^(99m)Tc-MIBI显像在^(131)I治疗分化型甲状腺癌淋巴结转移灶中的临床价值

Clinical value of ^(99m)Tc-MIBI imaging in ^(131)I treatment of lymph node metastases of differentiated thyroid cancer

目的:探讨^(99m)Tc-甲氧基异丁基异腈(methoxyisobutylisonitrile,MIBI)显像辅助诊断分化型甲状腺癌(differentiated thyroid carcinoma,DTC)淋巴结转移的价值。方法:纳入临床确诊DTC淋巴结转移患者78例。患者在接受放射性碘^(131)(iodine ^(131),^(131)I)治疗前均进行颈部超声、^(99m)Tc-MIBI颈胸部显像(多时相)、计算机体层成像(computed tomography,CT)和/或18F-FDG正电子发射体层成像(positron emission tomography,PET)/CT。^(131)I治疗后96 h进行^(131)I全身扫描和^(131)I单光子发射计算机体层成像(single-photon emission computed tomography,SPECT)/CT颈胸部显像。^(131)I治疗前后动态检测血清甲状腺球蛋白(thyroglobulin,Tg)和抗甲状腺球蛋白抗体(antithyroglobulin antibody,TgAb)水平变化及其他相关检查。^(131)I治疗后随访期为1~2年。结果:32例DTC淋巴结转移在^(99m)Tc-MIBI显像上为阳性,诊断灵敏度为41.0%(32/78),显著低于^(131)I治疗后扫描显示的淋巴结阳性率64.1%(50/78)(P<0.01)。而在^(131)I治疗后扫描为阴性中,^(99m)Tc-MIBI显像为阳性者为19例,阳性率67.9%(19/28)。^(131)I治疗后随访期内42例患者呈临床治愈或病情好转,其中35例^(99m)Tc-MIBI显像为阴性(83.3%);19例病情稳定,^(99m)Tc-MIBI显像阴性8例(42.1%);另17例病情呈进展趋势,^(99m)Tc-MIBI显像阴性者仅3例(17.6%),组间差异有统计学意义(P<0.01)。结论:^(99m)Tc-MIBI显像可有助于提高DTC淋巴结转移的阳性检出率,并可辅助预测^(131)I治疗后的转归趋势。

Objective:To investigate the clinical value of ^(99m)Tc-methoxyisobutylisonitrile(MIBI)imaging in the ^(131)I treatment of lymph node metastases from differentiated thyroid carcinoma(DTC).Methods:A total of 78 patients with DTC lymph node metastasis were selected.All patients underwent neck ultrasound,^(99m)Tc-MIBI neck and chest imaging(multi-phases),chest computed tomography(CT)scan and/or 18F-FDG positron emission tomography(PET)/CT whole body imaging before ^(131)I treatment.^(131)I whole body scan and ^(131)I single-photon emission computed tomography(SPECT)/CT neck and chest scan were performed 96 hours after ^(131)I treatment.Serum thyroglobulin(Tg)and thyroglobulin antibody(TgAb)levels were dynamically detected before and after ^(131)I treatment,as well as other related examinations.The follow-up period after ^(131)I treatment was 1-2 years.Results:Among those patients with DTC lymph node metastases,32 patients were found with positive lesions on ^(99m)Tc-MIBI imaging.The diagnostic sensitivity of ^(99m)Tc-MIBI imaging for DTC lymph node metastases was 41.0%(32/78),which was significantly lower than that of ^(131)I post-therapeutical scan(64.1%,50/78)(P<0.01).Among those patients with negative ^(131)I post-therapeutical scan for lymph node metastases,19 were positive on ^(99m)Tc-MIBI imaging,with a positive rate of 67.9%(19/28).During the follow-up period,42 patients were clinically cured or their condition improved,of which 35 were negative on ^(99m)Tc-MIBI imaging(83.3%).19 cases were stable,of which 8 cases(42.1%)were negative on ^(99m)Tc-MIBI imaging(42.1%).The other 17 cases were clinically found on progressive trend,of which only 3 cases were negative in on ^(99m)Tc-MIBI imaging(17.6%).The difference between the sub-groups was much significant (P<0.01). Conclusion: ^(99m)Tc-MIBI imaging could help to improve the diagnostic efficacy of DTC lymph node metastasesand enhance the prediction of the therapeutic effects after ^(131)I treatment.