible cervical lymph node and lung metastases.Results The mean uptake of 131I was 2.73% 7 days after the first administration, and decreased significantly to 0.26% 7 days after the second administration. The mean decrease was as high as 80.7%. The decrease in 131I uptake was significant in all patients except the two with lung metastases. In the two patients with lung metastases, no definite evidence of decreased uptake was noted; the uptake of 131I in the lung metastases even increased on the second 131I image in one of these patients. After administration of 1,480 MBq of 131I, the decreased uptake was significant in all neck lesions but not in lung metastases.Conclusion The use of fractionated ablative doses of 131I is not to be recommended in patients without lung metastases. However, the influence of fractionated ablative doses of 131I in patients with lung metastases is worthy of further study. 相似文献
12.
Maged Abdel Galil Hamed Ahmed Fathy Abdel Ghany Noha Mohamed Osman 《The Egyptian Journal of Radiology and Nuclear Medicine》2014
Objective
Patients with differentiated thyroid carcinoma (DTC) have generally an encouraging prognosis, however, some patients develop an increasing level of serum thyroglobulin (Tg) without detection of a recurrent tumor using conventional imaging tools such as the iodine-131 whole-body scanning (I131 scan). The objective of our study was to evaluate the clinical significance of [F18]-FDG-PET/CT in detection of tumor recurrence or metastases, in comparison to conventional imaging such as the I131 scan.Patients and methods
Between January 2013 and June 2013, [18F]-FDG-PET/CT examination was done for 12 DTC patients with elevated thyroglobulin levels and who did not show any pathological lesions when conventional imaging modalities were used. All involved patients had undergone total thyroidectomy, and who had been followed-up by whole body iodine scan [F18]-FDG PET/CT data were evaluated for detecting recurrent DTC lesions in study patients and compared with those of other radiological and/or cytological investigations.Results
Five of 12 patients (41.6 %) showed pathological [F18]-FDG uptake in the absence of abnormal uptake in whole body iodine scan.Conclusion
[F18]-FDG-PET/CT affords a valuable diagnostic method in detection of recurrence or metastasis in patients with DTC who are tumor-free on conventional imaging studies with high Tg levels. 相似文献13.
AIMS AND BACKGROUND: The aim of this study was to evaluate the potential contribution of Tc-99m-MIBI scintigraphy to the follow-up of patients with differentiated thyroid carcinoma, who had elevated Tg levels and negative I-131 whole-body scan results. MATERIALS AND METHODS: In this retrospective study, we evaluated 28 patients with differentiated thyroid carcinoma, who had total or near total thyroidectomy followed by an ablative dose of I-131 at various time intervals (15 women, 13 men; mean age 43 +/- 17 years). All patients were treated with T4 suppression. After a mean follow-up period of 6.1 years (range 3-15) all patients were determined to have a high serum Tg concentrations (>2 ng/ml) and previous negative I-131 WBS results. All patients were examined for metastatic sites using Tc-99m-MIBI scan. Scans were visually evaluated for detecting lymph node metastases and/or local recurrence, lung metastases and skeletal metastases. RESULTS: Tc-99m-MIBI scan demonstrated lesions in 23 patients (83.3%). In five patients with negative Tc-99m-MIBI scan findings (FN results): Chest CT showed small-sized mediastinal LN metastases in 2 patients and lung metastases in another 2 patients (<1 cm). Neck CT showed small-sized cervical LN involvement in 1 patient. The sensitivity of detection for neck was 94.4%, for lung 63.6%, and for bone lesions 100%. For all scan sites taken together, the sensitivity of disease detection was 83.3%, the specificity was 50%, positive predictive value (PPV) was 96.2%, and finally negative predictive value (NPV) was 16.7%. CONCLUSION: We concluded that Tc-99m-MIBI scan should be considered as a supplementary scintigraphic method for the follow-up of patients with high serum Tg levels and negative I-131 WBS results, and it can help clinicians in making the decision to treat these patients. 相似文献
14.
Zoller M Kohlfuerst S Igerc I Kresnik E Gallowitsch HJ Gomez I Lind P 《European journal of nuclear medicine and molecular imaging》2007,34(4):487-495
Purpose
18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a well-established method in the follow-up of patients with
differentiated thyroid carcinoma (DTC), elevated thyroglobulin (Tg) and negative 131I scans. This retrospective clinical study was designed to evaluate the impact of computed tomography (CT) and that of FDG-PET
in combined FDG-PET/CT examinations on the restaging of DTC patients.
Methods Forty-seven FDG-PET/CT scans of 33 patients with a history of DTC, elevated Tg levels and negative 131I uptake or additionally suspected 131I-negative lesions were studied. PET and CT images were analysed independently by an experienced nuclear medicine specialist
and a radiologist. Afterwards a final consensus interpretation, the gold standard in our department, was provided for the
fused PET/CT images and, if available, for supplementary investigations.
