分化型甲状腺癌患者^(131)I治疗后双肺弥漫性摄取^(131)I原因分析

Analysis of the reasons for diffuse uptake of^(131)I in both lungs of differentiated thyroid cancer patients after^(131)I treatment

目的探讨分化型甲状腺癌(DTC)患者^(131)I治疗后双肺弥漫性摄取^(131)I的可能原因。方法回顾性病例系列研究。收集山西省肿瘤医院2015年6月至2021年6月接受^(131)I治疗后第7天全身显像示双肺弥漫性摄取^(131)I的DTC患者46例,根据SPECT/CT同机融合图像、甲状腺球蛋白水平及甲状腺球蛋白抗体(TgAb)水平,分析双肺弥漫性摄取^(131)I的可能原因。结果10例患者SPECT/CT同机融合显像未见异常密度影;刺激性甲状腺球蛋白(sTg)(11±4)ng/ml,TgAb(1.2±0.5)%,抑制性甲状腺球蛋白(5.3±1.5)ng/ml;双肺弥漫性摄取^(131)I的可能原因为双肺存在普通CT扫描未能发现的早期微小转移结节,这类结节摄取^(131)I所致。36例患者SPECT/CT同机融合显像示双肺多发类圆形结节;sTg(281±10)ng/ml,TgAb(1.7±0.7)%;双肺弥漫性摄取^(131)I的原因为双肺转移灶摄取^(131)I所致。结论不同程度的肿瘤转移可能是导致DTC患者^(131)I治疗后双肺弥漫性摄取^(131)I的原因。

Objective To explore the possible reasons for diffuse uptake of^(131)I in both lungs of differentiated thyroid cancer(DTC)patients after^(131)I treatment.MethodsA retrospective case series study was conducted.Forty-six DTC patients who received^(131)I treatment at Shanxi Province Cancer Hospital from June 2015 to June 2021 were collected,and whole body scan of these patients showed diffuse uptake of^(131)I in both lungs on the 7th day after treatment.Based on SPECT/CT fusion images,thyroid globulin levels,and thyroid globulin antibody(TgAb)levels,the possible reasons for diffuse uptake of^(131)I in both lungs were analyzed.ResultsSPECT/CT fusion images showed no abnormal density shadows in 10 patients;stimulating thyroglobulin(sTg)was(11±4)ng/ml,TgAb was(1.2±0.5)%,inhibitory thyroglobulin was(5.3±1.5)ng/ml;the possible reason for diffuse uptake of^(131)I in both lungs was the presence of early small metastatic nodules that cannot be detected by conventional CT scans,and these nodules absorbed^(131)I.SPECT/CT fusion images showed multiple round nodules in both lungs in 36 patients;sTg was(281±10)ng/ml,TgAb was(1.7±0.7)%;the reason for diffuse uptake of^(131)I in both lungs was the uptake of^(131)I by metastatic lesions in both lungs.ConclusionsDifferent degrees of tumor metastasis may be the cause of diffuse uptake of^(131)I in both lungs of DTC patients after^(131)I treatment.