131I全身显像及血清甲状腺球蛋白测定在分化型甲状腺癌治疗随访中的作用

目的 评价131I全身显像联合血清甲状腺球蛋白(Tg)测定在分化型甲状腺癌(DTC)131I治疗随访中的临床应用价值。 方法 153例经手术病理确诊为DTC的患者，均在术后接受了1次以上的131I治疗，每次剂量为1.85~9.25 GBq，131I治疗前测定血清Tg，治疗5 d后进行131I全身显像。 结果 153例行131I治疗的DTC患者共行血清Tg和131I全身显像检查各为262次，其中55.6%(85/153)的患者的血清Tg水平与131I全身显像均异常，13.7%(21/153)的患者两者均为正常，30.7%(47/153)的患者两者结果不一致，不一致的47例患者经其他影像学检查证实19例131I全身显像异常的患者中有13例异常，28例血清Tg异常的患者中有25例异常。血清Tg诊断DTC转移的灵敏度和特异度分别为89%(110/123)和90%(27/30)，而131I全身显像的灵敏度和特异度分别为79.6%(98/123)和80%(24/30)。 结论 DTC手术及131I治疗后，常规进行血清Tg测定和131I全身显像检查，对术后判定复发转移灶及制定最佳131I诊疗计划、评价131I疗效具有重要的临床应用价值。

Significance of 131I whole body scan combined with serum thyroglobulin in the follow-up of differentiated hyroid cancer after thyroid ablation

Objective To evaluate the clinical value of 131I whole body scans with that of serum thyroglobulin(Tg)determination for the follow-up of differentiated thyroid carcinoma(DTC)receiving post-operative 131I therapy. Methods There were 153 patients with differentiated thyroid cancer receiving post-operative 131I therapy for more than one time at the dose of 1.85-9.25 GBq. Serum Tg levels were measured before 131I treatment and 131I whole body scans were performed 5 days after treatment. Results Among the 153 patients who underwent 131I therapy, serum Tg levels and 131I-whole body scans were both abnormal in 85 patients(55.6%). Both examinations were negative in 21 patients(13.7%). In the 19 patients with abnormal 131I whole body scans only, image study with means of 18F-FDG, SPECT, CT, ultrasonic or whole body bone scan revealed lesions in 13 patients; while in the 28 patients with abnormal Tg levels only, image study with the above means revealed lesions in 25 patients. The sensitivity of Tg positiveness and 131I whole body scans positiveness were 89%(110/123) and 79.6%(98/123) respectively, and the specificity were 90%(27/30)and 80%(24/30)respectively. Conclusions Routine serum Tg measurement and 131I whole body scans in patients with DTC with 131I radiotherapy after thyroidectomy is essential. It is of greatly clinical value in early detecting metastases, optimizing the 131I treatment protocol and evaluating the curative effect.