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分化型甲状腺癌(DTC)骨转移的诊断及疗效评价的核素显像方法较多,放射性核素显像在恶性肿瘤骨转移中的临床应用比较广泛,在DTC骨转移中主要用于骨转移的诊断、术后随访及疗效评价。放射性核素显像目前主要包括SPECT显像和PET显像,前者包括131I显像、99Tcm-MDP显像等,后者包括124I显像、18F-FDG显像、18F-NaF显像等。笔者将放射性核素显像方法在DTC骨转移中的诊断及治疗进展进行综述。 相似文献
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131I全身显像可为分化型甲状腺癌(DTC)患者转移或复发的诊疗方案提供主要依据,是目前临床不可或缺的辅助诊疗方法。然而,由于多种生理或病理原因,可能会导致131I全身显像假阳性,这对正确解读131I全身显像、判断是否存在复发和转移造成了较大困难。因此,了解造成131I全身显像假阳性的原因对DTC患者的正确诊治具有非常重要的价值。笔者从病因学的角度对DTC患者131I全身显像假阳性的原因进行综述。 相似文献
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^131I治疗分化型甲状腺癌骨转移的疗效评价和生存分析 总被引:1,自引:0,他引:1
目的评价^131I治疗DTC骨转移的疗效及影响因素,评估生存率及其影响因素。方法回顾分析经^131I治疗的106例DTC骨转移患者的临床资料,分别基于^131I治疗后血清Tg的变化、骨痛缓解情况和影像学变化评价^131I治疗疗效,并对影响^131I疗效的因素进行单因素分析;采用寿命表法评估DTC骨转移患者的^131I治疗后总生存率;采用Kaplan—Meier法对影响生存率的因素进行分析,应用Log-rank法比较各组间差异。结果经^131I治疗后血Tg显著下降者37例,有效率34.9%。骨转移伴疼痛的61例DTC经^131I治疗后疼痛明显缓解者39例,有效率63.9%。患者年龄、病理类型、是否合并其他非骨性远端转移等因素对^131I治疗后血Tg的变化有影响(x2=6.443,11.455和6.756,P均〈0.05),但对^131I治疗后骨痛缓解的影响无统计学意义(x2=0,0,0.060,P均〉0.05)。^131I治疗后77.4%的患者骨转移灶无明显影像学变化。该组DTC骨转移患者5年和10年生存率分别为86.47%和57.90%;骨转移灶数目、是否合并其他远端脏器转移、^131I治疗前是否行手术治疗对患者的10年生存率影响差异有统计学意义(Log-rank值为4.05,5.98和4.22,P均〈0.05);患者的性别、年龄、病理类型、是否以骨转移症状首诊等因素对10年生存率无明显影响(Log—rank值为0.01,1.56,2.59和0.04,P均〉0.05)。结论^131I治疗可使DTC骨转移患者血清Tg下降、骨痛缓解、病灶保持稳定或缩小,是治疗DTC骨转移的有效手段;单发病灶、单纯骨转移、手术+^131I治疗患者预后较好。 相似文献
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目的 探讨DTC手术和131I治疗后细针穿刺细胞学(FNAC)检查对颈部肿大淋巴结定性诊断的价值,并与超声、Tg和TgAb检测作比较.方法 61例经手术和131I清除残余甲状腺组织(简称清甲)治疗后的DTC患者,经体格检查或超声检查发现颈部淋巴结肿大,随后1周内对可疑淋巴结行超声引导下FNAC检查,并将检查结果与同期超声、Tg和TgAb结果进行对比.最终诊断根据病理、治疗后131I全身显像(Rx-WBS)及临床随访作出.3种检查方法间诊断效能的比较采用x2检验和Fisher确切概率法.结果 61例患者中,共58例患者获FNAC诊断,3例不能定性,经综合评判,淋巴结恶性40例,良性18例.39例经FNAC检查确诊为恶性者中20例经手术切除,19例行131I清除转移灶治疗;FNAC与术后病理诊断符合率为100% (20/20),与Rx-WBS的符合率为78.9%(15/19);19例经FNAC检查确诊为良性淋巴结者中15例持续随访3~6个月,余4例行131I治疗;FNAC与随访结果符合率为93.3%(14/15),与Rx-WBS均符合(4/4).FNAC检查、超声、Tg和TgAb检测诊断DTC转移淋巴结良恶性的灵敏度分别为97.5% (39/40)、87.5%(35/40)、92.5% (37/40),特异性分别为100%(18/18)、55.6% (10/18)、72.2% (13/18),准确性分别为98.3%(57/58)、77.6%(45/58)、86.2%(50/58);FNAC检查的准确性明显高于超声、Tg和TgAb(x2=4.336和11.697,均P<0.05),而超声与Tg和TgAb检测之间准确性的比较差异无统计学意义(X2=1.450,P〉0.05).超声与TS和TgAb检测结果一致者39例,与FNAC检查的符合率为97.4% (38/39);超声与Tg和TgAb检测结果不一致者19例,经FNAC检查证实4例为恶性,15例为良性.结论 对DTC患者颈部肿大淋巴结的良恶性诊断,FNAC检查明显优于超声与Tg和TgAb检测.当随访中超声与Tg和TgAb结果不一致,可作为FNAC检查的应用指征. 相似文献
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分化型甲状腺癌(DTC)是最常见的内分泌系统恶性肿瘤,早期易发生淋巴结转移。131I全身显像联合SPECT/CT(简称131I SPECT/CT)常可发现残留和(或)漏诊的淋巴结转移灶,可能会改变患者的术后再分期及危险度分层,从而影响后续的手术或131I治疗的方式选择。131I治疗是DTC术后颈部淋巴结转移的有效治疗方法之一,而131I SPECT/CT可以诊断淋巴结转移灶。笔者对131I SPECT/CT在DTC术后淋巴结转移的诊断及治疗中的应用价值进行综述。 相似文献
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分化型甲状腺癌(DTC)131I-全身显像(WBS)时除在功能性甲状腺组织显影外,非甲状腺组织假阳性病变也常有不同程度131I摄取而显影。笔者就DTC患者胸部131I显像假阳性的原因及其机制进行分析,以期为临床DTC患者的诊疗提供必要帮助。 相似文献
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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
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Domenico Rubello Renzo Mazzarotto Dario Casara 《European journal of nuclear medicine and molecular imaging》2000,27(4):431-440
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 131I 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.
