上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (8): 1150-.doi: 10.3969/j.issn.1674-8115.2011.08.023

• 论著（临床研究） • 上一篇    下一篇

131I-SPECT/CT融合显像对131I全身显像在分化型甲状腺癌诊治中的增益价值

叶智轶, 傅宏亮, 李佳宁, 王 辉   

  1. 上海交通大学 医学院附属新华医院核医学科, 上海 200092
  • 出版日期:2011-08-28 发布日期:2011-08-29
  • 通讯作者: 王 辉, 电子信箱: wanghuishanghai@hotmail.com。
  • 作者简介:叶智轶(1983—), 男, 住院医师, 硕士；电子信箱: e-zearo-ye@hotmail.com。
  • 基金资助:

    上海市重点学科建设项目(S30203)

Incremental value of 131I-SPECT/CT fusion imaging over 131I whole-body scintigraphy in management of patients with differentiated thyroid carcinoma

YE Zhi-yi, FU Hong-liang, LI Jia-ning, WANG Hui   

  1. Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
  • Online:2011-08-28 Published:2011-08-29
  • Supported by:

    Shanghai Leading Academic Discipline Project, S30203

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摘要：

目的 评价131I-SPECT/CT融合显像对131I全身显像（WBS）在分化型甲状腺癌（DTC）诊治中的增益价值。方法 131I治疗后82例患者分别行WBS及SPECT/CT显像。分析SPECT/CT显像对浓聚灶定位定性的判断能力，并与WBS比较。分析SPECT/CT显像探查不聚碘病灶的能力。评估SPECT/CT显像对转移部位诊断、临床分期和治疗方案制定的影响。结果 WBS发现聚碘灶203个，SPECT/CT显像定位后发现，WBS正确判断聚碘灶部位89个(43.84%)，判断正确率最高的部位依次为残余甲状腺74.24%(49/66)和骨62.86%(22/35)。WBS判断聚碘灶性质为良性52个，恶性36个，不确定115个；SPECT/CT显像判断为良性94个，恶性79个，不确定30个。SPECT/CT显像给出的“不确定”判断30个(14.78%)，明显少于WBS的115个(56.65%)，差异有统计学意义(χ2=77.51，P<0.01)。SPECT/CT显像发现不聚碘的病灶6处，最终均证实为转移。82例患者中，与WBS作出的最初诊断相比，SPECT/CT显像改变了14例(17.07%)转移部位的诊断，改变了5例(6.1%)临床分期的诊断，并最终改变了23例(28.05%)患者的治疗方案。结论 SPECT/CT显像对于聚碘灶的鉴别诊断、不聚碘病灶的探查作用明显，能提高诊断的准确性，帮助调整治疗方案。SPECT/CT显像可以弥补平面显像的不足，对于DTC的诊治有增益价值。

关键词: 分化型甲状腺癌, 碘放射性核素, 体层摄影术, 发射型计算机

Abstract:

Objective To investigate the incremental value of 131I-SPECT/CT fusion imaging over 131I whole-body scintigraphy (WBS) in the management of patients with differentiated thyroid carcinoma (DTC). Methods Eighty-two patients with DTC underwent both WBS and SPECT/CT imaging after 131I therapy. The capacity of location and qualitative analysis of radioiodine avid lesions of SPECT/CT imaging was compared with that of WBS. The capacity of SPECT/CT imaging in detecting non-radioiodine avid lesions was analysed. The impact of SPECT/CT imaging on diagnosis of metastases, clinical staging and therapeutic strategy was evaluated. Results Two hundred and three radioiodine avid lesions were detected by WBS. Eighty-nine of them (43.84%) were located by WBS, which was verified by SPECT/CT imaging. Thyroid remnant and bone were the regions with highest accuracy, with accuracy rates of 74.24% (49/66) and 62.86% (22/35) respectively. WBS determined 52 benign radioiodine avid lesions, 36 malignant ones and 115 uncertain ones, and SPECT/CT imaging determined 94, 79 and 30 respectively. The percent of uncertain radioiodine avid lesions determined by SPECT/CT imaging was significantly lower than that determined by WBS (14.78% vs 56.65%, χ2=77.51, P<0.01). Besides, 6 non-radioiodine avid metastatic lesions were detected by SPECT/CT imaging. Among all the 82 patients, 14 (17.07%) were changed about the diagnosis of metastasis, 5 (6.1%) were changed about the clinical stage, and 23 (28.05%) were changed about the therapeutic strategy through SPECT/CT imaging. Conclusion SPECT/CT fusion imaging has incremental value in differentiating radioiodine avid lesions, detecting non-radioiodine avid lesions, improving accuracy of diagnosis, and adjusting therapeutic strategy of DTC.

Key words: differentiated thyroid carcinoma, iodine radioisotopes, tomography, emission computed