Cholewinski S P, Yoo K S, Klieger P S, O'Mara R E
Department of Radiology, University of Rochester Medical Center, New York, USA.
J Nucl Med. 2000 Jul;41(7):1198-202.
There has been recent controversy regarding the optimal protocol for imaging and ablation of post-thyroidectomy patients. Several authors have suggested that a scanning dose of 185-370 MBq (5-10 mCi) (131)I may be capable of producing a stunning effect on thyroid tissue that may interfere with the uptake and efficacy of the subsequent ablation dose of radioiodine. The purpose of this study was to determine whether a 185-MBq (5 mCi) diagnostic dose of (131)I produces a visually apparent stunning effect 72 h before (131)I ablation therapy.
One hundred twenty-two consecutive post-thyroidectomy patients for differentiated thyroid carcinoma received a 185-MBq (5 mCi) diagnostic dose of (131)I followed by a whole-body diagnostic scan at 72 h. On the same day the diagnostic scan was completed, the patient was admitted to the hospital and received an (131)I ablation therapy dose of 5550 MBq (150 mCi) in most cases. A postablation, whole-body scan was obtained at 72 h and compared with the previous diagnostic scan for any visual evidence of stunning.
No cases of visually apparent thyroid stunning were observed on any of the postablation scans with regard to the number of (131)I foci identified or the relative intensity of (131)I uptake seen.
Diagnostic whole-body scanning can be performed effectively with a 185-MBq (5 mCi) dose of (131)I 72 h before radioiodine ablation without concern for thyroid stunning.
近期关于甲状腺切除术后患者的成像和消融最佳方案存在争议。几位作者认为，185 - 370 MBq（5 - 10 mCi）的（131）I扫描剂量可能会对甲状腺组织产生“顿抑”效应，这可能会干扰后续放射性碘消融剂量的摄取和疗效。本研究的目的是确定185 MBq（5 mCi）的（131）I诊断剂量在（131）I消融治疗前72小时是否会产生明显的“顿抑”效应。
122例连续的分化型甲状腺癌甲状腺切除术后患者接受了185 MBq（5 mCi）的（131）I诊断剂量，随后在72小时进行全身诊断性扫描。在完成诊断性扫描的同一天，患者入院，大多数情况下接受5550 MBq（150 mCi）的（131）I消融治疗剂量。在72小时进行消融后全身扫描，并与之前的诊断性扫描比较，以寻找任何“顿抑”的视觉证据。
在任何消融后扫描中，就识别出的（131）I病灶数量或所见的（131）I摄取相对强度而言，均未观察到明显的甲状腺“顿抑”病例。
在放射性碘消融前72小时，使用185 MBq（5 mCi）的（131）I剂量可以有效地进行诊断性全身扫描，而无需担心甲状腺“顿抑”。
