^18F-FDG PET-CT对分化型甲状腺癌肺转移患者的诊断和疗效评价的价值

目的 探讨18F-氟脱氧葡萄糖（18F-FDG）PET-CT对分化型甲状腺癌（DTC）肺转移病灶的诊断和疗效评价的价值.方法 收集2006年7月至2010年12月上海交通大学附属第六人民医院对38例DTC肺转移患者行18F-FDG PET-CT、131I全身扫描（131I-WBS）检查,并随访,了解患者肺内病灶变化及预后情况.结果 18F-FDG PE-CT、131I-WBS共发现肺内病灶68个,45个病灶131I-WBS阳性、18F-FDG PET-CT呈阴性,19个病灶18F-FDG PET-CT阳性、131I-WBS阴性;4个病灶两种检查均为阴性,两者联合检测的灵敏度为94.11%,而在131I-WBS阴性的患者中18F-FDG PET-CT阳性率为82.61%.18F-FDG PET-CT对DTC肺内转移灶的检出率与患者血清促甲状腺激素水平密切相关.结论 131I-WBS联合18F-FDG PET-CT在探测DTC转移病灶时具有重要的临床价值,明显优于各自独立应用的结果.DTC细胞对18F-FDG的摄取与肿瘤细胞的分化程度相关,对指导治疗和预后的判断有重要作用.     

18F-FDG PET/CT显像在131I全身扫描及血清Tg均阴性的已清除残留甲状腺组织的分化型甲状腺癌患者中的应用价值

目的探讨18F-FDG PET/CT显像在血清Tg和131I-全身扫描均为阴性的行甲状腺癌切除和清除残留甲状腺组织治疗后的患者中检测肿瘤复发和转移的应用价值。方法 41例接受了甲状腺全切和大剂量131I清除残留甲状腺组织治疗的DTC患者,在随访中进行了血清Tg测定、131I-WBS、颈部B超、胸部CT及18F-FDG PET/CT全身显像。结果 41例患者血清Tg和131I-WBS均为阴性,颈部B超或胸部CT均显示存在异常病灶;其中23例患者18F-FDG PET/CT显像阳性,18例患者18F-FDG PET/CT显像阴性。18F-FDG PET/CT显像阳性患者中,有3例经病理检查证实为甲状腺癌转移;18F-FDG PET/CT显像阳性病灶与阴性病灶的长短径差异无统计学意义。结论接受甲状腺全切和大剂量131I清除残留甲状腺组织治疗后的DTC患者术后随访血清Tg及131I-WBS均为阴性时,18F-FDG PET/CT显像可显示可疑的阳性病灶,有助于发现复发和转移病灶。     

Diffuse pulmonary metastases with negative 18FDG positron emission tomography/computed tomography and positive post-radioiodine therapy scan of papillary thyroid cancer

A female papillary thyroid cancer patient with diffuse micronodular pulmonary metastases was confirmed only by post radioactive iodine (RAI) therapy whole body scan (RxWBS).Her diagnostic iodine-131 whole body scan (DxWBS),chestCT and 18FDG PET/CT scan were all negative.Attention and pitfalls of this case concerning surgical and RAI dosemanagement are against current international guidelines on thyroid cancer.     

Diffuse pulmonary metastases with negative ¹⁸FDG positron emission tomography/computed tomography and positive post-radioiodine therapy scan of papillary thyroid cancer

A female papillary thyroid cancer patient with diffuse micronodular pulmonary metastases was confirmed only by post radioactive iodine (RAI) therapy whole body scan (RxWBS). Her diagnostic iodine-131 whole body scan (DxWBS), chest CT and 18FDG PET/CT scan were all negative. Attention and pitfalls of this case concerning surgical and RAI dose management are against current international guidelines on thyroid cancer.     

