^(18)F-FDG符合线路显像对甲状腺乳头状癌颈部淋巴结转移^(131)I疗效的预测价值

Value of 18F-FDG dual head coincidence imaging in predicting the efficacy of radioiodine therapy for papillary thyroid carcinoma with cervical lymph node metastasis

目的探讨18F-FDG符合线路显像在预测甲状腺乳头状癌颈部淋巴结转移131I疗效中的临床价值。方法经过甲状腺手术及成功"清甲"治疗的36例甲状腺乳头状癌颈部淋巴结转移患者,在转移灶治疗前一周内行18F-FDG符合线路显像,并在给予剂量3.7~7.4 GBq131I后4 d行131I-全身显像。根据显像结果分为两组,第Ⅰ组:18F-FDG符合线路显像阳性和131I-全身显像阳性,第Ⅱ组:18F-FDG符合线路显像阴性和131I-全身显像阳性,半年后随访患者疗效,评价显像结果与疗效之间的关系。结果第Ⅰ组共14例,发现淋巴结转移灶49个,第Ⅱ组共22例,发现淋巴结转移灶76个。在第Ⅰ组患者中,18F-FDG符合线路显像和131I-全身显像总体灵敏度分别为67.3%及89.8%,差异具有统计学意义(P=0.027);18F-FDG符合线路显像和131I-全身显像对颈部转移性淋巴结的总体灵敏度分别为26.0%及94.5%,差异有统计学意义(P<0.001)。两组患者131I有效率分别为35.7%和81.8%,差异有统计学意义(P=0.011)。t检验显示T/NT(靶与非靶)比值为影响颈部转移性淋巴结131I疗效因素之一(P<0.001)。结论甲状腺乳头状癌颈部转移性淋巴结18F-FDG符合线路显像总体灵敏度低于131I-全身显像的总体灵敏度;在18F-FDG符合线路显像及131I-全身显像均阳性的患者中,131I-全身显像较18F-FDG符合线路显像发现更多的颈部转移性淋巴结;颈部转移性淋巴结131I-全身显像阳性的患者中18F-FDG符合线路显像阳性组131I的疗效较18F-FDG符合线路显像阴性组差;18F-FDG符合线路显像阳性的颈部转移性淋巴结T/NT值与131I疗效有关。

Objective To assess the value of 18F-FDG dual head coincidence imaging in the prediction of the efficacy of radioiodine therapy in patients with cervical lymph node（LN） metastasis of papillary thyroid carcinoma（PTC）.Methods Thirty-six patients undergoing thyroidectomy and radioiodine ablation of the residual normal thyroid tissue received 18F-FDG dual head coincidence imaging and then therapeutic 131I-whole body imaging（131I-WBI） in the same week.According to those imaging results,the patients were divided into group I with positive results of both imaging examinations and group II with positive results by 131I-WBI but negative results by18F-FDG dual head coincidence imaging.All the patients were followed up for 6 months.Results In group I（14 patients）,a total of 49 lesions were diagnosed as cervical LN metastases,and the total sensitivity differed significantly between 18F-FDG dual head coincidence imaging and 131I-WBI（67.3% vs 89.8%,P=0.027）.In both groups,the total sensitivity of 18F-FDG dual head coincidence imaging and 131I-WBI showed a significant difference（26.0% vs 94.5%,P〈0.001）.The target and non-target ratio（T/NT） was identified as one of the factors affecting the radioiodine efficacy（P〈0.001）.In group II（22 patients）,76 lesions were diagnosed as cervical LN metastases.The effective rates of groups I and II were 35.7% and 81.8%,respectively,showing a significant difference between them（P=0.011）.Conclusion 131I-WBI is more sensitive than 18F-FDG dual head coincidence imaging in detecting cervical LN metastasis in patients with PTC.Patients with cervical LN metastases who have positive results in both 131I-WBI and 18F-FDG dual head coincidence imaging tend to have a poorer response to the therapy than the patients with negative results in 18F-FDG dual head coincidence imaging.The T/NT of the cervical LN metastases in 18F-FDG dual head coincidence imaging is associated with the efficacy of radioiodine therapy.