^(131)I SPECT/CT评价分化型甲状腺癌患者^(131)I清甲后的甲状舌管残留

The Clinical Significance of SPECT/CT Fusion Imaging for Diagnosis and Staging in Patients with DTC

目的评价^(131)I SPECT/CT判断DTC患者清甲治疗时甲状舌管的存在情况及其对^(131)I治疗的影响。方法回顾性分析127例以^(131)I清甲为目的 DTC术后患者,男29例,女98例,平均年龄39. 7±12. 8岁,^(131)I治疗前停用左甲状腺素钠3周以上,测得刺激后血清TSH、Tg和TgAb水平,完成颈部^(99)Tc^mO_4^-显像,治疗剂量为(384. 0±64. 3)×10~7Bq(103. 90±17. 37mCi)。服^(131)I后72～96小时内完成颈胸部SPECT/CT融合显像。结果 127例患者中,SPECT/CT显示有甲状舌管残留58例,无甲状舌管残留69例。有或无甲状舌管残留人群的刺激后Tg分别为5.31 pmol/L(3.05～14.26 pmol/L和3.58pmol/L(2.15～7.10 pmol/L),^(131)I治疗剂量分别为(389.0±64.3)×10~7Bq(105.17±17.37 mCi)和(381.2±64.8)×10~7Bq(102. 90±17. 51 mCi)。有或无甲状舌管残留人群在年龄、性别、病理类型、刺激后Tg-Ab和^(131)I治疗剂量等方面均无明显差异,但前者的刺激后Tg要明显高于后者(Z=2.435,P=0.015)。^(99m)TcO4^-显像示甲状舌管残留者42例,无甲状舌管残留者85例;以SPECT/CT结果为诊断标准,则^(99)Tc^mO_4^-显像诊断甲状舌管的敏感性、特异性和准确性分别为67. 2%、95.7%和82. 7%。结论甲状舌管残留在DTC术后接受^(131)I清甲治疗的人群中较常见,^(131)I SPECT/CT显像有助于判断甲状舌管的残留情况、指导诊疗策略的正确制定。

Objective To investigate the clinical value of thyroglossal tract thyroid tissue using SPECT/CT fusion imaging in DTC patients. Methods 127 patients (29 males and 98 females)underwent the first ^131 I ablation were included in our study.The average age of patients was 39.7±12.8.All patients were prepared with thyroid hormone withdrawal for at least three weeks and measured the levels of serum TSH,Tg and TgAb.These patients underwent 99 TcmO- 4 neck planar imaging.72- 96 hours after the oral therapeutic ^131 I,and ^131 I dose was (384.0±64.3)×10^7 Bq (103.90±17.37mCi). All patients undertook 131 I SPECT/CT regional fusion imaging. Results Of all 127 patients,thyroglossal tract thyroid tissue was present on the images of SPECT/CT fusion imaging for 58 patients.69 patients did not have thyroglossal tract on SPECT/CT.Based on the results of SPECT/CT,the stimulated serum Tg of patients with or without thyroglossal tract were 5.31 pmol/L (3.05-14.26 pmol/L)and 3.58 pmol/L(2.15-7.10 pmol/L). The doses of 131 I were ( 389.0± 64.3 )×10^7 Bq (105.17±17.37 mCi)and (381.0±64.8)×10^7 Bq (102.90±17.51 mCi).There weren’t significant differences of age,gender,pathology and stimulated TgAb and dose of ^131 I,however,the level of stimulated Tg was higher in patients with thyroglossal tract than that of the patients without thyroglossal tract.According to the results of SPECT/CT,the sensitivity,specificity and accuracy of 99 TcmO- 4 imaging were 67.2%、95.7% and 82.7%,respectively. Conclusion Thyroglossal tract thyroid tissue is present in nearly one half of our study population.^131 I regional SPECT/CT fusion imaging can provide valuable information to evaluate the present of thyroglossal tract and guide the treatment.