^(131)I SPECT/CT断层融合显像评价分化型甲状腺癌远处转移的临床研究

Clinical research on ^(131)I SPECT/CT fusion imaging in evaluating distant metastases of differentiated thyroid carcinoma

目的:探讨治疗量^(131)I单光子发射型计算机断层扫描(single-proton emission computed tomography,SPECT)/CT融合显像在评价分化型甲状腺癌(differentiated thyroid carcinoma,DTC)远处转移中的价值。方法:将153例确诊为肺转移和(或)骨转移的DTC患者(均无其他恶性肿瘤病史)纳入本研究,其中男性57例、女性96例,平均年龄(45.5±18.26)岁。所有DTC患者于口服治疗量^(131)I[平均(147.97±45.35)m Ci]后的80~96 h完成^(131)I全身平面显像和SPECT/CT断层融合显像,并单独对SPECT、CT和SPECT/CT融合图像进行分析和评价。结果:127例受检者经SPECT/CT显像显示为单纯肺转移(双肺转移109例、单纯右肺转移9例、单纯左肺转移9例)。其中80例SPECT图像表现为病灶摄碘或部分摄碘,另47例SPECT图像未见病灶明显摄碘。15例患者SPECT/CT中胸部CT图像未见肺内有转移性病变征象,但SPECT图像见异常^(131)I浓聚灶。所有153例患者中,26例SPECT/CT显像发现骨转移性病变,病灶部位最长见为脊柱(14例),然后依次为肋骨(6例)、四肢骨(6例)、胸骨(5例)、骨盆骨(5例)和锁骨(2例)。所有病例均表现为病灶部位^(131)I异常浓聚,但3例CT图像为阴性。结论:^(131)I SPECT/CT有助于诊断和评价DTC患者肺、骨等远处转移,可为DTC患者的疗效评价和治疗方案制订提供有价值的信息。

Objective： To investigate the clinical value of 131 I single-proton emission computed tomography（SPECT）/CT in assessing distant metastases of differentiated thyroid carcinoma（DTC）. Methods： A total of 153 DTC patients with pulmonary metastasis and（or） bone metastasis were included in this study. All the patients were treated with oral 131 I [average dose：（147.97± 45.35） m Ci] and performed 131 I planar whole body imaging and SPECT/CT scan 80-96 h after administration of 131 I. The values of SPECT images, CT images and SPECT/CT fusion images were compared. Results： Based on the SPECT/CT fusion images, 127 patients were confirmed with pulmonary metastasis（109 patients with bilateral lung metastasis, 9 patients with right lung metastasis and 9 patients with left lung metastasis）. Of 127 patients, 80 patients＇ SPECT images were positive, and 47 patients＇ SPECT images were negative. In addition, 15 patients with lung metastasis were observed on SPECT images, but the corresponding CT images were negative. Of all 153 patients, 26 patients were found bone metastasis on SPECT/CT images. Bone metastatic lesions were located at spine in 14 patients, at ribs in 6 patients, at limbs in 6 patients, at sternum in 5 patients, at pelvis in 5 patients and at clavicle in 2 patients. 131 I was abnormally accumulated in all patients with bone metastasis, however, CT images were negative in 3 patients. Conclusion： 131 I SPECT/CT fusion imaging can do help to evaluate pulmonary metastasis and bone metastasis of DTC.