Küçük Nuriye Ozlem, Külak Hülya Atalay, Aras Gülseren
Department of Nuclear Medicine, Ankara University Faculty of Medicine, Ankara, Turkey.
Ann Nucl Med. 2006 Jul;20(6):393-7. doi: 10.1007/BF03027374.
The aim of this study was to evaluate the potential contribution of Tc-99m-MIBI scintigraphy to the follow-up of patients with differentiated thyroid carcinoma, who had elevated Tg levels and negative I-131 whole-body scan results.
In this retrospective study, we evaluated 28 patients with differentiated thyroid carcinoma, who had total or near total thyroidectomy followed by an ablative dose of I-131 at various time intervals (15 women, 13 men; mean age 43 +/- 17 years). All patients were treated with T4 suppression. After a mean follow-up period of 6.1 years (range 3-15) all patients were determined to have a high serum Tg concentrations (>2 ng/ml) and previous negative I-131 WBS results. All patients were examined for metastatic sites using Tc-99m-MIBI scan. Scans were visually evaluated for detecting lymph node metastases and/or local recurrence, lung metastases and skeletal metastases.
Tc-99m-MIBI scan demonstrated lesions in 23 patients (83.3%). In five patients with negative Tc-99m-MIBI scan findings (FN results): Chest CT showed small-sized mediastinal LN metastases in 2 patients and lung metastases in another 2 patients (<1 cm). Neck CT showed small-sized cervical LN involvement in 1 patient. The sensitivity of detection for neck was 94.4%, for lung 63.6%, and for bone lesions 100%. For all scan sites taken together, the sensitivity of disease detection was 83.3%, the specificity was 50%, positive predictive value (PPV) was 96.2%, and finally negative predictive value (NPV) was 16.7%.
We concluded that Tc-99m-MIBI scan should be considered as a supplementary scintigraphic method for the follow-up of patients with high serum Tg levels and negative I-131 WBS results, and it can help clinicians in making the decision to treat these patients.
本研究旨在评估锝-99m-甲氧基异丁基异腈（Tc-99m-MIBI）闪烁扫描术对甲状腺球蛋白（Tg）水平升高且碘-131全身扫描结果为阴性的分化型甲状腺癌患者进行随访的潜在作用。
在这项回顾性研究中，我们评估了28例分化型甲状腺癌患者，这些患者均接受了甲状腺全切术或近全切术，并在不同时间间隔接受了消融剂量的碘-131治疗（15例女性，13例男性；平均年龄43±17岁）。所有患者均接受甲状腺素（T4）抑制治疗。在平均6.1年（范围3 - 15年）的随访期后，所有患者血清Tg浓度均较高（>2 ng/ml）且既往碘-131全身显像（WBS）结果为阴性。所有患者均采用Tc-99m-MIBI扫描检查转移部位。通过视觉评估扫描结果以检测淋巴结转移和/或局部复发、肺转移及骨转移。
Tc-99m-MIBI扫描在23例患者（83.3%）中发现了病变。在5例Tc-99m-MIBI扫描结果为阴性（FN结果）的患者中：胸部CT显示2例患者有小尺寸纵隔淋巴结转移，另外2例患者有肺转移（<1 cm）。颈部CT显示1例患者有小尺寸颈部淋巴结受累。颈部检测的敏感性为94.4%，肺部为63.6%，骨病变为100%。对于所有扫描部位综合来看，疾病检测的敏感性为83.3%，特异性为50%，阳性预测值（PPV）为96.2%，最终阴性预测值（NPV）为16.7%。
我们得出结论，对于血清Tg水平高且碘-131 WBS结果为阴性的患者，Tc-99m-MIBI扫描应被视为一种辅助闪烁扫描方法，它有助于临床医生对这些患者做出治疗决策。
