^131I SPECT／CT显像对分化型甲状腺癌术后临床再分期和复发危险度评价的意义及对治疗决策的影响  

Value of ^131I SPECT/CT on the re-staging and recurrence risk stratification and its impact on subsequent treatment strategy in post-surgical patients with differentiated thyroid cardnoma

作　　者：黄劲雄[1] 何小江[1] 俞浩[1] 陈贵兵[1] 许威毅[1] 林玲云 庄惠真[1] 吴华[1] 

机构地区：[1]厦门大学附属第一医院厦门肿瘤医院核医学科、闽南PET中心,361003

出　　处：《中华核医学与分子影像杂志》2017年第9期550-554,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨^131I SPECT/CT显像对DTC术后临床再分期和复发危险度分层评价的作用及对治疗决策的价值。方法118例DTC术后患者（男33例、女85例，平均年龄45岁）行^131I治疗，服^131I后5～7 d同时行^131I－WBS和^131I SPECT/CT显像，比较两者对摄碘灶定位、定性能力的差别及对DTC患者术后临床再分期和复发危险度分层评价的差别，评价^131I SPECT/CT显像对临床TNM分期的诊断、对患者复发危险度分层的判断及对治疗方案制定的影响。采用配对χ^2检验分析数据。结果118例患者中临床最终诊断出摄^131I灶509处。^131I－WBS发现449处，正确定位、定性354处，正确率为78.84%（354/449）；^131I SPECT/CT显像发现509处，正确定位、定性504处，正确率为99.02%（504/509），两者间差异有统计学意义（χ^2＝21.51，P〈0.01）。^131I－WBS与^131I SPECT/CT显像分别改变了13例和19例DTC术后患者临床分期的诊断，正确率分别为5/13和19/19（χ^2＝74.41，P〈0.01）。^131I－WBS与^131I SPECT/CT显像分别改变了13例和22例DTC患者术后复发危险度分层的判断，正确率分别为5/13和100%（22/22）; χ^2＝74.41，P〈0.01。^131I SPECT/CT显像共改变了50例患者^131I－WBS的治疗计划。结论相较^131I－WBS，^131I SPECT/CT显像可为^131I治疗DTC提供更为准确的定位、定性信息，对于术后临床再分期和复发危险度分层的判断更准确。Objective To evaluate the role of ^131I SPECT/CT in post-surgical re-staging and recurrence risk stratification in patients with DTC and its impact on subsequent treatment strategy. Methods ^131I WBS and ^131I SPECT/CT were performed at the same time 5 to 7 d after ^131I treatment in 118 patients （33 males, 85 females, average age 45 years） with DTC. Difference in the localization and qualitative diagnosis of ^131I uptake lesions between ^131I-WBS and ^131I SPECT/CT were compared. Value of ^131I SPECT/CT in the diagnosis of TNM staging, risk stratification and impact on the treatment strategy was evaluated. Paired Х^2 test was used for data analysis. Results A total of 509 foci with ^131I uptake were detected. ^131I131I-WBS found 449 foci with ^131I uptake, 354 of which （78.84%） were correctly diagnosed. ^131I SPECT/CT found 509 foci with ^131I uptake, and 504（99.02%） were correctly diagnosed. The difference was statistically significant （Х^2 = 21.51, P〈 0.01 ）. ^131 I-WBS changed the clinical staging in 13 cases with diagnostic accuracy of 5/13. ^131I SPECT/CT changed the clinical staging in 19 cases and with diagnostic accuracy of 19/19 （Х^2= 74.41, P〈 0.01 ）. mI-WBS changed the risk stratification of 13 patients after operation and the accuracy was 5/13, the corresponding data were 22 and 100% （22/22） for ^131I SPECT/CT （Х^2 = 74.41, P〈0.01）. The treatment strategy was changed in 50 patients with ^131I SPECT/CT. Conclusions Compared with ^131I-WBS, ^131I SPECT/CT could provide more accurate positioning and qualitative information for ^131I treatment and is more accurate in re-staging and risk stratification.

关 键 词：甲状腺肿瘤 肿瘤分期 肿瘤复发 局部 危险性评估 体层摄影术 发射型计算机 单光子 体层摄影术 X线计算机 碘放射性同位素 

分 类 号：R730.44[医药卫生—肿瘤] R736.1[医药卫生—临床医学]