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分化型甲状腺癌患者131I全身显像及SPECT显像对于判定病情、决定下一步治疗方案具有重要意义。然而,显像有时会出现假阳性结果,即异常浓聚灶并不是残留的甲状腺组织或甲状腺癌转移灶。系统全面地了解这些假阳性分布及原因有助于图像的准确判读,更可避免患者后续不必要或过大剂量的131I治疗。笔者就分化型甲状腺癌131I全身显像假阳性情况分布、特点及其可能的机制展开综述。 相似文献
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林岩松 《国际放射医学核医学杂志》2022,46(7):389-391
分化型甲状腺癌(DTC)患者在规范的手术、选择性131I治疗、TSH抑制治疗下多数预后良好。131I治疗目标分为清甲治疗、辅助治疗及清灶治疗,其可完善疾病分期、便于随诊、降低疾病复发及死亡风险,但临床实践中仍在存诸多待明确的问题,如术后131I治疗前评估中,亚临床病灶判断困难,且无用以指导治疗的Tg临界值,增加了辅助治疗的决策难度;治疗后随诊中,尚无评价结构性病灶131I治疗疗效的标准;TgAb的存在会影响病情判断;131I累积剂量相关并发症亦需监测管理。本期重点号刊登了数篇DTC患者131I治疗相关的文章,多方位讨论了当下131I治疗中的难点和我国学者的探索。 相似文献
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碳酸锂增强分化型甲状腺癌术后残留甲状腺131I吸收剂量的研究 总被引:5,自引:0,他引:5
目的 探讨碳酸锂对提高分化型甲状腺癌(DTC)术后残留甲状腺摄碘功能、延长有效半衰期(Teff)及增强^131I吸收剂量的作用。方法 30例DIC术后患者随机分为碳酸锂组与对照组,每组各15例。碳酸锂组给予碳酸锂250mg/次,4次/d,连用1周;对照组给予安慰剂VB4 10mg/次,3次/d,连用1周。2组均分别于服药前后测定24h甲状腺吸^131I率及Teff,通过自身前后比较、组间比较及可能影响因素相关分析以评价试验效果。结果 碳酸锂组24h吸^131I率明显提高,7ld明显延长,^131I吸收剂量明显增加,其24h吸^131I率提高与Teff延长有关。结论 碳酸锂能提高DTC术后残留甲状腺摄碘功能、延长Teff,明显增强残留甲状腺^131I吸收剂量。 相似文献
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目的 评估分化型甲状腺癌(DTC)患者^131I治疗后体内残留放射性活度.方法 本研究共纳入了35例DTC患者,分为“清甲”(20例)与“清灶”(15例)组,分别于服^13I后2、6、24、48、72 h进行^131I全身显像及1m处当量剂量率的测定,以2h时显像计数和活度作为总计数和总活度.根据各时间点显像计数与2h的显像计数比值间接估算体内残留放射性活度,并估算患者体内残留放射性活度达到400 MBq时的1m处当量剂量率.统计学分析采用直线相关与回归分析.结果 “清甲”组服^131I后2、6、24、48、72 h体内残留^131I活度占服^131I总活度的百分比分别为99%±4%、86%±6%、35%±10%、12%±8%、7%±8%, “清灶”组分别为99%±1%、91%±7%、47%±17%、11%±9%、4%±6%. “清甲”组服^131I后2、6、24、48、72 h的1m处当量剂量率分别为(157±37)、(120±36)、(35±13)、(11±9)、(9±11)μSv/h,“清灶”组分别为(234±43)、(186±51)、(49±20)、(12±11)、(4±6)μSv/h.体内残留的放射性活度与1m处当量剂量率呈正相关(r=0.87,P<0.001).“清甲”与“清灶”组服^131I后48、72 h体内残留放射性活度分别为(432±292)、(265±281) MBq及(731±701)、(277±470) MBq,对应的1m处当量剂量率为8~ 11 μSv/h.结论 DTC患者服^131I后48~72 h体内残留放射性活度达到国家标准规定的400 MBq时,即DTC患者1m处当量剂量率达到8~11 μSv/h时方可出院. 相似文献
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全身131I显像时,除了甲状腺组织、分化型甲状腺癌(DTC)转移及复发灶显影外,非甲状腺组织来源的假阳性病变也常不同程度地摄取131I而显影。探讨DTC患者腹盆部非甲状腺组织来源的假阳性病变摄取131I的不同原因,分析其可能存在的病变信息,可以给临床诊疗提供必要的帮助,笔者就有关腹盆部131I显像假阳性研究进行综述。 相似文献
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131I治疗分化型甲状腺癌(DTC)的技术成熟、效果显著,是DTC患者术后综合治疗的主要方法之一,目前已被广泛应用于临床。但其造成的唾液腺辐射损伤(口干、腮腺肿痛、味觉改变等)会对DTC患者的生活质量造成一定影响。近年来,各种唾液腺辐射损伤防护剂层出不穷,但其确切疗效较为局限,且治疗方案尚未规范统一。笔者就DTC患者术后行131I治疗对唾液腺的辐射损伤及其防治的研究进展进行综述。 相似文献
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唾液腺功能受损是头颈部肿瘤患者放化疗中常见的不良反应,其对患者的生活质量及治疗效果产生严重影响,唾液腺功能受损发生率随着头颈部疾病发病率的增高而增高,亟需明确的防治手段。目前已有大量国内外研究结果揭示了唾液腺功能放射性损伤的部分机理并提供了一些防治措施予以临床参考。笔者重点综述由131I治疗引起的唾液腺功能损伤的机制、症状、诊断及防治措施。 相似文献
