治疗剂量~(131)ISPECT/CT在评价分化型甲状腺癌(DTC)局部淋巴结转移中的价值
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摘要
目的治疗剂量~(131)ISPECT/CT在评价分化型甲状腺癌(DTC)局部淋巴结转移中的价值。方法回顾性分析我院2016年1月-2017年12月收治的100例分化型甲状腺癌患者临床资料。应用SPECT/CT、多层螺旋CT扫描检查。结果 ~(131)I-WBS结果:300例患者中有110例患者为单纯甲状腺残留,转移95例,完全去除20例。阳性病灶共680枚,残留病灶330枚,转移病灶350枚,其中颈部或纵隔淋巴结转移140枚,远处转移210枚。SPECT/CT断层融合显像结果:300例患者经SPECT/CT诊断后发现,单纯甲状腺残留有120例患者,转移病例有104例,共有712枚阳性病灶,甲状腺残留病灶378枚,转移病灶410枚,其中颈部或纵隔淋巴结转移160枚,远处转移250枚。患者有淋巴结转移者,通常是在~(131)I治疗后随访观察淋巴结有无缩小、增大或者消失,如有复发者,才行穿刺活检继而手术治疗。二合并肺、骨等远处转移者,SPECT-CT都是阳性,即可确诊,无需手术病理。SPECT/CT诊断DTC转移病灶灵敏度、特异性、准确性显著高于~(131)IWBI(P<0.05)。SPECT/CT淋巴结数、远处转移、淋巴结检出率、远处转移检出率显著高于~(131)I-WBI(P<0.05)。结论 SPECT/CT能显著提高分化型甲状腺癌局部淋巴结转移诊断率,值得推荐使用。
Objective To investigate the clinical value of radioiodine ~(131)I ablation with SPECT/CT fusion imaging for evaluating lymph node metastasis in differentiated thyroid cancer(DTC). Methods The clinical data of 100 patients with DTC who were admitted to our hospital from January 2016 to December 2017 were retrospectively analyzed, all patients underwent the SPECT/CT fusion imaging and CT examination. Results The ~(131)I-WBI showed that of the 300 patients, 110 patients had simple thyroid residuals, 95 had metastases, and 20 had been completely removed. There were 680 positive lesions including 330 residual lesions, and 350 metastatic lesions, of which 140 lymph nodes metastasis from the neck or mediastinum, and 210 cases of distant metastasis. The SPECT/CT fusion imaging showed that the there were 120 patients with residual thyroid alone and 104 cases with metastatic disease. There were 712 positive lesions, 378 residual thyroid lesions, and 410 metastatic lesions, of which 160 were cervical or mediastinal lymph node metastases and 250 distant metastases. The surgical results showed that there were 110 cases of simple thyroid residue, 104 cases of metastasis, 398 residual lesions and 413 metastatic lesions, of which 152 were cervical or mediastinal lymph node metastasis and 261 were distant metastasis. The sensitivity, specificity and accuracy of SPECT/CT in diagnosing DTC metastases were significantly higher than those in ~(131)I-WBI(P<0.05). The detection rate of lymph node and distant metastasis in SPECT/CT was significantly higher than that of ~(131)I-WBI(P<0.05). Conclusion SPECT/CT can significantly improve the diagnostic rate of regional lymph node metastasis in differentiated thyroid cancer and is worth recommending.
Objective To investigate the clinical value of radioiodine ~(131)I ablation with SPECT/CT fusion imaging for evaluating lymph node metastasis in differentiated thyroid cancer(DTC). Methods The clinical data of 100 patients with DTC who were admitted to our hospital from January 2016 to December 2017 were retrospectively analyzed, all patients underwent the SPECT/CT fusion imaging and CT examination. Results The ~(131)I-WBI showed that of the 300 patients, 110 patients had simple thyroid residuals, 95 had metastases, and 20 had been completely removed. There were 680 positive lesions including 330 residual lesions, and 350 metastatic lesions, of which 140 lymph nodes metastasis from the neck or mediastinum, and 210 cases of distant metastasis. The SPECT/CT fusion imaging showed that the there were 120 patients with residual thyroid alone and 104 cases with metastatic disease. There were 712 positive lesions, 378 residual thyroid lesions, and 410 metastatic lesions, of which 160 were cervical or mediastinal lymph node metastases and 250 distant metastases. The surgical results showed that there were 110 cases of simple thyroid residue, 104 cases of metastasis, 398 residual lesions and 413 metastatic lesions, of which 152 were cervical or mediastinal lymph node metastasis and 261 were distant metastasis. The sensitivity, specificity and accuracy of SPECT/CT in diagnosing DTC metastases were significantly higher than those in ~(131)I-WBI(P<0.05). The detection rate of lymph node and distant metastasis in SPECT/CT was significantly higher than that of ~(131)I-WBI(P<0.05). Conclusion SPECT/CT can significantly improve the diagnostic rate of regional lymph node metastasis in differentiated thyroid cancer and is worth recommending.
引文
[1]程旭,李永军,徐兆强,等.SPECT/CT显像对131I治疗分化型甲状腺癌患者的临床意义[J].标记免疫分析与临床,2017,24(5):481-485.
[2]夏亮,陆涤宇,周俊,等.131I-SPECT/CT多模态显像联合超声及血清Tg对分化型甲状腺癌颈部淋巴结转移的诊断价值[J].肿瘤学杂志,2017,23(4):278-281.