FDG-PET in head and neck, and thyroid cancer

FDG-PET has become a standard clinical imaging modality in patients with head and neck cancer. It contributes valuable information in localizing a primary tumor in patients with neck nodal metastases from an unknown primary, in the staging of primary head and neck cancer, and in the detection of recurrent disease. In addition, FDG-PET provides independent prognostic information in patients with newly diagnosed and recurrent head and neck cancer. PET-CT improves lesion localization and accuracy of FDG-PET and is strongly recommended in patients with head and neck cancer. After thyroidectomy, FDG-PET has proven useful in patients with clinical or serological evidence of recurrent or metastatic thyroid carcinoma but negative whole body iodine scan. PET shows metastatic disease in up to 90% of these patients, thereby providing a rational basis for further studies and therapy. In patients with medullary thyroid cancer with elevated calcitonin levels following thyroidectomy, FDG-PET has a sensitivity of 70-75% for localizing metastatic disease. Occasionally incidental intense FDG uptake is observed in the thyroid gland on whole-body PET studies performed for other indications. Although diffuse FDG uptake usually indicates thyroiditis, focal uptake has been related to thyroid cancer in 25-50% of cases and should therefore be evaluated further if a proven malignancy would cause a change in patient management.     

Radioiodine therapy in thyrotoxicosis

One hundred and two patients (81 females, 21 males) suffering from thyrotoxicosis as diagnosed clinically and confirmed by laboratory investigations including the estimation of thyroid hormones in blood were treated with radioiodine (I-131) at the University of Minnesota Hospital between 1976 and 1986. Nine (9%) patients needed two and 3 (3%) patients needed three therapeutic doses of I-131. The age range of the patients was 17-82 years (mean 43, SD 17). The doses of I-131 administered ranged from 3.9 to 100 mCi (mean 13.7). Twenty of these patients received a relatively high dose from 20 to 100 mCi. The others were given smaller calculated doses based on radioiodine uptake and thyroid size is determined by palpation and nuclear scans. Of the 73 patients for whom follow-up information was available, 66 (90%) eventually became hypothyroid as judged by clinical criteria. These data also suggest that the incidence of hypothyroidism is quite independent of the dose (microCi/g thyroid) administered.     

肺癌放射免疫显像的临床观察

采用两类单抗进行肺癌的放免显像，即抗小细胞肺癌单抗２Ｆ７和抗ＣＥＡ单抗，２Ｆ７单单抗并经胃蛋白酶裂解，得其片段Ｆ＾１３１Ｉ标记用Ｉｏｄｏｇｅｎ法，标记率８０％。共对３６例肺部病变作了放免显像，其中小细胞肺癌２５例，非小细胞肺癌病变１１例。在２５例小细胞肺癌中，１９例行＾１３１Ｉ－２Ｆ７显像，结果１７例阳性，２例阴性；另６例行＾１３１Ｉ－２Ｆ７Ｆ显像，结果５例阳性，１例阴性，１１例非小细胞肺癌病变包     

~(18)F-PET/CT显像在甲状腺癌失分化患者定期复查中临床意义研究

目的探讨18F-PET/CT显像在甲状腺癌失分化患者定期复查中的应用价值。方法收集我院2012年1月至2016年6月收治的行18F-FDG PET/CT检查的分化型甲状腺癌患者45例作为研究对象展开回顾性分析,以手术/随访结果为基准,计算18F-FDG PET/CT的敏感性与阳性预测值。结果 45例患者中,18F-FDG PET/CT检查示42例患者为阳性显像,敏感性为93.3%(42/45)。45例患者共发现105个颈部转移淋巴结、9例肺转移、6枚纵隔淋巴结,术后病理证实111个为肿瘤复发或转移、9例为炎性病灶,阳性预测值为92.5%(111/120)。结论 18F-FDG PET/CT显像在术后大剂量131I治疗后Tg升高而131I-全身扫描结果显示为阴性的失分化甲状腺癌患者中的应用,可通过对肿瘤代谢状态的观察有效避免漏诊,以定期复查方式尽早发现患者复发或转移病灶,并为后续治疗提供指导,具有显著临床应用价值     

The role of surgery in the management of thyroid cancer.