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陈永辉 《国际放射医学核医学杂志》2008,32(6)
青少年分化型甲状腺癌发病率不高,但与成人分化型甲状腺癌相比,具有一些鲜明的特征:发现时往往体积较大,诊断时多出现颈部淋巴结或远处转移,肿瘤细胞钠.碘转运体表达数量和频率多,治疗后复发率高,尽管如此,其总体存活率较高.手术后131Ⅰ去除残余甲状腺组织和131Ⅰ治疗远处转移依然是治疗青少年分化型甲状腺癌的重要手段. 相似文献
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目的通过分析正常甲状腺及分化型甲状腺癌(DTC)组织中促甲状腺激素受体(TSHR)表达位置及表达强度的差异,探讨TSHR对DTC术后131I治疗效果的预测价值。方法回顾性分析DTC术后进行~(131)I清甲治疗患者49例,采用免疫组化ABC法,检测上述病例甲状腺癌组织及癌旁正常甲状腺组织中TSHR的表达位置及表达强度,根据~(131)I治疗效果分组,分析比较两组TSHR表达情况及相关临床资料。结果 49例患者病理切片中,正常甲状腺组织细胞膜TSHR表达阳性率近乎100%,甲状腺癌组织细胞膜TSHR表达阳性率为57.14%,差异有统计学意义(P<0.05);甲状腺癌组织细胞质内TSHR表达阳性率(87.76%)高于正常甲状腺组织(32.65%),差异有统计学意义(P<0.05)。一次性清甲成功患者DTC组织细胞膜上TSHR表达强度(阳性率70.00%及强阳性率46.67%)高于清甲治疗次数≥2次患者(阳性率36.84%及强阳性率15.79%),差异有统计学意义(P<0.05)。结论 DTC细胞膜TSHR的表达强度较正常甲状腺组织低,而其细胞质内TSHR表达强度升高,分化型甲状腺癌细胞膜TSHR表达强度或许能够预测~(131)I治疗效果。 相似文献
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分化型甲状腺癌(DTC)是最常见的甲状腺恶性肿瘤,其中包括乳头状甲状腺癌、滤泡状甲状腺癌和混合型甲状腺癌。治疗方法有手术治疗、^131I治疗和内分泌治疗。其中^131I治疗是甲状腺癌重要的治疗环节或步骤。随着对DTC术后^131I治疗方案的不断研究与探索,在重组人促甲状腺激素辅助,^131I清甲的应用、^131I清除大量残留的甲状腺叶组织、^131I清甲治疗碘剂量的选择等方面的认识与实践也不断更新。该文就以上几个清甲治疗方法的研究进行综述。 相似文献
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Robert Dorn Juergen Kopp Harry Vogt Peter Heidenreich Robert G Carroll Seza A Gulec 《Journal of nuclear medicine》2003,44(3):451-456
This study is a retrospective analysis of 124 differentiated thyroid cancer patients who underwent dosimetric evaluation using MIRD methodology over a period of 15 y. The objectives of the study were to demonstrate the clinical use of dosimetry-guided radioactive iodine ([RAI] (131)I) treatment and the safe and effective application of a 3-Gy bone marrow (BM) dose in patients with differentiated thyroid cancer. METHODS: Tumor and BM dose estimates were obtained. The administered activity that would deliver a maximum safe dose to the organ at risk (red BM or lungs) was determined as well as the resulting doses to the metastases. The clinical benefit of an individual RAI treatment was predicted on the basis of the dose estimates and the expected therapeutic response. Each patient's response to treatment was assessed clinically and by monitoring the hematologic profile. RESULTS: One hundred twenty-four patients underwent 187 dosimetric evaluations. One hundred four RAI treatments were performed. A complete response at metastatic deposits was attained with absorbed doses of >100 Gy. No permanent BM suppression was observed in patients who received absorbed doses of <3 Gy to BM. The maximum administered dose was 38.5 GBq (1,040 mCi) with the BM dose limitation. CONCLUSION: Dosimetry-guided RAI treatment allows administration of the maximum possible RAI dose to achieve the maximum therapeutic benefit. Estimation of tumor dose rates helps to determine the curative versus the palliative intent of the therapy. 相似文献
