Tharp K, Israel O, Hausmann J, Bettman L, Martin W H, Daitzchman M, Sandler M P, Delbeke D
Vanderbilt University Medical Center, Nashville, TN 37232-2675, USA.
Eur J Nucl Med Mol Imaging. 2004 Oct;31(10):1435-42. doi: 10.1007/s00259-004-1565-2. Epub 2004 Jun 19.
The purpose of the study was to determine the diagnostic impact of 131I-SPECT/CT imaging compared with conventional scintigraphic evaluation in the follow-up of patients with thyroid carcinoma.
Seventy-one patients with thyroid carcinoma underwent concurrent 131I-SPECT/CT, using an integrated imaging system, at various stages of their disease in order to evaluate foci of uptake detected on planar whole-body images.
SPECT/CT imaging had an incremental diagnostic value in 57% (41/71) of patients. Uptake in the neck was evaluated in 61 patients, and SPECT/CT imaging in this region had an incremental diagnostic value in 27% of the whole patient population (19/71). Low-resolution integrated CT images allowed for the precise characterization of equivocal neck lesions on planar imaging in 14/17 patients and changed the assessment of the lesion location in five patients as compared with planar studies. Thirty-six patients underwent SPECT/CT for evaluation of foci of uptake distant from the neck. SPECT/CT imaging improved characterization of equivocal foci of uptake as definitely benign in 13% (9/71) of patients. Precise localization of malignant lesions to the skeleton was possible in 17% (12/71) and to the lungs versus the mediastinum in 6% (5/71) of patients.
Integrated 131I-SPECT/CT was found to have an additional value over planar imaging in patients with thyroid cancer for correct characterization of equivocal tracer uptake seen on planar imaging as well as for precise localization of malignant lesions in the neck, chest, and skeleton. SPECT/CT optimized the localization of 131I uptake to lymph node metastases versus remnant thyroid tissue, to lung versus mediastinal metastases, and to the skeleton. It also had a further clinical impact on patient management by influencing referral for 131I treatment, tailoring of the administered radioiodine dose, and/or the addition of surgery or external radiation therapy when indicated.
本研究的目的是确定与传统闪烁扫描评估相比，¹³¹I-SPECT/CT成像在甲状腺癌患者随访中的诊断价值。
71例甲状腺癌患者在疾病的不同阶段使用一体化成像系统同时进行¹³¹I-SPECT/CT检查，以评估平面全身图像上检测到的摄取灶。
SPECT/CT成像在57%（41/71）的患者中具有额外的诊断价值。对61例患者的颈部摄取情况进行了评估，该区域的SPECT/CT成像在全部患者中27%（19/71）具有额外的诊断价值。低分辨率一体化CT图像能够对14/17例患者平面成像上不明确的颈部病变进行精确特征描述，与平面研究相比，改变了5例患者病变位置的评估。36例患者接受SPECT/CT检查以评估颈部以外的摄取灶。SPECT/CT成像在13%（9/71）的患者中将不明确的摄取灶明确为良性。17%（12/71）的患者能够将恶性病变精确定位到骨骼，6%（5/71）的患者能够将其定位到肺部与纵隔。
发现一体化¹³¹I-SPECT/CT在甲状腺癌患者中相对于平面成像具有额外价值，可正确描述平面成像上不明确的示踪剂摄取情况，并精确确定颈部、胸部和骨骼中恶性病变的位置。SPECT/CT优化了¹³¹I摄取对淋巴结转移与残余甲状腺组织、肺转移与纵隔转移以及骨骼转移的定位。它还通过影响¹³¹I治疗的转诊、调整放射性碘给药剂量和/或在必要时增加手术或外照射治疗，对患者管理产生进一步的临床影响。
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