甲状腺癌术后患者颈淋巴结转移影像学比较研究  

Comparisons of imageology in postoperative cervical lymph node metastasis of thyroid carcinoma

作　　者：王强[1] 余永利[1] 高秀丽[1] 朱兆领[2] 

机构地区：[1]上海交通大学第六人民医院核医学科,上海200233 [2]上海交通大学第六人民医院超声科,上海200233

出　　处：《上海交通大学学报（医学版）》2009年第9期1085-1087,1091,共4页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的探讨超声、99mTc-甲氧基异丁基异腈(99mTc-MIBI)核素显像和131I全身扫描(131I-WBS)检测分化型甲状腺癌(DTC)术后患者颈淋巴结转移的临床价值。方法117例DTC术后患者131I治疗前行99mTc-MIBI和超声检查,治疗6d后行131I-WBS,结合血清甲状腺球蛋白(Tg)、131I-SPECT/CT、淋巴结穿刺活检及临床随访等手段确定颈淋巴结转移灶。结果超声、99mTc-MIBI和131I-WBS诊断117例DTC术后患者颈淋巴结转移敏感度为76.5%、67.1%、83.5%(P<0.05),特异度为75.0%、78.1%、84.4%,准确度为76.1%、70.1%、83.8%(P<0.05);三项联合检查的敏感度、特异度、准确度为98.8%、75.0%和92.3%。134个颈淋巴结转移灶检出率分别为超声75.4%、99mTc-MIBI66.4%、131I-WBS80.6%(P<0.05),前两项合并对26个131I-WBS假阴性显像灶检出率为96.2%。结论超声、99mTc-MIBI和131I-WBS联合检查可显著提高DTC术后患者颈淋巴结转移诊断敏感度和准确度,前两项联合检查可提高131I-WBS假阴性显像灶检出率。Objective To explore the clinical manifestations of ultrasonography（US）,99mTc-methoxyisobutylisonitrile（99mTc-MIBI）,and 131I whole body scan（131I-WBS）of patients with differentiated thyroid carcinoma（DTC）and cervical lymph node metastasis.Methods A total of 117 cases received examinations of US and 99mTc-MIBI before uses of 131I and received 131I-WBS after 6 d of 131I treatment.Combined with serum thyroglobulin（Tg）,131I-SPECT/CT,lymph node biopsy and clinical follow-up of patients,cervical lymph node metastases were identified.Results In 117 patients,the sensitivity of US,99mTc-MIBI and 131I-WBS were 76.5%,67.1% and 83.5%（P〈0.05）;the specificity of US,99mTc-MIBI,and 131I-WBS were 75.0%,78.1% and 84.4%;and the accuracy of US,99mTc-MIBI and 131I-WBS were 76.1%,70.1% and 83.8%（P〈0.05）,respectively.The total sensitivity,total specificity,and total accuracy of combination of the three examinations were 98.8%,75.0% and 92.3%,respectively.Detection rates by US,99mTc-MIBI,and 131I-WBS of 134 cervical lymph node metastasis were 75.4%,66.4% and 80.6%（P〈0.05）.Combined US with 99mTc-MIBI,detection rate for 26 false-negative 131I-WBS imaging was 96.2%.Conclusion The combination of US,99mTc-MIBI,and 131I-WBS could improve the sensitivity,specificity,and accuracy of post-operative cervical lymph node metastases of DTC.The combined results of US and 99mTc-MIBI could detect false-negative 131I-WBS imaging.

关 键 词：甲状腺肿瘤 淋巴结 131I 超声检查 放射性核素显像 

分 类 号：R736.1[医药卫生—肿瘤] R73-37[医药卫生—临床医学]