[3]黄劲雄,何小江,俞浩,等.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[J].中华核医学与分子影像杂志,2 0 1 7,37(9):550-554.
[4]刘永,陈鹏,宋长祥,等.分化型甲状腺癌术后首次131I治疗前刺激性Tg水平与转移灶的关系[J].中国临床医学影像杂志,2017,28(7):471-474.
[5]赵继华,宋武战,袁荣国,等.SPECT/C T融合显像在分化型甲状腺癌转移灶诊断中的应用价值分析[J].标记免疫分析与临床,2016,23(12):1443-1445.
[6]叶智轶,马超,傅宏亮,等.18F-FDG PET/CT显像在131I全身显像阴性的分化型甲状腺癌中的应用价值[J].上海交通大学学报(医学版),2016,36(1):76-79.
[7]刘敏,程凌霄,阮茂美,等.18FFDG PET/CT在评价索拉非尼治疗131I难治性分化型甲状腺癌疗效中的应用[J].中国癌症杂志,2016,26(1):88-96.
[8]程小杰,陆涤宇,周俊,等.131I治疗后单光子发射计算机断层成像术与多层螺旋CT同机融合显像诊断甲状腺癌术后肺转移的价值[J].肿瘤研究与临床,2016,28(6):378-382.
[9]芦亚洲,高晓峰,丁义,等.138例131I治疗分化型甲状腺癌的回顾性分析[J].标记免疫分析与临床,2016,23(5):512-513.
[10]刘伯元,张然,金晓毛,等.131I治疗分化型甲状腺癌伴肺转移的疗效及影响因素分析[J].安徽医科大学学报,2017,52(2):252-255.
[11]梁坤,李诗运,戴儒奇,等.放射性碘-131治疗分化型甲状腺癌转移灶的疗效及其影响因素[J].临床内科杂志,2017,34(5):323-325.
[12]卢彦祺,牟兴宇,李猛,等.分化型甲状腺癌131I固定剂量清甲治疗唾液腺功能影响评价[J].肿瘤学杂志,2016,22(11):902-906.
[13]余济春.分化型甲状腺癌颈淋巴结清扫术[J].山东大学耳鼻喉眼学报,2016,30(2):10-12.
[14]曹丽.分化型甲状腺癌肺转移的CT影像学表现分析[J].中国CT和MRI杂志,2016,14(7):31-33.
[15]宋小康,李兴华,毛常青,等.纳米碳甲状旁腺负显影辨认保护技术在甲状腺癌手术中的应用[J].海南医学,2017,28(21):3548-3550.
[2]夏亮,陆涤宇,周俊,等.131I-SPECT/CT多模态显像联合超声及血清Tg对分化型甲状腺癌颈部淋巴结转移的诊断价值[J].肿瘤学杂志,2017,23(4):278-281.
[3]黄劲雄,何小江,俞浩,等.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[J].中华核医学与分子影像杂志,2 0 1 7,37(9):550-554.
[4]刘永,陈鹏,宋长祥,等.分化型甲状腺癌术后首次131I治疗前刺激性Tg水平与转移灶的关系[J].中国临床医学影像杂志,2017,28(7):471-474.
[5]赵继华,宋武战,袁荣国,等.SPECT/C T融合显像在分化型甲状腺癌转移灶诊断中的应用价值分析[J].标记免疫分析与临床,2016,23(12):1443-1445.
[6]叶智轶,马超,傅宏亮,等.18F-FDG PET/CT显像在131I全身显像阴性的分化型甲状腺癌中的应用价值[J].上海交通大学学报(医学版),2016,36(1):76-79.
[7]刘敏,程凌霄,阮茂美,等.18FFDG PET/CT在评价索拉非尼治疗131I难治性分化型甲状腺癌疗效中的应用[J].中国癌症杂志,2016,26(1):88-96.
[8]程小杰,陆涤宇,周俊,等.131I治疗后单光子发射计算机断层成像术与多层螺旋CT同机融合显像诊断甲状腺癌术后肺转移的价值[J].肿瘤研究与临床,2016,28(6):378-382.
[9]芦亚洲,高晓峰,丁义,等.138例131I治疗分化型甲状腺癌的回顾性分析[J].标记免疫分析与临床,2016,23(5):512-513.
[10]刘伯元,张然,金晓毛,等.131I治疗分化型甲状腺癌伴肺转移的疗效及影响因素分析[J].安徽医科大学学报,2017,52(2):252-255.
[11]梁坤,李诗运,戴儒奇,等.放射性碘-131治疗分化型甲状腺癌转移灶的疗效及其影响因素[J].临床内科杂志,2017,34(5):323-325.
[12]卢彦祺,牟兴宇,李猛,等.分化型甲状腺癌131I固定剂量清甲治疗唾液腺功能影响评价[J].肿瘤学杂志,2016,22(11):902-906.
[13]余济春.分化型甲状腺癌颈淋巴结清扫术[J].山东大学耳鼻喉眼学报,2016,30(2):10-12.
[14]曹丽.分化型甲状腺癌肺转移的CT影像学表现分析[J].中国CT和MRI杂志,2016,14(7):31-33.
[15]宋小康,李兴华,毛常青,等.纳米碳甲状旁腺负显影辨认保护技术在甲状腺癌手术中的应用[J].海南医学,2017,28(21):3548-3550.