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目的分析尿碘浓度(UIC)在不同危险度分层的分化型甲状腺癌(DTC)患者中与131I治疗效果的关系。方法选取2018年1月至2019年2月在天津医科大学总医院接受首次131I治疗的DTC患者181例[男75例,女106例,年龄(44.1±12.5)岁]进行回顾性分析。将患者分为中低危组和高危组,131I疗效分为疗效满意(ER)和疗效不满意(non-ER),评价指标包括性别、年龄、治疗前刺激性甲状腺球蛋白(ps-Tg)、UIC等。采用Mann-WhitneyU检验进行组间UIC差异比较;采用logistic回归分析疗效影响因素。结果181例患者中113例为中低危患者,UIC为111.60(55.80,204.65)μg/L;ps-Tg为2.08(0.63,4.91)μg/L。中低危患者中,和ER组(86例)比较,non-ER组(27例)有较高的UIC和ps-Tg水平(z值:-2.585、-4.511,均P<0.05)。68例高危患者的UIC为115.40(61.23,167.28)μg/L;ps-Tg为16.65(4.52,43.45)μg/L。高危患者中,和ER组(20例)比较,non-ER组(48例)有较高的ps-Tg水平(z=-4.677,P<0.01),但UIC水平差异无统计学意义(z=-0.013,P>0.05)。多因素logistic回归分析示ps-Tg是中低危患者[比值比(OR)=6.157(95%CI:1.046~36.227);OR=22.965(95%CI:3.591~146.857),均P<0.05]和高危患者[OR=9.696(95%CI:1.379~68.169),P<0.05]non-ER的危险因素;中低危non-ER患者中UIC是non-ER的危险因素[OR=3.715(95%CI:1.201~11.488),P<0.05]。结论在中低危DTC患者中non-ER与UIC有关,但在高危患者中UIC不影响non-ER。中低危及高危患者较高的ps-Tg与non-ER有关。 相似文献
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Objective
To evaluate the relationship between microscopic cancerous involvement of surgical margin and recurrence in patients with differentiated papillary thyroid cancer (PTC) who underwent total thyroidectomy followed by high-dose radioactive iodine ablation (HDRIA).Methods
Consecutive 197 PTC patients (184 women; mean age 44.9?years) who underwent total thyroidectomy without gross residual tumor followed by HDRIA were retrospectively reviewed. Resection margin involvement was evaluated and recurrence of the disease was assessed with clinicopathologically. Recurrence detected within 12?months after HDRIA were defined as early recurrence, detected after 12?months were defined as late recurrence.Results
The mean follow-up was 85.9?±?16.6?months. Twelve patients (6.1%) had microscopic cancerous involvement of surgical margin [margin (+) group], and 185 patients had negative surgical resection margins [margin (?) group]. Three patients (25.0%) in the margin (+) group and 11 patients (5.9%) in the margin (?) group had early recurrence. Margin (+) group showed higher incidence of early recurrence and lower incidence of disease free compared to margin (?) group (25.0 vs. 5.9%, p?0.01; 66.7 vs. 81.1%, p?0.01, respectively); however, there was no difference in incidence of late recurrence between the two groups (p?=?1.00). There were no significant differences in the disease-free survival between the margin (+) and margin (?) groups after exclusion of early recurrence (p?=?0.78).Conclusions
