分化型甲状腺癌术后^(99)Tc^m-MIBI显像与^(131)Ⅰ显像比较及其意义  

Research on application of ^(99)Tc^m-MIBI scan compared with ^(131)Ⅰ whole-body scan to the postsurgical patients with DTC

作　　者：邱李恒[1] 林岩松[1] 龙明清[1] 巴建涛[1] 王正华[1] 马艳茹[1] 牛娜[1] 刘轶敏[1] 李方[1] 

机构地区：[1]中国医学科学院北京协和医院核医学科,北京100730

出　　处：《中华肿瘤防治杂志》2011年第18期1482-1486,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的:探讨分化型甲状腺癌(DTC)术后99 Tcm-MIBI显像结果的意义。方法:300例DTC术后患者中随机选取69例行99 Tcm-MIBI显像。2名有经验核医学医师盲法阅片。将99 Tcm-MIBI显像结果与治疗后131I显像结果比较。另对经高分辨CT或治疗后131I显像诊断肺转移和无肺转移患者行半定量分析,比较靶本底比值(T/B)。结果:排除1例死于血管肉瘤者,余按照手术方式及131I治疗情况分为3组(A组:44例甲状腺癌术后拟131I治疗组;B组:22例有再次131I治疗指征组;C组:2例甲状腺大部切除组)。A组99 Tcm-MIBI显示残余甲状腺34.1%(15/44),转移灶30.0%(6/20)。B组99 Tcm-MIBI显示复发及转移灶63.6%(7/11)。C组99 Tcm-MI-BI显示残余甲状腺100.0%(2/2),并为唯一一种发现颈部转移显像方法。5例患者同时存在多种性质转移灶:MI-BI+I-,MIBI-I+及MIBI+I+。肺转移与无肺转移患者T/B比值差异无统计学意义。结论:99 Tcm-MIBI可发现分化好及失分化病灶,联合131I显像为DTC术后患者选择治疗方式提供重要信息,有临床应用价值。OBJECTIVE： To evaluate the clinical utility of ^99Tc^m MIBI scintigraphy in the postsurgical patients with differentiated thyroid cancer （DTC）. METHODS： A prospective study of 69 patients randomized picked out from 300 DTC patients underwent ^99Tc^m -MIBI scan after thyroidectomy. Visual analysis of the scintigraphic images was performed by two experienced physicians without clinical findings and results of the other imaging. The result compared with posttherapy ^131I scan. In addition, ^99 Tc^m-MIBI uptake in lung was semi-quantitatively evaluated by calculating the target-to background （T/B） ratio. RESULTS： One patient who died of angiosarcoma was excluded. According to radioiodine therapy and surgery style, the patients were categorized into 3 groups for analysis. Group A （n= 44）： prepare for initial ^131 I treatment after thyroidectomy. Group B （n =22）： need further ^131I treatment. Group C （n= 2） ： underwent partial thyroidectomy alone. In group A, ^99Tc^m-MIBI scans detected thyroid remnants in 15 of 44 pa tients （34. 1%） and metastatic loci in 6 of 20 （30.0%） patients. In group B, ^99 Tc^m-MIBI scans detected recurrent and metastatic loci in 7 of 11 （63.6%）. In group C, ^99Tc^m- MIBI scan detected all the remnants （2/2,100.0%）, and to be the only examination detecting a cervical lymph node metastasis in one patient. Five patients had three type metastases： MIBI＋1-, MIBI-I＋ and MIBI＋I- metastases. T/B ratio showed no significant difference between non-metastatic and metastatic groups in lung which confirmed by high-resolution CT or posttherapy ^131I scan. CONCLUSIONS： ^99Tc^m-MIBI can reveal both functioning and non-functioning metastases, so ^99 Tc^m MIBI scan may be useful for choosing the best therapeutic approach. The combination of ^99Tc^m-MIBI with ^131 I offers the highest diagnostic yield.

关 键 词：甲状腺肿瘤 99M锝甲氧基异丁基异腈 放射性核素显像 

分 类 号：R736.1[医药卫生—肿瘤]