PET-CT与PET-MRI在颈部持续或复发性分化型甲状腺癌再次术前评估中应用与研究进展

Application progress of PET-CT and PET-MRI in reoperation for neck persistent or recurrent differentiated thyroid cancer

分化型甲状腺癌(DTC)预后良好,但仍有部分病人因颈部持续或复发性病灶需要再次手术。充分的术前影像学评估能有效提高再次手术疗效。正电子发射断层扫描(PET)融合显像作为先进影像学技术,可以在现有的超声、增强CT、增强MRI及诊断性全身核素显像等基础上进一步提高颈部持续或复发性DTC病灶评估的精准性。其中,18氟-氟代脱氧葡萄糖(^(18)F-FDG)PET-CT的最佳适应证为初始治疗后甲状腺球蛋白水平增高但碘扫描阴性的病人。再次术前使用PET-CT与PET-MRI检查,并通过不同示踪剂和模式评估各亚型病灶,将极大程度地改变DTC病人的管理。

Patients with differentiated thyroid cancer(DTC)generally have excellent prognoses after appropriate treatment,but some still need reoperations to dissect neck persistent or recurrent disease.Adequate preoperative imaging evaluation can improve the efficacy of reoperation.Conventional imaging modalities for DTC,such as ultrasound,contrast CT or MRI,each have their own limitations.With the combination of functional and anatomical imaging technology,PET fusion imaging can further improve the accuracy on the basis of existing ultrasound,CT,MRI and diagnostic whole-body radionuclide imaging in the efficacy of persistent or recurrent DTC diagnosis.^(18)F-FDG PET-CT is a susceptible and specific diagnostic procedure for patients with thyroglobulin elevated and negative iodine scintigraphy,which can better identify persistent or recurrent DTC.Recently,the introduction of PET-CT and PETMRI in reoperation has substantially changed the management of DTC patients,with the continuous development of new PET tracers and modalities.