After high-dose radioactive iodine ablation, PTC patients with microscopic cancerous surgical margin involvement had a higher incidence of early recurrence and no different late recurrence rate compared to patients without microscopic cancerous surgical margin involvement. 相似文献18.
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Aytekin Guven Serpil Salman Harika Boztepe Sema Yarman Refik Tanakol Halil Azizlerli Faruk Alagol 《Annals of nuclear medicine》2009,23(5):437-441
Objective The study aimed to investigate the effect of high dose radioactive iodine (RAI) on parathyroid function in patients with differentiated
thyroid cancer.
Methods Nineteen patients (8 men/11 women, age 46.5 ± 13.2 years) undergoing RAI for thyroid remnant ablation were enrolled in the
study. The biochemical parameters related to parathyroid function [serum calcium (Ca), phosphate (P), creatinine (Cr), alkaline
phosphatase (ALP), intact parathyroid hormone (iPTH), urinary Ca, cAMP concentrations and the maximum tubular capacity for
phosphate per unit volume of glomerular filtrate (TmP/GFR)] were evaluated at baseline and at the 1st, 3rd, 6th and 12th months
of RAI administration. SPSS 15.0 was used for statistical analysis.
Results For all patients, thyroid-stimulating hormone levels were >30 U/ml at baseline and <0.1 U/ml at the following visits. Serum
iPTH levels were decreased significantly at the 6th month and reached basal levels at the 12th month (baseline vs. 6th p = 0.027, 1st vs. 6th p = 0.011, 3rd vs. 6th p = 0.047, 3rd vs. 12th p = 0.014, 6th vs. 12th p = 0.001). At the 6th month, P and TmP/GFR levels were higher (p = 0.036, 0.017, respectively), and urinary cAMP measurements were lower (p = 0.020) compared to those of the 1st month. No difference was detected concerning the other parameters. Serum Ca levels
decreased below 2.1 mmol/l in several patients (n = 5 at 1st month, n = 4 at 3rd month, n = 8 at 6th month and n = 3 at 12th month) without clinical symptoms.
Conclusions The study indicated a transient decline in PTH levels at the 6th month following RAI therapy. Although this decrease did not
cause symptoms in any of the present cases, this pattern might be important especially in individuals with diminished parathyroid
background. 相似文献
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Dam HQ Manzone TA Grady EC Tulchinsky M 《Journal of nuclear medicine》2012,53(4):661-2; author reply 662-663