摘要
目的探讨颈部超声及^18F-FDG PET/CT在经手术及131I治疗后,血清TgAb阳性而Tg及131I-Dx-WBS均阴性的DTC患者随访中的诊断价值。方法对2014年9月至2016年3月间41例(男10例,女31例,年龄16~73岁)血清TgAb阳性(〉115 kU/L)而血清Tg及131I-Dx-WBS均阴性的DTC患者进行前瞻性研究。根据颈部超声是否提示异常分为阳性组和阴性组,评价2组复发或转移率差别是否有统计学意义,同时对此41例患者行^18F-FDG PET/CT检查,评价显像对患者复发或转移的诊断价值。最终诊断依据病理得出。使用χ^2 检验分析数据。结果41例血清TgAb阳性而Tg及131I-WBS均阴性的DTC患者中,颈部超声阳性患者复发或转移率(9/17)明显高于颈部超声阴性患者(16.67%,4/24; χ^2=6.047, P〈0.05),^18F-FDG PET/CT显像诊断41例患者复发或转移的灵敏度、特异性、阳性预测值、阴性预测值分别为12/13、78.57%(22/28)、12/18、95.65%(22/23);ROC曲线分析示,当SUVmax的界值定为4.35时,^18F-FDG PET/CT显像诊断复发或转移的灵敏度和特异性分别为11/13和100%(28/28)。12例患者因行^18F-FDG PET/CT检查而改变了治疗方案,其中8例再次行手术治疗,4例行大剂量131I治疗。结论颈部超声及^18F-FDG PET/CT显像对血清TgAb阳性而Tg及131I-WBS均阴性DTC患者复发或转移的诊断及后续治疗方案的选择具有重要意义。
ObjectiveTo evaluate the diagnostic value of neck ultrasonography (NUS) and ^18F-FDG PET/CT imaging during the follow-up of DTC patients with elevated serum TgAb but negative serum Tg and 131I-Dx-WBS after thyroidectomy and 131I ablation.MethodsFrom September 2014 to March 2016, 41 DTC patients (10 males, 31 females, age 16-73 years) with elevated serum TgAb level (〉115 kU/L) but negative serum Tg and 131I-Dx-WBS were enrolled in this prospective study. Patients were divided into positive group and negative group, according to the results of NUS. The rates of recurrence or metastasis between the 2 groups were compared. ^18F-FDG PET/CT imaging was performed and the results were compared with pathological results. χ^2 test was used to analyze the data.ResultsThe rate of recurrence or metastasis in the NUS positive patients(9/17) was significantly higher than that in the patients with negative NUS results(16.67%, 4/24; χ^2=6.047, P〈0.05). The sensitivity, specificity, positive predictive value, negative predictive value of ^18F-FDG PET/CT imaging for diagnosis of recurrence or metastasis were 12/13, 78.57%(22/28), 12/18 and 95.65% (22/23) respectively. ROC curve analysis showed that the sensitivity and specificity of ^18F-FDG PET/CT imaging were 11/13 and 100%(28/28) respectively when the threshold of SUVmax was set at 4.35. The treatment strategy was changed after ^18F-FDG PET/CT imaging in 12 patients, of which 8 underwent surgery and 4 underwent 131I ablation therapy.ConclusionThe NUS and ^18F-FDG PET/CT imaging have important significance in clinical diagnosis and subsequent treatment of the DTC patients with elevated serum level of TgAb but negative serum Tg and 131I-Dx-WBS.
出处
《中华核医学与分子影像杂志》
北大核心
2017年第12期772-776,共5页
Chinese Journal of Nuclear Medicine and Molecular Imaging
基金
河南省医学科技攻关计划项目(201403038)