Szakáll Szabolcs, Esik Olga, Bajzik Gábor, Repa Imre, Dabasi Gabriella, Sinkovics István, Agoston Péter, Trón Lajos
PET Center, University of Debrecen, Debrecen, Hungary.
J Nucl Med. 2002 Jan;43(1):66-71.
Postsurgically elevated or increasing serum calcitonin levels strongly suggest the presence of residual or recurrent medullary thyroid carcinoma (MTC). Several imaging modalities (sonography, MRI, CT, scintigraphy with different types of radiolabeled ligands, etc.) are routinely used in an attempt to localize tumorous tissue, but such efforts often fail. In the search for a more reliable method, 18F-FDG PET was applied to detect tumor tissue of residual or recurrent MTC.
Forty patients with a postoperatively elevated plasma calcitonin level were included. These patients underwent routine diagnostic imaging procedures (CT, MRI, and 131I-metaiodobenzylguanidine [MIBG] whole-body planar scintigraphy or SPECT) and 18F-FDG PET examinations. Two independent experts visually analyzed the images provided by each method to detect pathologic lesions. Lymph nodes of > or = 1 cm in short diameter that were detected by radiologic methods were considered to be pathologic. 18F-FDG accumulation with a sharp contour reported by both independent observers was similarly regarded as pathologic.
PET detected 270 foci with a high tracer accumulation, whereas only 116 lesions were detected by MRI and 141 by CT. The numbers of such foci determined by PET, MRI, and CT were 98, 34, and 34, respectively, in the neck; 25, 5, and 6, respectively, in the supraclavicular regions; and 117, 35, and 39, respectively, in the mediastinum. 131I-MIBG scintigraphy findings were positive for only 3 patients.
For MTC patients with a postoperatively elevated plasma tumor marker level, PET was more sensitive and superior in localizing tumorous lymph node involvement than were the other imaging modalities, especially in the cervical, supraclavicular, and mediastinal lymphatic regions.
术后血清降钙素水平升高或持续升高强烈提示存在残余或复发性甲状腺髓样癌（MTC）。几种成像方式（超声、MRI、CT、使用不同类型放射性标记配体的闪烁显像等）经常用于试图定位肿瘤组织，但这些努力往往失败。为寻找更可靠的方法，采用18F-FDG PET检测残余或复发性MTC的肿瘤组织。
纳入40例术后血浆降钙素水平升高的患者。这些患者接受了常规诊断成像检查（CT、MRI和131I-间碘苄胍[MIBG]全身平面闪烁显像或SPECT）以及18F-FDG PET检查。两名独立专家对每种方法提供的图像进行视觉分析以检测病理性病变。通过放射学方法检测到的短径≥1 cm的淋巴结被视为病理性淋巴结。两名独立观察者均报告的轮廓清晰的18F-FDG摄取同样被视为病理性摄取。
PET检测到270个示踪剂高摄取灶，而MRI检测到116个病变，CT检测到141个病变。PET、MRI和CT确定的此类病灶数量在颈部分别为98个、34个和34个；在锁骨上区域分别为25个、5个和6个；在纵隔分别为117个、35个和39个。131I-MIBG闪烁显像结果仅3例为阳性。
对于术后血浆肿瘤标志物水平升高的MTC患者，PET在定位肿瘤性淋巴结受累方面比其他成像方式更敏感且更具优势，尤其是在颈部、锁骨上和纵隔淋巴区域。