This is a review of one surgeon's personal experience with 85 patients with thyroid cancer treated over a 20-year period. The data confirm that for papillary thyroid tumours, with rare exceptions, the prognosis is excellent. Anaplastic lesions, however, are consistently lethal. Follicular carcinoma and medullary carcinoma fall between these extremes. A simple clinical classification is offered as a guide to operative management and a reliable index of prognosis. Patients with clinically apparent, "manifest cancer" have serious, life-threatening disease; many such patients die of their disease. Patients with "neck lumps not yet diagnosed" usually have papillary carcinoma; their prognosis is excellent. Patients whose thyroid tumours fall into the category of "malignant nodule" or "pathologist's cancer" are particularly fortunate: in this series no such patient has died. The importance of age in relation to thyroid cancer is also confirmed: non of the patients first treated before the age of 40 years has died of cancer. For young patients with favourable disease the author recommends conservative surgical treatment, which avoids cosmetic deformity or functional disability, to be followed by administration of levothyroxine to suppress production of thyroid=stimulating hormone. For patients with "unfavourable" thyroid cancer valuable palliation can often be achieved by a combination of surgery and irradiation. Survival rates for the total series are 76% at 5 years and 60% at 10 years.     

313例甲状腺疾病核素显像的回顾性分析

目的 分析甲状腺疾病核素显像的特点,探讨核素显像在甲状腺疾病中的诊断价值.方法 回顾性分析行核素显像检查的313例患者,其中亚急性甲状腺炎和桥本氏甲状腺炎各110例、甲状腺结节性疾病(不包含亚急性甲状腺炎、慢性淋巴细胞性甲状腺炎患者)93例,根据各种甲状腺炎的放射功能特点进行分组,用SPSS15.0进行统计分析.结果 ...     

18氟标记脱氧葡萄糖正电子发射计算机断层摄影术在非小细胞肺癌分期中的应用价值

目的 探讨^18F－氟代脱氧葡萄糖正电子发射计算机断层摄影术（FDG PET）对非小细胞肺癌（NSCLC）术前分期的准确性及其应用价值。方法 对82例经病理证实的NSCLC患者胸部CT扫描、全身FDG PET显像和病理检查资料进行回顾性分析。结果 82例NSCLC患者肺部病灶及转移灶部位FDG摄取均增高。FDG PET对预测NSCLC纵隔淋巴结转移的敏感性为94．4％,特异性为100％;对探测胸外转移的敏感性明显高于CT。42例患者手术治疗的结果证实,FDG PET对NSCLC的分期准确性达95．2％。经全身FDG PET显像,82例患者中37例（45．1％）的CT分期得到改变,为患者治疗方案的选择提供了重要依据。结论 FDG PET在NSCLC的术前分期方面优于CT等常规检查,但在精确定位方面仍然需要结合解剖显像技术。     

Thyroid carcinoma in an autonomously hyperfunctioning thyroid nodule

A 44-year-old woman presented with hyperthyroidism and a nodule in her thyroid. ¹³¹I-scintigraphy of the gland showed concentration of the tracer within the nodule and suppressed activity in the rest of the gland. Histology of the resected thyroid proved the nodule to be a papillary carcinoma. The presence of carcinoma within an autonomous hyperactive thyroid in a patient with hyperthyroidism has been reported only rarely, and to the authors'' knowledge such a case has never been reported in Great Britain. Furthermore, unlike previously reported cases, the carcinoma was confined solely to the nodule.     

~(18)FDG-PET在肿瘤临床中的应用

恶性肿瘤是人类死亡的主要原因之一。但至今尚缺乏灵敏度高,特异性好的检测方法,临床可借助于这些方法来诊断肿瘤,做术前临床分期的检测,治疗后的复发等病灶。为达到上述目的,用~(18)FDG-PET做肿瘤代谢显像(metabolic imaging),有可能满足此要求。~(18)FDG可用于测定肿瘤葡萄糖代谢和其降解率,现已证明:快速增殖的恶性肿瘤具有较高的葡萄糖降解率,经治疗后的恶性肿瘤,其葡萄糖降解率的变化可做为治疗好坏的一个标志。 FDG-PET将在下列5个方面为肿瘤的诊断和处理担负着重要的使用。 (1)用于诊断肺内单发孤立结节病灶。 (2)肿瘤术前的临床分期。 (3)评定的治疗后肿瘤的复发和放疗后的纤维化。 (4)用于肿瘤分级。 (5)用于反应放化疗后的疗效指标。 本文将简要介绍FDG-PET在肿瘤临床应用的现状,讨论其优势和限度以及临床潜在应用的价值。     

