Brandt-Mainz K, Müller S P, Görges R, Saller B, Bockisch A
Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Essen, Germany.
Eur J Nucl Med. 2000 May;27(5):490-6. doi: 10.1007/s002590050533.
The early detection of metastases from medullary thyroid cancer (MTC) is important because the only curative therapy consists in surgical removal of all tumour tissue. There is no single sensitive diagnostic imaging modality for the localization of all metastases in patients with MTC. Therefore, in many cases several imaging modalities (e.g. ultrasonography, magnetic resonance imaging, computerized tomography and scintigraphy using pentavalent technetium-99m dimercaptosuccinic acid, thallium-201 chloride, indium-111 pentetreotide, anti-CEA antibodies or metaiodobenzylguanidine) must be performed consecutively in patients with elevated calcitonin levels until the tumour is localized. In this prospective study, we investigated the value of fluorine-18 fluorodeoxyglucose positron emission tomography ([18F]FDG PET) in the follow-up of patients with MTC. [18F]FDG PET examinations of the neck and the chest were performed in 20 patients with elevated calcitonin levels or sonographic abnormalities in the neck. Positive [18F]FDG findings were validated by histology, computerized tomography or selective venous catheterization. [18F]FDG PET detected tumour in 13/17 patients (nine cases were validated by histology, four by computerized tomography). Five patients showed completely negative PET scans (of these cases, one was true-negative and four false-negative). One patient with [18F]FDG accumulation in pulmonary lesions from silicosis and one patient with a neck lesion that was not subjected to histological validation had to be excluded. Considering all validated localizations, [18F]FDG PET detected 12/14 tumour manifestations in the neck, 6/7 mediastinal metastases, 2/2 pulmonary metastases and 2/2 bone metastases. In two patients with elevated calcitonin levels, no diagnostic modality was able to localize a tumour. The sensitivity of [18F]FDG PET in the follow-up of MTC was 76% (95% confidence interval 53%-94%); this is encouraging. [18F]FDG PET promises to be a valuable diagnostic method, especially for the detection of lymph node metastases, surgical resection of which can result in complete remission.
甲状腺髓样癌（MTC）转移灶的早期检测很重要，因为唯一的治愈性疗法是手术切除所有肿瘤组织。对于MTC患者所有转移灶的定位，没有单一的敏感诊断成像方式。因此，在许多情况下，对于降钙素水平升高的患者，必须连续进行几种成像方式（如超声检查、磁共振成像、计算机断层扫描以及使用五价锝-99m二巯基丁二酸、氯化铊-201、铟-111喷替肽、抗癌胚抗原抗体或间碘苄胍的闪烁扫描），直到肿瘤被定位。在这项前瞻性研究中，我们研究了氟-18氟脱氧葡萄糖正电子发射断层扫描（[18F]FDG PET）在MTC患者随访中的价值。对20例降钙素水平升高或颈部超声检查异常的患者进行了颈部和胸部的[18F]FDG PET检查。[18F]FDG阳性结果通过组织学、计算机断层扫描或选择性静脉插管进行验证。[18F]FDG PET在17例患者中的13例检测到肿瘤（9例经组织学验证，4例经计算机断层扫描验证）。5例患者PET扫描完全阴性（其中1例为真阴性，4例为假阴性）。1例肺部病变因矽肺有[18F]FDG聚集的患者和1例颈部病变未进行组织学验证的患者必须排除。考虑所有经验证的定位，[18F]FDG PET检测到颈部14处肿瘤表现中的12处、纵隔转移灶7处中的6处、肺转移灶2处中的2处以及骨转移灶2处中的2处。在2例降钙素水平升高的患者中，没有诊断方式能够定位肿瘤。[18F]FDG PET在MTC随访中的敏感性为76%（95%置信区间53%-94%）；这很令人鼓舞。[18F]FDG PET有望成为一种有价值的诊断方法，尤其是对于检测淋巴结转移，手术切除淋巴结转移灶可导致完全缓解。