Results Thirty-five investigations (74%) revealed pathological FDG-PET/CT findings. In summary, 25 local recurrences, 62 lymph node
metastases and 122 organ metastases (41 lung, 60 bone, 21 other organs) were diagnosed. In 36 out of 47 examinations (77%),
the original PET diagnoses were modified in the final consensus interpretation owing to the CT assessments. In 8 of the 35
pathological FDG-PET/CT examinations (23%), the final consensus interpretation of the PET/CT images led to an alteration in
the treatment plan.
Conclusion PET/CT is a powerful fusion of two pre-existing imaging modalities, which not only improves the diagnostic value in restaging
DTC patients with elevated Tg and negative 131I scan, but also provides accurate information regarding subsequent treatment options and may lead to a change in treatment
management. 相似文献
15.
目的评价131ISPECT/CT显像在DTC患者中相对于131I全身显像(WBS)的增益价值。方法回顾性对比分析97例DTC患者[男31例,女66例,平均年龄44.1(17—74)岁]176个摄碘灶的131IWBS和131ISPECT/CT显像资料。显像均为131I治疗后的常规扫描,SPECT/CT显像针对WBS发现的病灶进行。由2位核医学科医师阅片,以病理及随访结果为诊断标准,分析131ISPECT/cT及131IIWBS对摄碘灶定位定性的诊断能力,并应用SPSS13.0对两者诊断准确性进行∥检验。结果131IWBS检出摄碘灶175个(颈部128个,远处灶47个),SPECT/CT检出病灶176个(颈部128个,远处灶48个)。173个病灶经病理及随访确诊,良性78个,恶性95个;3个未定性(仍在随访中)。确诊的摄碘灶中,残留甲状腺组织51个,颈部淋巴结转移或局部残留病灶67个,生理性摄取灶7个,远处转移灶30个,远处生理性摄取灶18个。131IIWBS诊断摄碘灶的灵敏度73.7%(70/95),特异性78.2%(61/78),准确性61.3%(106/173);其准确性低于131ISPECT/CT(98.8%,171/173;x2=72.3,P〈0.05)。131ISPECT/CT纠正131IWBS误判摄碘灶67个,其中纠正定位错误27个,定性错误40个;颈部37个[占全部颈部灶的28.9%(37/128)],远处灶30个(62.5%,30/48)。与131IWBS的最初诊断相比,131IISPECT/CT显像改变了27个转移部位的诊断,改变了8例患者临床分期的诊断,并最终改变了14例患者的治疗方案。结论131ISPECT/CT可以弥补131IWBS的不足,更准确区分残余甲状腺组织和淋巴结、肺或骨等远处转移及生理性摄取,对于DTC的诊治有较好的增稀价值。 相似文献
16.
Salvatori M Ardito G Pelizzo MR Mariani G Gross M Al-Nahhas A Rubello D 《Nuclear medicine review. Central & Eastern Europe》2006,9(2):119-124
BACKGROUND/MATERIAL AND METHODS: The aim of this study was to assess the reliability of radioiodine ((131)I) and a gamma probe for radio-guided surgery (RGS) to detect and radically dissect lymph node recurrence (LNR) in 15 patients with differentiated thyroid cancer (DTC). The major inclusion criterion was the presence of a radioiodine-positive LNR after previous total thyroidectomy and at least two ineffective (131)I treatments. The protocol was designed as follows: Day 0--all patients were hospitalized and received 3.7 GBq of (131) I while clinically hypothyroid. Day 3--pre-surgery whole-body scan with a therapeutic (131)I dose (TxWBS) was acquired. Day 5--neck surgery using a gamma probe (Navigator GPS, AutoSuture, Italy), recording the absolute counts and the lesion/background (L/B) counts ratio was performed. Day 7--post-surgery TxWBS was performed using the remaining radioactivity. RESULTS AND CONCLUSIONS: This protocol permitted us to identify neoplastic foci with high sensitivity and specificity, enabling us to remove lymph node metastases resistant to radioiodine therapy in a single session. The protocol also allowed detection of some additional tumoural foci in sclerotic areas or behind vascular structures that were not seen at the pre-surgery TxWBS evaluation. 相似文献
17.