宫颈癌远处淋巴结转移18FDG PET诊断价值的探讨

目的 探讨18氟-脱氧葡萄糖正电子发射断层扫描仪(18FDG PET)在宫颈癌远处淋巴结转移的临床应用价值。方法 对拥有完整CT和18FDG PET资料的23例宫颈癌远处淋巴结转移患者,进行回顾性分析,并对两种检查方法的结果进行比较。结果 23例患者中,18FDG PET与CT比较,大体肿瘤体积大小无变化的占56.5%(13/23)、增加的占26.1%(6/23)、缩小的占17.4%(4/23)。肿瘤数目无变化的占47.8%(11/23)、增加的占30.4%(7/23)、减少的占21.8%(5/23)。18FDG PET随访复查与初次检查结果一致的达95.7%(22/23)。结论 18FDG PET是宫颈癌远处淋巴结转移诊断及评价预后的重要工具。     

分化型甲状腺癌甲状腺清除术后血清Tg与^131I-全身显像的关系

目的探讨分化型甲状腺癌（DTC）甲状腺清除术后血清甲状腺球蛋白（Tg）与^131I-全身显像（^131I-WBS）之间的关系,为临床随访和治疗分化型甲状腺癌提供一定的依据。方法检测83例DTC病人甲状腺清除术后血清Tg水平,在给予5．55GBq ^131I-治疗5～7d后行^131I全身显像,对^131I-全身显像所示肿瘤转移灶的数量和范围行半定量法评分,用斯皮尔曼相关性分析评价血清Tg与^131I-全身显像评分之间的关系,同时比较不同病理类型DTC血清Tg与^131I-全身显像评分之间关系的差异。结果87．95％（73,／83）的DTC病人甲状腺清除术后血清Tg水平和^131I-WBS显像符合,9．64％（8／83）的DTC病人血清Tg阳性（Tg〉0．10μg／L）而^131I-WBS阴性,有2．41％（2／83）的DTC病人血清Tg阴性而^131I-WBS阳性（肿瘤转移灶浓聚^131I-DTC甲状腺清除术后血清Tg水平与^131I-全身显像评分呈高度正相关（r=0．725～0．849,P〈0．01）,不同病理类型的DTC血清Tg水平与^131I-全身显像评分之间相关性差异无统计学意义（P〉0．05）。结论DTC甲状腺清除术后血清Tg水平与^131I-全身显像有相关性,Tg水平升高预示DTC病人体内存有大量肿瘤转移灶,应对其密切随访并给予适当治疗。     

甲状腺结节性疾病与碘营养水平关系的临床研究

目的:探讨广东惠州地区甲状腺结节性疾病发病与尿碘含量的关系,为该地区甲状腺疾病患者科学补碘提供依据。方法:选取2013年至2015年惠州市第一人民医院和惠州市中心人民医院收治的甲状腺结节性疾病住院患者200例(结节性甲状腺肿55例,慢性淋巴细胞性甲状腺炎17例,甲状腺乳头状癌128例),并选取同期体检中心的甲状腺正常人群50例为对照组,采集空腹晨尿,测定尿碘含量。结果:甲状腺乳头状癌的尿碘中位数为182.5μg/L,高于健康人群组(133.5μg/L)和良性甲状腺结节组(133μg/L),差异有统计学意义(P<0.05)。结论:广东惠州地区甲状腺乳头状癌患者摄碘量高于甲状腺良性结节患者和一般健康人群,但甲状腺癌的发病与高碘摄入是否有直接关系仍有待进一步研究明确。     

甲状腺“冷”结节~(99)Tc~m-MIBI显像对甲状腺癌诊断的初步探讨

目的　探讨99Tcm MIBI显像在甲状腺癌诊断中的价值。方法　对 51例99TcmO- 4甲状腺显像为“冷”结节的患者行99Tcm MIBI显像。患者均行外科手术治疗 ,并作病理检查。结果　 1 6例病理检查证实为甲状腺癌患者中 ,1 2例99Tcm MIBI显像阳性 ;35例良性病变患者中 ,5例99Tcm MIBI显像阳性。99Tcm MIBI显像对甲状腺癌诊断的灵敏度、特异性和准确性分别为 75 .0 %、85 .7%和 82 .4%。结论　甲状腺“冷”结节行99Tcm MIBI显像对于甲状腺癌的诊断具有重要的临床参考价值     

