分化型甲状腺癌首次大剂量131^I治疗后99^Tc^m-MIBI显像的价值  

Clinical value of 99^Tc^m-MIBI scintigraphy in patients with differentiated thyroid carcinoma after surgery and first 131^I therapy

作　　者：潘晓梅[1] 段东[1] 朱玉泉[1] 庞华[1] 

机构地区：[1]重庆医科大学附属第一医院核医学科,610041

出　　处：《中华核医学与分子影像杂志》2015年第5期383-386,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨99^Tc^m-MIBI显像对诊断DTC患者首次大剂量131^I治疗后残留甲状腺组织（简称残甲）和转移灶的应用价值。方法回顾性分析2010年2月至2014年3月间192例[男38例，女154例；平均年龄（43．2±8．6）岁；乳头状癌171例，滤泡状癌21例]经手术病理确诊的DTC患者，在首次131^I治疗半年后先行99^Tc^m-MIBI显像（740．925MBq），显像后第2天口服131^I（平均剂量5550～8140MBq），治疗后第4天行131^I显像。显像前患者均停用甲状腺素制剂4周，并检测血清Tg、TSH及TgAb水平。2种显像方法中任一方法发现甲状腺床区或腺外有异常放射性摄取者即为阳性。数据分析采用疋。检验及两样本t检验。结果共纳入191例患者的显像结果，其中阳性65例，阴性126例。131^I显像和99^Tc^m-MIBI显像的灵敏度分别为92．3％（60／65）和56．9％（37／65），差异有统计学意义（x^2=14．7，P〈0．01）。65例阳性中残甲者43例，转移病灶者22例，131^I显像和99^Tc^m-MIBI显像发现残甲的灵敏度分别为100％（43／43）和39．5％（17／43），差异有统计学意义（x^2=24．0，P〈0．01）；发现转移灶的灵敏度分别为77.3％（17／22）和90．9％（20／22），差异无统计学意义（x^2=0．57，P〉0．05）。2个99^Tc^m-MIBI阳性组血清Tg水平均高于99^Tc^m-MIBI阴性且131^I阴性组（t=-20．7和-6．0，均P〈0．01），99^Tc^m-MIBI阳性且131^I阴性组明显高于131^I阳性且99^Tc^m-MIBI阴性组（t=-2．7，P〈0．05）。结论DTC患者首次大剂量131^I清除残甲后．99^Tc^m-MIBI显像能较好地评价患者体内是否存在转移灶，但对评价患者颈部残甲清除效果欠理想。Objective To evaluate the clinical value of 99^Tc^m-MIBI scintigraphy for diagnosis of re- sidual thyroid tissue and metastasis in patients with DTC after their first 131^I therapy. Methods From Feb- ruary 2010 to March 2014, 192 DTC patients （38 males, 154 females, average age （43.2_＋8.6） years） who received total or near-total thyroidectomy and were pathologically diagnosed as DTC （ 171 papillary and 21 follicular carcinomas） underwent 99^Tc^m-MIBI scan （average dosage： 740-925 MBq） 6 months after their first 131^I therapy, 131^I scans was performed 4 d after oral administration of 131^I of therapeutic dose （average dosage： 5 550-8 140 MBq）. Pre- and post-therapeutic images and the serum Tg level （detected before the imagings） were compared and analyzed. Any abnormal uptake of agent found inside or outside the thyroid was regarded as positive result. Patient-based and lesion-based data analysis were performed by X2 test and two-sample t test. Results A total of 191 patients were finally included, of which 65 positive cases were found. The sensitivity of 99^Tc^m-MIBI imaging was significantly lower than that of 1311 imaging（ 56.9% （37/ 65） vs 92.3%（60/65） ; x^2= 14.7, P〈0.01）. Among 43 thyroid remnants and 22 metastatic lesions, 99^Tc^m-MIBI imaging detected 39.5% （17/43） of thyroid remnants and 90.9% （20/22） of metastases, and those of 131^I imaging were 100%（43/43） and 77.3%（17/22） respectively. The sensitivity of 131^I imaging in de- tecting thyroid remnants was significantly higher than that of 99^Tc^m-MIBI imaging（x^2 = 24.0, P〈0.01 ）. The sensitivities in detecting metastasis were not significantly different （x^2= 0.57, P〉0.05）. The serum Tg levelof positive groups （99Tcm-MIBI positive ＋ 131^I positive or 131^I negative） were significantly higher than that of 99^Tc^m-MIBI negative ＋ 131^I negative group （t=-20.7 and -6.0, both P〈0.01）, and that of 99^Tc^m-MIBI positive ＋ 131^I negative group was higher than that of 131^

关 键 词：甲状腺肿瘤 放射疗法 碘放射性同位素 放射性核素显像 MIBI 

分 类 号：R736.1[医药卫生—肿瘤]