131I-WBS与131I-SPECT/CT对分化型甲状腺癌诊治价值比较研究

目的:探讨131I全身显像(131I-WBS) 与131I单光子发射型计算机断层显像/计算机体层摄影术(131I-SPECT/CT)同机融合显像对于分化型甲状腺癌(DTC)术后131I治疗患者的诊治价值?方法:选择术后经病理证实并接受131I治疗的DTC 48例,3~5 d后同期行131I-WBS和131I-SPECT/CT断层融合显像?将131I-WBS与131I-SPECT/CT断层融合图像进行对比分析,探讨各自显像特点与临床价值?结果:48例DTC患者共行131I-WBS 48次,131I-SPECT/CT断层融合显像60次?在131I-WBS发现的总计145处摄碘灶中,甲状腺床占34.3%,恶性病灶占60.5%,非甲状腺生理性和良性病变摄取以及污染占5.2%?131I-SPECT/CT融合显像比131I-WBS多发现23处转移灶?在131I-WBS无法确诊的20例65处摄碘灶中,通过131I-SPECT/CT断层融合显像获得准确定位和定性诊断的分别占100%和94%?共使18例(37.5%,18/48)患者获得了更多的增益价值,且其中8例(44.4%,8/18)患者治疗方案发生了改变?结论:131I-WBS应常规应用于DTC术后131I治疗患者?当131I-WBS诊断不明确或者与临床表现不符时,加做 131I-SPECT/CT断层融合显像在提高DTC诊断正确率?制定和调整治疗方案上具有重要临床价值?

Comparison of 131I-WBS and 131I-SPECT/CT fusion imagings on management of patients with differentiated thyroid carcinoma

Objective:To explore the clinical values of 131I whole-body scan (131I-WBS) and 131I single photon emission computed tomography/computed tomography (131I-SPECT/CT) on the management of patients with differentiated thyroid carcinoma (DTC) after 131I therapy,respectively. Methods:After 3~5 days 131I therapy,48 DTC patients underwent 131I-WBS and 131I-SPECT/CT. The imaging features and clinical values of 131I-WBS and 131I-SPECT/CT were comparatively analyzed. Results:The patients had totally 48 131I-WBS and 60 131I-SPECT/CT. 145 foci were observed by 131I-WBS,including 34.3% of foci localized in the thyroid bed,60.5% of malignant lesions,and 5.2% caused by nonthyroid physiologic or benign uptake or a contaminant. There were 23 additional metastases detected by 131I-SPECT/CT. Futhermore,there were 20 patients whose 131I-WBS showed 65 inconclusive lesions. Precise localization and characterization by 131I-SPECT/CT fusion images were 65(100 %) and 61(94 %) of the 65 foci,respectively. 131I-SPECT/CT fusion images were considered to be of much benefit to 18(37.5%) of 48 patients. Changes of therapeutic plans happened to 8(44.4%) of 18 patients. Conclusion:131I-WBS should be routinely performed in the management of patients with DTC after 131I therapy. If 131I-WBS images were inconclusive or inconsistent with the clinical manifestations,131I-SPECT/CT must be required to increase the diagnostic accuracy and modulate therapeutic plans.