睾丸嗜铬细胞瘤并多发淋巴结及肺转移18F-FDG PET/CT特征1例并文献复习

目的：探讨睾丸异位嗜铬细胞瘤的18F-氟-2-脱氧葡萄糖(18F-fluroro-2-deoxyglucose,18F-FDG)正电子发射断 层成像-计算机断层成像(positron emission tomography and computed tomography,PET/CT)特点,以提高对其诊断水平。 方法：报告1例病理确诊为异位嗜铬细胞瘤并多发淋巴结及肺转移的患者资料。结果：患者有典型的血压升高症状, 血儿茶酚胺及尿香草扁桃酸值显著升高。PET/CT检查发现患者右侧睾丸糖代谢增高的软组织结节,邻近伴1个子 灶,右侧精索可见糖代谢增高的肿块,双侧腹股沟区及腹膜后多发糖代谢增高的淋巴结,右肺下叶后基底段糖代谢 增高的结节,全身多处可见糖代谢弥漫性增高的棕色脂肪影;右侧睾丸异位嗜铬细胞瘤原发灶与转移灶切除后PET/ CT检查则可见棕色脂肪组织糖代谢增高表现消失。结论：PET/CT检查对异位嗜铬细胞瘤原发灶的定位诊断、临床分 期与疗效评估有着较好的价值,而棕色脂肪组织的18F-FDG摄取增高对异位嗜铬细胞瘤的定性诊断具有一定的提示作用。     

RADIOIODINE THERAPY FOR DIFFERENTIATED THYROID CARCINOMA : INHS ASVINI EXPERIENCE

During last 17 years, 175 patients of carcinoma thyroid were treated in this centre. Hundred patients (57%) of papillary carcinoma formed majority. Fifty four patients (31%) were follicular carcinoma and 15 (8.5%) were mixed variety. Two (1.3%) were medullary carcinoma, 3 (1.7%) anaplastic type and 1 (0.5%) hurthle cell carcinoma. After surgery these patients were assessed for radio iodine uptake, residual thyroid tissue and distant metastasis which determined the dose of radioiodine for ablation. Fifty two per cent (91) patients presented as multi nodular goitre, 22.3 per cent (39) as solitary nodule, 13.7 per cent (24) had lymph node metastasis, 5.7 per cent (10) bone metastasis, 2.5 per cent (4) had lung metastasis and 3.8 per cent (7) presented as thyrotoxicosis. Average number of therapy for complete ablation in papillary carcinoma was 1.5, follicular 1.78 and mixed variety 1.5. 72.6 per cent cases (127) needed single dose for ablation, 14.9 per cent (26) needed 2 doses and 5.7 per cent (10) required 3 doses. Only 6.8 per cent (12) cases needed 4 to 8 doses. Average dose of I⁻¹³¹ administered for ablation was 157 mci in males and 124 mci in females of papillary carcinoma thyroid. Males in follicular variety required 204 mci and females needed only 120 mci. In mixed variety males required 177 mci and females required 62.5 mci for complete ablation. 144 patients (82.3%) were followed up to 5 years and remaining patients from 6 to 17 years. These patients are followed up once in a year or alternate years. Follow-up and medical record keeping for defence personnel is done with meticulous care, therefore followup results are very encouraging.KEYWORDS: Differentiated thyroid cancer, Radio iodine therapy, Thyroid ablation     

甲状腺功能亢进症合并甲状腺癌的临床分析

目的 了解甲状腺功能亢进症（甲亢）合并甲状腺癌的状况。方法 对本院１９８３年１月～１９９８年６月,接受手术方法治疗的３９４例甲亢和经手术病理诊断的２４５例甲状腺一并进行回顾性分析。结果 共发现甲亢合并甲状腺癌１２例,占甲亢的３．０％（１２／３９４）,占甲状腺癌的４．９％（１２／２４５）,Ｇｒａｖｅｓ病合并甲状腺癌６例,毒性结节必 腺肿合并甲状腺癌６例。１２例患者中,甲状腺呈弥漫性肿大３例甲,弥漫性