FDG显像监测分化型甲状腺癌转移复发的价值

目的：本研究回顾性分析在我科接受过131Ⅰ治疗的13位甲状腺癌患者的资料，探讨FDG显像在监测甲状腺癌转移、复发中的价值。方法：（1）对象：接受131Ⅰ治疗的13位分化型甲状腺癌患者（8例乳头型、4例滤泡型、1例滤泡乳头混合型），具有同期131Ⅰ及FDG肿瘤显像，和血浆Tg，TSH水平测定结果。（2）显像方法：欲行甲状腺癌131Ⅰ治疗的患者停服T4四周，治疗前测定血浆TSH和Tg水平。患者口服131Ⅰ治疗后5～7天做全身平面显像和131ⅠSPECT／CT局部断层显像。一周内行FDG显像。结合患者的临床表现、影像学分期及血浆TSH和Tg水平，对患者做出有无术后转移和复发的诊断。血浆Tg〉10ng／ml做为肿瘤复发转移的诊断阈值。（3）131Ⅰ影像学分期标准：根据图像显示的病灶摄取量、位置、数量及波及范围将病人分为4个期别：Ⅰ-摄取范围局限于甲状腺床；Ⅱ-甲状腺床＋颈部淋巴结摄取或甲状腺床＋纵隔淋巴结摄取；Ⅲ-颈部淋巴结或纵隔淋巴结摄取＋肺摄取；Ⅳ-二颈部淋巴结和纵隔淋巴结＋肺部弥漫性摄取，或，颈部淋巴结和纵隔淋巴结＋骨等其它脏器摄取。（4）统计学分析方法：SPSS软件包和EXCEL统计表，非参数秩合检验和相关性分析。结果：FDG显像的灵敏度为92％。与131ⅠSPECT／CT显像的分期结果相比，13例甲状腺癌FDG显像中7例（7／13）的分期发生改变，其中6例影像学分期提高，1例分期降低。FDG显像结果与血浆Tg、TSH水平的相关性分析显示两者没有显示明显的相关性。结论：对于分化型甲状腺癌，如果131ⅠSPECT／CT显像阴性，血浆Tg水平升高，有必要进行行FDG显像，阳性FDG显像结果说明病灶肿瘤细胞出现去分化，应结合各项检查信息，及时调整治疗方案，改善预后。

Value of FDG Imaging in the Detection of Recurrence or Distant Metastasis of Differentiated Thyroid Carcinoma

Subject： The aim of this study is to assess the utility of FDG imaging in the detection of recurrence or metastasis for the follow-up of patients with differentiated thyroid cancer （WDTC）. Materials and Methods： subject： We retrospectively reviewed the materials of 13 patients, they had been established differentiated thyroid cancer, and were treated with radioiodine between March 2001 and December 2007, 8 of them were papillary type, 4 of them were follicular type, and one of them was papillary ＆ follicular type. The level of serum Tg and TSH were measured before the treatment, 131Ⅰ SPECT / CT scans and 131Ⅰ whole body scans were acquired at 5-7 days after the patients being treated, FDG scans were acquired at no more than 7 days after 131Ⅰscans. The recurrence and metastases of differentiated thyroid cancer were diagnosis according the results of imaging and the level of serum Tg and TSH. The diagnosis threthold of serum Tg was definded as 〉 10ng/ml .Staging scores of 131Ⅰ image： According to the concentration, location, size, and range of radioactive uptake in the 131 Ⅰ images, the recurrence and metabasis of differentiated thyroid cancer （WDTC） were divided into four levels： stageⅠ- only thyroid beds were involved; stageⅡ- thyroid beds and neck lymph nodes were were involved or thyroid beds and mediastinal lymph nodes were involved; stageⅢ - Neck lymph nodes or mediastinal lymph nodes and lung were involved; stageⅣ - Cervical lymph nodes, mediastinal lymph nodes and lung were involved, or neck lymph nodes, mediastinal lymph nodes, bone and some other organs were involved. Statistical analysis： The results were statistically analyzed using the test of non-rank parameters and related analysis. Results： The detective sensitivity of FDG imaging was 92%. Compared with the staging results of 131 Ⅰ SPECT / CT scan, 6 Imaging stages （6/13） were changed, 5 of them were upgraded （5/13） and 1（1/13） were degraded. The correlation analysis was processed between FDG imaging results and the level of serum Tg, The results show that they were no obvious relevance. Conclusion： 18F-FDG imaging displayed good value for differentiated thyroid carcinomas when high thyroglobulin was present and iodine imaging was negative. The increase of the 18F-FDG uptake indicates poorly differentiation （with more aggression and poor prognosis）, and this may benefit clinical management.