^(131)Ⅰ治疗分化型甲状腺癌肺内转移灶的疗效及影像分析

Effectiveness and image analysis of ^(131)Ⅰ treatment of pulmonary metastases from papillary thyroid carcinoma

目的分析大剂量^(131)I治疗分化型甲状腺癌肺内转移灶的影像学特征、临床疗效及其影响因素。方法应用大剂量^(131)I治疗分化型甲状腺癌患者156例,其中肺内出现转移灶12例(均已行甲状腺次全或全切除术及颈部淋巴结清扫)。^(131)I的单次使用剂量2.22～7.4GBq,总剂量7.4GBq～33.3GBq。随访持续时间至少一年。疗效判定:胸部X光及/或CT检查、^(131)I显像、血清甲状腺球蛋白和甲状腺球蛋白抗体水平测定,但主要为^(131)I显像。结果12例患者中11例在治疗后^(131)I显像发现肺内转移灶,其中9例在第1次治疗后显示肺内^(131)I摄取,2例在第2次治疗后显示肺内^(131)I摄取,另有1例患者治疗后肺内转移灶未显示有^(131)I摄取。11例显示肺内^(131)I摄取的患者中,6例X光胸片或CT检查未发现异常。所有患者大剂量^(131)I治疗后均有不同程度的好转,多次治疗后^(131)I显像示肺内^(131)I摄取逐渐降低,3例在治疗后最终显示正常。结论^(131)I是治疗分化型甲状腺癌肺内转移灶的有效方法,治疗后^(131)I显像是判断其疗效的可靠方法。

Objective To analyze the image characteristics, clinical treatment effect of the large amounts of ^131I treatment of pulmonary metastases from papillary thyroid carcinoma. Methods Of 156 patients treated with ^131I for thyroid carcinoma, evidence of pulmonary metastases was exhibited in 12 patients （each patient had undergone total or nearly total thyroidectomy and cervical lymph nodedissection）.Individual activities of ^131I ranged from 2.22 to 7.40GBq, the total dose ranged from 7.4 to 33.3GBq.The duration of follow-up was at least one year. Effects of treatment were measured by chest X-ray and/or CT images, ^131I imaging, and serum thymoglobulin and thymoglobulin antibody levels. But the primary measurement was ^131I imaging. Results Of 12 patients with pulmonary metastases, 11 cases with lung metastases were found in ^131I imaging after treatment, including 9 patients showing lung metastases after first treatment, 2 after second treatment. Another patient didn＇t show uptake of ^131I in the pulmonary metastases after treatment. Of 11 patients showing uptake of ^131I in the lungs, 6 patients had a normal X-ray or CT images. All patients showed improvement more or less after the large amounts of ^131I treatment, and the ^131I imaging showed the uptake of ^131I in the lungs decreased gradually after several times treatment. 3 patients attained normality finally after treatment. Conclusion ^131I therapy is an effective way for the pulmonary metastases from papillary thyroid carcinoma, the ^131I imaging after treatment is credible for estimating its treatment effect.