Kumnig Gerhild
Abteilung für Nuklearmedizin und spezielle Endokrinologie, PET-Zentrum, Landeskrankenhaus Klagenfurt, St. Veiterstrasse 47, A-9020 Klagenfurt.
Wien Med Wochenschr. 2002;152(11-12):280-5. doi: 10.1046/j.1563-258x.2002.02022.x.
In the preoperative assessment of thyroid nodules, ultrasonography and ultrasonography-guided fine needle aspiration biopsy play the most important role, especially for papillary thyroid cancer. The problem to differentiate follicular adenoma from highly differentiated follicular carcinoma remains the problem in preoperative diagnostic. Also the additional use of a multi tracer imaging strategy (Tl-201/Tc-99 m subtraction scan, Tc-99 m Sestamibi, Tc-99 m Tetrofosmin dual phase scintigraphy) has not solved this problem. Although it is unlikely, the question whether F-18-fluorodeoxy-glucose-positron emission tomography is able to give a better differentiation between benign and malignant tumors in the preoperative assessment of thyroid nodules is not answered up to now. In contrast to preoperative diagnostics F-18-fluorodeoxyglucose-positron emission tomography is of great value in the postoperative follow up of differentiated thyroid cancer. In case of elevated serum thyroglobulin but negative I-131 WBS F-18-fluorodeoxy-glucose-positron emission tomography is the method of choice to detect I-131 negative recurrences and metastases. F-18-fluorodeoxy-glucose uptake in metastases from differentiated thyroid cancer is correlated to low differentiation and maybe bad prognosis. There is also evidence that F-18-fluorodeoxyglucose-positron emission tomography may have a role of in anaplastic and especially in medullary thyroid cancer in the future.
在甲状腺结节的术前评估中,超声检查和超声引导下细针穿刺活检起着最重要的作用,尤其是对于甲状腺乳头状癌。区分滤泡性腺瘤与高分化滤泡癌仍是术前诊断中的难题。此外,多示踪剂成像策略(Tl-201/Tc-99m减影扫描、Tc-99m 锝甲氧异腈、Tc-99m 替曲膦双期闪烁显像)的应用也未能解决这一问题。尽管可能性不大,但F-18氟脱氧葡萄糖正电子发射断层扫描在甲状腺结节术前评估中能否更好地区分良性和恶性肿瘤这一问题至今仍未得到解答。与术前诊断不同,F-18氟脱氧葡萄糖正电子发射断层扫描在分化型甲状腺癌的术后随访中具有重要价值。在血清甲状腺球蛋白升高但I-131全身显像阴性的情况下,F-18氟脱氧葡萄糖正电子发射断层扫描是检测I-131阴性复发和转移灶的首选方法。分化型甲状腺癌转移灶中的F-18氟脱氧葡萄糖摄取与低分化相关,可能提示预后不良。也有证据表明,F-18氟脱氧葡萄糖正电子发射断层扫描未来可能在未分化癌尤其是髓样癌中发挥作用。