18F-FDG PET/CT检测Tg阳性而131I-诊断剂量全身显像阴性分化型甲状腺癌患者复发和转移

目的 探讨¹⁸F-FDG PET/CT显像对甲状腺球蛋白(Tg)阳性而¹³¹I-诊断剂量全身显像(¹³¹I-Dx-WBS)阴性的分化型甲状腺癌(DTC)患者复发或转移的诊断价值及对治疗方案的影响。方法 对33例接受甲状腺全切或次全切术并进行大剂量¹³¹I治疗后随访中发现Tg阳性而¹³¹I-Dx-WBS阴性的DTC患者行¹⁸F-FDG PET/CT显像,将显像结果与手术病理或6~36个月的临床随访结果进行对照,评价¹⁸F-FDG PET/CT显像对Tg升高而¹³¹I-Dx-WBS阴性的DTC患者复发或转移的诊断效能。结果 ¹⁸F-FDG PET/CT诊断Tg升高而¹³¹I-Dx-WBS阴性的DTC患者复发或转移的灵敏度和阳性预测值分别为85.71%(18/21)和90.00%(18/20)。¹⁸F-FDG PET/CT显像对血清Tg≥47.59 ng/ml的DTC患者诊断复发或转移的灵敏度(100%)明显高于对血清Tg<47.59 ng/ml的DTC患者(66.67%)。¹⁸F-FDG PET/CT显像改变了15例(15/33,45.45%)患者的治疗方案,其中4例(4/15,26.67%)再次接受手术治疗,11例(11/15,73.33%)再次接受大剂量¹³¹I治疗。结论 ¹⁸F-FDG PET/CT显像对诊断Tg升高而¹³¹I-Dx-WBS阴性的DTC患者有无复发或转移是一种有价值的方法,同时可用于指导后续治疗。

18F-FDG PET/CT in detection of recurrence or metastatic of DTC patients with elevated serum Tg levels and negative 131I-Dx-WBS

Objective To investigate the diagnostic value and the impact on treatment decision of ¹⁸F-FDG PET/CT in differentiated thyroid carcinoma (DTC) patients with elevated serum thyroglobulin (Tg) levels and negative radioiodine diagnostic ¹³¹I whole body scan (¹³¹I-Dx-WBS).Methods A total of 33 patients with DTC,who had elevated serum Tg levels and negative ¹³¹I-Dx-WBS,were enrolled,and ¹⁸F-FDG PET/CT were performed.The imaging results of ¹⁸F-FDG PET/CT were compared with the clinical results of surgical pathology or 6-36 months follow-up.The diagnostic efficacy of ¹⁸F-FDG PET/CT in detection of the recurrence or metastasis DTC with elevated Tg levels and negative ¹³¹I-Dx-WBS were evaluated.Results The sensitivity and positive predictive value of ¹⁸F-FDG PET/CT in diagnosis of DTC with elevated Tg levels and negative ¹³¹I-Dx-WBS were 85.71% (18/21) and 90.00% (18/20),respectively.The sensitivity of ¹⁸F-FDG PET/CT increased significantly in patients with serum Tg levels more than 47.59 ng/ml (100%) in comparison with patients with serum Tg levels less than 47.59 ng/ml (66.67%).¹⁸F-FDG PET/CT changed the treatment strategies of 15 patients (15/33,45.45%) in 33 patients,4 of 15 patients (4/15,26.67%) underwent the reoperation,and the other 11 patients (11/15,73.33%) received ¹³¹ I ablation therapy.Conclusion ¹⁸F-FDG PET/CT is a valuable method in detection of recurrence or metastasis DTC with elevated Tg levels and negative ¹³¹I-Dx-WBS,which can also be used to guide the follow-up treatment strategy.