摘要
目的:探讨18F-FDG正电子发射体层成像(positron emission tomography,PET)/计算机体层成像(computed tomography,CT)在131I治疗分化型甲状腺癌(differentiated thyroid carcinoma,DTC)转移灶中的临床价值.方法:纳入DTC术后临床疑有转移灶的患者305例,实施131I治疗前均行18FDG PET/CT和其他相关的影像学检查,131I治疗后96 h行131I全身扫描(131I whole body scan,131I-WBS)和局部131I单光子发射计算机体层成像(single-photon emission computed tomography,SPECT)/CT.131I治疗前后动态检测患者血清甲状腺球蛋白(thyroglobulin,Tg)及甲状腺球蛋白抗体(thyroglobulin antibody,TgAb)水平变化.131I治疗后随访期均≥2年.结果:以血清Tg=10.0 ng/mL为阈值,Tg≥10.0 ng/mL组,62.1%(90/145)DTC患者在18F-FDG PET/CT图像上有高代谢转移灶;Tg＜10.0 ng/mL组,25.0%(40/160)患者在18F-FDG PET/CT图像上有高代谢转移灶;组间差异有统计学意义(P＜0.01).动态随访结果显示:18F-FDG呈阳性者,血清Tg的初始均值较高,131I治疗无效比例也较高;18F-FDG阴性者,初始血清Tg水平较低,无论131I治疗是否有效,其后血清Tg可趋稳定或逐渐下降.结论:以血清Tg=10.0 ng/mL为阈值,可提高18F-FDG PET/CT判断DTC转移灶的阳性率,但有不确定性.18F-FDG PET/CT还有助于预判131I治疗DTC转移灶的效果和病情转归.
Abstract
Objective:To investigate the clinical value of 18F-FDG positron emission tomography(PET)/computed tomography(CT)in 131I treatment of metastases from differentiated thyroid cancer(DTC).Methods:A total of 305 cases with DTC metastases were included in this study.18F-FDG PET/CT as well as other routine imaging diagnostic methods were carried out before 131I treatment,followed by 131I-whole body scan(WBS)and 131I single-photon emission computed tomography(SPECT)/CT 96 h later.Dynamic serum thyroglobulin(Tg)and thyroglobulin antibody(TgAb)immunoassay was performed pro-131I treatment and follow-up for at least two years.Results:With cutoffvalue of serum Tg=10 ng/mL,in cases with serum Tg≥10 ng/mL,62.1%(90/145)cases with DTC metastases were found with positive lesions on 18F-FDG PET/CT images.In cases with serum Tg＜10.0 ng/mL,only 25.0%(40/160)cases were found with positive lesions on 18F-FDG PET/CT,significantly lower than those former cases(P＜0.01).Dynamic follow-up data showed that those cases with 18F-FDG positive and initial high serum Tg were related with high probability of invalid 131I treatment or unfavorable outcomes.On the other hand,those with negative 18F-FDG uptake were more likely associated with low initial serum Tg and came off with either effective 131I treatment or gradual decline of serum Tg during the follow-up.Conclusion:The cut offvalue of serum Tg=10.0 ng/mL may well be evident for 18F-FDG PET/CT indication for the patients with DTC metastases,those some uncertainties remained unresolved.18F-FDG PET/CT imaging results also help predict the outcomes of 131I treatment and follow-up.
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