Received 21 October and in revised form 20 December 1999 相似文献
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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
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F. Tenenbaum M. Schlumberger F. Bonnin J. Lumbroso B. Aubert H. Benali C. Parmentier 《European journal of nuclear medicine and molecular imaging》1993,20(12):1168-1174
Iodine-131 is uniquely able to demonstrate iodine uptake of differentiated thyroid carcinoma (DTC), but precise localization may be difficult, especially in the thorax, due to the quality of image resolution with 1311 and the lack of anatomical landmarks. When bone metastases do not show radioiodine uptake, bone scintigraphy can be used to detect them. We studied two groups of patients. In group 1, 15 patients with known bone metastases of DTC were treated with 3.7 GBq 131I. After 4 or 5 days, technetium-99m hydroxymethylene diphosphonate (HMDP; 740 MBq) was injected and a whole-body scan with simultaneous acquisition of 131I and 99mTc-HMDP images was carried out using a large field of view gamma camera fitted with a high-energy collimator. Technetium uptake was abnormal in 47 of 63 localizations, being increased in 29 foci, decreased in 7 and heterogeneous in 11. The superimposition of 131I and 99mTc-HMDP scans permitted an accurate localization in 80% of spine metastases and in 46% of osseous thoracic localizations, even in the presence of lung metastases. In group 2, 9 patients, who had bone pain, neurological signs or elevated serum thyroglobulin, had DTC bone metastases without iodine uptake. They received a diagnostic dose of 99mTc-HMDP 3h prior to scintigraphy with a large field of view gamma camera fitted with a low-energy collimator. Technetium uptake was abnormal in 37 of 38 localizations, being increased in 34 foci and decreased in 3. One false-negative was found in a skull metastasis. In both groups of patients, 99mTc-HMDP scans were useful. The procedure allows accurate localization of bone metastases and can be used as a guide for subsequent radiological investigations. 相似文献
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分化型甲状腺癌肺转移灶早期显影与^131I疗效关系分析 总被引:2,自引:1,他引:1
目的探讨DTC肺转移患者首次应用^131I清除甲状腺组织(简称清甲)时肺转移灶显像与^131I治疗效果的关系,及影响肺转移灶早期显影的因素。方法回顾分析1997至2009年41例DTC肺转移患者清甲治疗时肺转移灶显影情况,评价^131I治疗DTC肺转移疗效。疗效评价分临床治愈、好转和无效。前两者为治疗有效。采用SPSS11.5软件,对有效率、有无远处转移、显像特点进行,检验及交叉分类2×2列联表关联分析。结果41例患者中8例为临床治愈,18例好转,有效率63%(26/41),14例无效,1例患者死亡,无效率37%(15/41)。清甲治疗时肺部转移灶显影患者^131I治疗有效率76%(22/29),随访和重复治疗中显影患者^131I治疗有效率为33%(4/12),两者差异有统计学意义0,2=4.911,P=0.027);肺转移灶^131I摄取呈弥漫性或局灶性,两者间有效率分别为67%(12/18)和61%(14/23),差异无统计学意义(χ2=0.146,P=0.702);肺外有远处转移者^131I治疗DTC肺转移灶有效率为22%(2/9),无远处转移者有效率为75%(24/32),差异有统计学意义(χ2=6.312,P=0.012);83%(24/29)行甲状腺全切的患者在首次清甲治疗时即有肺转移灶显影,而行甲状腺部分切除患者中仅有42%(5/12),甲状腺手术方式与肺转移灶早期显影有相关性(r=0.411,P〈0.05);乳头状癌和滤泡状癌患者中首次清甲治疗时肺转移灶早期显影患者分别为72%(23/32)和6/9,病理分型和肺转移灶显影早晚无关(r=0.047,P〉0.05)。结论DTC肺转移患者清甲治疗时转移灶显影阳性、无肺外远处转移灶者的^131I疗效好。 相似文献
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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. 相似文献
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