多模态影像引导下放射性^(125)I粒子植入治疗甲状腺癌肺转移瘤的研究

Clinical efficacy of radioactive iodine-125 seed implantation for recurrent lung metastasis of thyroid cancer under the guidance of multimodal imaging

目的探讨传统增强CT及多模态影像[增强CT、正电子发射计算机体层显像仪(PET/CT)结合单光子发射计算机断层成像(SPECT)]引导下放射性^(125)I粒子植入(RISI)对甲状腺癌肺转移瘤治疗的效果。方法本研究为回顾性研究,选取2017年1月至2021年6月北部战区总医院核医学科收治的25例甲状腺癌术后肺转移瘤患者,男11例,女14例,年龄(53.1±13.4)岁,年龄范围为22~74岁。根据影像引导^(125)I粒子植入治疗方式的不同,分为传统组(n=15)及多模态影像组(n=10),传统组采用传统增强CT引导下RISI治疗,多模态影像组采用多模态影像(PET/CT全身显像、SPECT扫描及胸部增强CT)引导下RISI治疗,比较两组患者^(125)I粒子植入情况、治疗效果、甲状腺球蛋白(Tg)水平、卡诺夫斯凯计分(KPS)及并发症发生情况。结果两组患者均成功进行^(125)I粒子植入治疗,植入成功率为100%。两组患者疾病控制率比较,差异无统计学意义(P>0.05)。治疗后,患者Tg水平均降低,KPS均升高。术后1个月,多模态影像组Tg水平[(556.8±161.7)μg/L]低于传统组[(749.5±206.3)μg/L],KPS[(82.2±1.6)分]高于传统组[(77.8±0.9)分],差异有统计学意义(P<0.05)。两组患者并发症发生率比较,差异无统计学意义(P>0.05)。结论传统增强CT及多模态影像(增强CT、PET/CT结合SPECT)引导下RISI治疗甲状腺癌肺转移瘤可获得较好的治疗效果。多模态影像较传统增强CT引导下RISI治疗,具有一定的优势。

Objective To evaluate the efficacy of radioactive iodine-125 seed implantation(RISI)guided by conventional enhanced CT and multimodality imaging[enhancement CT,positron emission tomography and computed tomography(PET/CT),singlephoton emission computed tomography(SPECT)]in the treatment of thyroid cancer pulmonary metastases.Methods This study was a retrospective study,a total of 160 patients with lung metastases after thyroid cancer in the nuclear medicine department of the General Hospital of Northern Theater Command from January 2017 to June 2021,including 11 males and 14 females,aged(53.1±13.4)years old,ranging from 22 to 74 years old.According to the different ways of image-guided^(125)I seed implantation,the patients were divided into traditional group(n=15)and multimodal group(n=10),the traditional group was treated with RISI under the guidance of conventional enhanced CT,the multimodality group were treated with RISI guided by multimodality images[PET/CT,SPECT,enhancement CT].The^(125)I seed implantation,therapeutic effect,thyroglobulin(Tg)level,Kanofsky performance score(KPS)and complications were compared between the two groups.Results Both groups were successfully treated with^(125)I seed implantation,the success rate was 100%.There was no significant difference in disease control rate between the two groups(P>0.05).After treatment,Tg level decreased and KPS increased.One month after treatment,the level of Tg[(556.8±161.7)μg/L]and KPS(82.2±1.6)in the multimodality group were significantly lower than those in the traditional group[(749.5±206.3)μg/L,(77.8±0.9)],the differences were statistically significant(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusions RISI under the guidance of conventional enhanced CT and multi-modality imaging[PET/CT,SPECT,enhancement CT]has a better therapeutic effect in the treatment of thyroid cancer pulmonary metastases.Multimodality imaging has some advantages over conventional enhanced CT guided RISI.