AIMS: (1) To investigate whether elevated serum anti-thyroglobulin antibody (ATG) reflects the recurrence of cancer in patients with differentiated thyroid carcinoma (DTC) in whom thyroglobulin was undetectable after radioiodine ablation. (2) To assess the sensitivity of disease detection for (99m)Tc-MIBI whole-body scans (WBSs) in these patients and investigate the correlation between MIBI WBS results and high serum ATG levels. MATERIALS AND METHODS: In this retrospective study, we evaluated 14 patients (13 women and 1 man; mean age 44 +/- 19 years) with DTC who underwent total or near-total thyroidectomy followed by an ablative dose of I at various time intervals. According to histopathological findings, 10 patients (71.4%) who were diagnosed as having papillary carcinoma and four patients (28.6%) as having follicular cell carcinoma, had high serum ATG concentrations (> 40 IU x ml(-1); range, 62-2000 IU x ml(-1)), but low serum thyroglobulin concentrations (< 1.6 ng x ml). Post-therapeutic and diagnostic (131)I WBSs and (99m)Tc-MIBI WBSs were performed. Scans were visually evaluated for detecting recurrence. If necessary, bone scans, chest X-rays, computerized tomography, ultrasonography and histopathological evaluation were performed. RESULTS: Recurrent and/or persistent disease was found in 12 of the patients. This was confirmed pathologically in four patients and by using other imaging methods in eight (bone scans, computerized tomography, ultrasonography). The sensitivity and specificity of disease detection for MIBI WBSs was 66.7% and 100%, respectively. For (131)I WBSs, the sensitivity of disease detection was 55.6%. Among these 12 patients, 10 responded to treatment (three underwent surgery, seven received radioiodine therapy, and two had surgery + radioiodine therapy). ATG levels decreased in eight of the 10 patients, but remained persistently elevated in two despite treatment. CONCLUSIONS: (1) Persistently elevated ATG levels appear to serve as a useful marker for recurrent or persistent DTC in patients with undetectable serum tyroglobulin levels. Thus, the routine measurement of ATG antibody in such patients is of great value. (2) In these patients, (99m)Tc-MIBI has a relatively high sensitivity in the diagnosis of a recurrence of thyroid cancer or metastases. So, in patients with elevated ATG but undetectable serum thyroglobulin levels, (99m)Tc-MIBI can be used to determine whether there is a recurrence of DTC or metastases. 相似文献
18.
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. 相似文献
19.
Value of FDG PET in papillary thyroid carcinoma with negative 131I whole-body scan. 总被引:10,自引:0,他引:10
J K Chung Y So J S Lee C W Choi S M Lim D S Lee S W Hong Y K Youn M C Lee B Y Cho 《Journal of nuclear medicine》1999,40(6):986-992
The management of metastatic thyroid carcinoma patients with a negative 131I scan presents considerable problems. Fifty-four athyrotic papillary thyroid carcinoma patients whose 1311 whole-body scans were negative underwent 18F-fluorodeoxyglucose (FDG) PET; the purpose was to determine whether this procedure could localize metastatic sites. We also assessed its usefulness in the management of these patients. METHODS: Whole-body emission scan was performed 60 min after the injection of 370-555 MBq 18F-FDG, and additional regional attenuation-corrected scans were obtained. Metastasis was pathologically confirmed in 12 patients and was confirmed in other patients by overall clinical evaluation of the findings of other imaging studies and of the subsequent clinical course. RESULTS: In 33 patients, tumor had metastasized, whereas 21 patients were in remission. FDG PET revealed metastases in 31 patients (sensitivity 93.9%), whereas thyroglobulin levels were elevated in 18 patients (sensitivity 54.5%). FDG PET was positive in 14 of 15 metastatic cancer patients with normal thyroglobulin levels. In 20 of 21 patients in remission, FDG PET was negative (specificity 95.2%), whereas thyroglobulin levels were normal in 16 patients (specificity 76.1%). The sensitivity and specificity of FDG PET were significantly higher than those of serum thyroglobulin. In patients with negative 1311 scans, FDG PET detected cervical lymph node metastasis in 87.9%, lung metastasis in 27.3%, mediastinal metastasis in 33.3% and bone metastasis in 9.1%. In contrast, among 117 patients with 131I scan-positive functional metastases, 131I scan detected cervical lymph node metastasis in 61.5%, lung metastasis in 56.4%, mediastinal metastasis in 22.2% and bone metastasis in 16.2%. In all 5 patients in whom thyroglobulin was false-negative with negative antithyroglobulin antibody, PET showed increased 18F-FDG uptake in cervical lymph nodes, mediastinal lymph nodes, or both. Among patients with increased 18F-FDG uptake only in the cervical lymph nodes, the nodes were dissected in 11. Metastasis was confirmed in all, even in normal-sized lymph nodes. CONCLUSION: FDG PET scan localized metastatic sites in 131I scan-negative thyroid carcinoma patients with high accuracy. In particular, it was superior to 131I whole-body scan and serum thyroglobulin measurement for detecting metastases to cervical lymph nodes. FDG PET was helpful for determining the surgical management of these patients. 相似文献
20.