SPECT／CT显像和甲状腺球蛋白检测对分化型甲状腺癌转移的预测价值

Value of SPECT/CT scan and serum thyroglobulin in predicting metastasis for patients with differentiated thyroid carcinoma

目的:评价分化型甲状腺癌(DTC)术后首次131I去除治疗5d后SPECT/CT显像(首次显像)和血清甲状腺球蛋白(Tg)水平在预测6个月后颈、胸部的摄131I转移灶中的价值。方法:120例DTC患者术后首次131I去除治疗前测Tg水平,去除治疗5d后行SPECT/CT显像,6个月后复查SPECT/CT显像(复查显像)和测Tg水平,比较2次显像颈、胸部摄131I转移灶的变化。结果:首次显像未见摄131I转移灶患者100例(A组),复查显像发现有摄131I转移灶患者6例(阳性率6.0%)。Tg<10μg/L者59例(A1组),其中1例复查显像发现摄131I转移灶(阳性率1.7%);Tg≥10μg/L患者41例(A2组),其中5例复查显像发现摄131I转移灶(阳性率12.2%)。首次显像有摄131I转移灶患者20例(B组),复查显像7例仍有摄131I转移灶(阳性率35.0%)。Tg<10μg/L者9例(B1组),其中1例复查显像发现摄131I转移灶(阳性率11.1%);Tg≥10μg/L者11例(B2组),其中6例复查显像仍有摄131I转移灶(阳性率54.6%)。A组和B组复查显像阳性率差异有统计学意义(校正χ2=11.664,P=0.001),A1组和A2组,B1组和B2组两两组间复查显像阳性率差异均无统计学意义(P>0.05)。结论:DTC术后首次131I去除治疗5d后SPECT/CT显像对预测6个月后颈、胸部的摄131I转移灶有一定价值。

Aim ：To investigate the value of first post-therapy 131 I-SPECT/CT scan and serum thyroglobulin （Tg） level in predicting the cervical and thoracic radioiodine-positive metastases 6 months later for patients with differentiated thyroid carcinoma. Methods：The study included 120 DTC patients that had determined the serum lever of Tg and had accepted SPECT/CT after radioablation of thyroid remnants after thyroidectomy. The patients were re-examined 6 months later at TSH stimulation. Results：Out of 100 patients without SPECT/CT diagnosis of 131 I -positive metastases at first radioablation （group A） ,6 patients were detected having radioiodine-positive metastases at follow up （6.0%）. Out of 59 patients who had Tg 〈 10μg/L （group Am ） , only 1 patient was detected having a new radioiodine-positive metastasis at follow up （1.7%） ; Out of 41 patients who had Tg≥ 10 μg/L （group A2 ）, 5 patients were detected having new radioiodine-positive metastases at follow up （12.2%） ;Out of 20 patients with SPECT/CT diagnosis of m I -positive metastases at first radioab- lation （group B）, 7 patients were detected having radioiodine-positive metastases at follow up （35.0%）. Out of 9 patients who had Tg 〈 10 μg/L （ group B1 ）, only one was detected having a new radioiodine-positive metastasis at follow up（11.1%） ; out of 11 patients who had ＇rg~〉 10 μg/L（ group B2 ） , 6 patients persisted in radioiodine-positive metastases at follow up （54.6%）. Chi-square test showed that the difference between group A and B was significant（x2adj = 11. 664 ,P = 0. 001 ） , the differences between group Am and A2, Bl and B2 were not significant （P 〉 0.05 ）. Gorlclusion ：The first post- therapy 1311-SPECT/CT scan is useful to predict the occurrence and/or persistence of cervical and thoracic radioiodine-posi- tire metastases 6 months later.