核医学分子影像在放射性碘难治性分化型甲状腺癌评估中的独特价值与争议  

The unique value and controversy of nuclear medicine molecular imaging in the evaluation of radioiodinerefractory differentiated thyroid cancer

作　　者：王任飞 卢改霞 WANG Renfei;LU Gaixia(Department of Nuclear Medicine,Shanghai Tenth People’s Hospital,Tongji University School of Medicine,Shanghai 200072,China)

机构地区：[1]同济大学附属第十人民医院核医学科,上海200072

出　　处：《中国癌症杂志》2025年第1期49-57,共9页China Oncology

摘　　要：核医学分子影像具有无创、高灵敏度、时空动态可视化、可定性及定量分析等特点,借助融合影像技术的优势,兼备了反映功能代谢和解剖结构的特点。核医学分子影像评估贯穿于放射性碘难治性分化型甲状腺癌(radioactive iodine-refractory differentiated thyroid cancer,RAIR-DTC)诊治管理的全流程,包括界定、探查病灶、指导治疗决策、评价疗效及评估预后等。^(131)I全身显像(^(131)I-whole body scan,^(131)I-WBS)是判断RAIR-DTC的重要依据。其中诊断性^(131)I-WBS可在^(131)I治疗前探查术后残留甲状腺及可疑摄碘性转移灶,有助于后续^(131)I治疗决策。治疗后^(131)I-WBS可进一步明确病灶摄碘特征,以及探查诊断性WBS未能显示的病灶,为明确患者临床分期、制订随访管理方案提供参考依据。治疗后^(131)I-WBS显示的病灶摄碘能力还可预判^(131)I治疗效果。^(131)I-WBS结合血清学及其他影像学检查还可用于评价^(131)I治疗效果。18F-FDG正电子发射计算机体层成像(positron emission tomography and computed tomography,PET/CT)主要用于血清甲状腺球蛋白(thyroglobulin,Tg)或Tg抗体(Tg antibody,TgAb)水平持续增高而^(131)I-WBS阴性的高危DTC患者,可辅助寻找和定位病灶。18F-FDG PET/CT与^(131)I-WBS结合有助于全面评估全身肿瘤负荷。DTC转移灶摄取18F-FDG预示着^(131)I治疗效果不佳,患者生存预后较差,是疾病快速进展及肿瘤特异性死亡风险增高的预测因素。RAIR-DTC病灶接受局部或系统治疗后,可通过治疗前后的早期代谢反应预测患者的临床获益,以便及时调整治疗方案。此外,靶向反映新生血管生成的RGD肽及前列腺特异性膜抗原、靶向成纤维细胞激活蛋白、靶向生长抑素受体等的多种新型核素显像可作为18F-FDG PET/CT阴性时的补充手段,探查RAIRDTC病灶,还可根据对显像剂的摄取能力筛选适合行靶向性核素治疗的患者,为多线治疗后疾病仍进�Nuclear medicine molecular imaging has the characteristics of non-invasiveness,high sensitivity,spatiotemporal dynamic visualization,qualitative and quantitative analysis,and by virtue of the advantages of fusion imaging technology,it combines the features of functional metabolism and anatomical structure.Nuclear medicine molecular imaging evaluation is integrated throughout the management of radioactive iodine-refractory differentiated thyroid cancer(RAIR-DTC),including defining RAIR,exploring the lesions,guiding treatment decisions,evaluating efficacy,and assessing prognosis.^(131)I-whole body scan(^(131)I-WBS)is critical for determining RAIR-DTC.Diagnostic ^(131)I-WBS can be used to explore postoperative residual thyroid and suspected iodine-avid metastases before ^(131)I treatment,which is helpful for subsequent ^(131)I treatment decisions.Post-treatment ^(131)I-WBS can further clarify the iodine uptake characteristics of lesions and explore lesions not shown by diagnostic WBS,providing a reference for clarifying the clinical stage of patients and formulating follow-up management plans.The iodine uptake ability of lesions shown by post-treatment ^(131)I-WBS can also predict the therapeutic efficacy of ^(131)I treatment.^(131)I-WBS combined with biochemical changes and other imaging examinations can also be used to evaluate the therapeutic efficacy of ^(131)I treatment.18F-FDG positron emission tomography and computed tomography(PET/CT)is mainly used for high-risk DTC patients with persistently elevated serum thyroglobulin(Tg)or Tg antibody(TgAb)levels and negative ^(131)I-WBS,and can explore and locate lesions.Combining 18F-FDG PET/CT with ^(131)I-WBS provides a thorough evaluation of the overall tumor burden.The uptake of 18F-FDG by DTC metastases indicates poor ^(131)I treatment response and poor prognosis for patients,and is a predictor of rapid disease progression and an increased risk of tumor-specific death.After local or systemic treatment of RAIR-DTC lesions,the early metabolic response to treatment c

关 键 词：分子影像 分化型甲状腺癌 放射性碘难治 诊断 治疗前评估 疗效评价 

分 类 号：R736.1[医药卫生—肿瘤]