F-18氟代脱氧葡萄糖正电子发射断层显像/计算机断层扫描在甲状腺癌管理中的应用
F-18 FDG PET/CT in the management of thyroid cancer.
作者信息
Iagaru Andrei, Kalinyak Judith E, McDougall I Ross
机构信息
Division of Nuclear Medicine, Stanford University School of Medicine, Stanford, California 94305, USA.
出版信息
Clin Nucl Med. 2007 Sep;32(9):690-5. doi: 10.1097/RLU.0b013e318125037a.
PURPOSE
There are approximately 32,000 new cases of thyroid carcinoma annually in the United States. F-18 FDG PET/CT has an established role in cancer management, including thyroid cancer, usually in patients who are thyroglobulin (Tg) positive/iodine negative. We reviewed our experience with F-18 FDG PET/CT in thyroid cancer, with an emphasis on correlation with Tg, and maximum standardized uptake values (SUV). We also analyzed the role of thyroid stimulating hormone (TSH) on PET/CT results.
MATERIALS AND METHODS
This is a retrospective study (January 2003 to December 2006) of 76 patients with differentiated thyroid cancer, who had F-18 FDG PET/CT scans. There were 44 women and 32 men, with age range of 20 to 81 years (average, 51.1 +/- 18.1). The administered doses of F-18 FDG ranged from 396 to 717 MBq (15.8-19.4 mCi) (average, 566 +/- 74.8) (15.3 +/- 2). Reinterpretation of the imaging studies for accuracy and data analysis from medical records were performed.
RESULTS
A total of 98 PET/CT scans were analyzed (59 patients had 1 scan, 12 patients had 2, and 5 patients had 3). PET/CT was 88.6% sensitive (95% CI: 78.-94.3) and 89.3% specific (95% CI: 71.9-97.1). Mean Tg level was 1203 ng/mL (range, 0.5-28,357) in patients with positive PET/CT and 9.72 ng/mL (range, 0.5-123.0) in patients with negative PET/CT scans (P = 0.0389). Mean SUV max was 10.8 (range, 2.5-32) in the thyroid bed recurrence/residual disease and 7.53 (range, 2.5-26.2) in metastatic lesions (P = 0.0114). Mean SUV max in recurrent/residual disease in patients with TSH </=30 mIU/L was 9.3 (range, 2.5-34.1) and in patients with TSH >30 mIU/L was 8.1 (range, 2.6-32) (P = 0.2994).
CONCLUSION
F-18 FDG PET/CT had excellent sensitivity (88.6%) and specificity (89.3%) in this patient population. Metastatic lesions were reliably identified, but were less F-18 FDG avid than recurrence/residual disease in the thyroid bed. TSH levels at the time of PET/CT did not appear to impact the FDG uptake in the lesions or the ability to detect disease. In the setting of high or rising levels of Tg, our study confirms that it is indicated to include PET/CT in the management of patients with differentiated thyroid cancer.
目的
在美国，每年约有32000例甲状腺癌新发病例。F-18 FDG PET/CT在癌症管理中发挥着既定作用，包括甲状腺癌，通常用于甲状腺球蛋白（Tg）阳性/碘阴性的患者。我们回顾了我们在甲状腺癌中使用F-18 FDG PET/CT的经验，重点是与Tg的相关性以及最大标准化摄取值（SUV）。我们还分析了促甲状腺激素（TSH）对PET/CT结果的作用。
材料与方法
这是一项对76例接受F-18 FDG PET/CT扫描的分化型甲状腺癌患者的回顾性研究（2003年1月至2006年12月）。其中女性44例，男性32例，年龄范围为20至81岁（平均51.1±18.1岁）。F-18 FDG的给药剂量范围为396至717 MBq（15.8 - 19.4 mCi）（平均566±74.8）（15.3±2）。对影像学研究进行准确性重新解读，并对病历进行数据分析。
结果
共分析了98次PET/CT扫描（59例患者进行了1次扫描，12例患者进行了2次，5例患者进行了3次）。PET/CT的敏感性为88.6%（95%CI：78. - 94.3），特异性为89.3%（95%CI：71.9 - 97.1）。PET/CT阳性患者的平均Tg水平为1203 ng/mL（范围0.5 - 28357），PET/CT阴性扫描患者的平均Tg水平为9.72 ng/mL（范围0.5 - 123.0）（P = 0.0389）。甲状腺床复发/残留疾病的平均SUV最大值为10.8（范围2.5 - 32），转移病灶的平均SUV最大值为7.53（范围2.5 - 26.2）（P = 0.0114）。TSH≤30 mIU/L的患者复发/残留疾病的平均SUV最大值为9.3（范围2.5 - 34.1），TSH>30 mIU/L的患者为8.1（范围2.6 - 32）（P = 0.2994）。
结论
F-18 FDG PET/CT在该患者群体中具有出色的敏感性（88.6%）和特异性（89.3%）。转移病灶能够可靠地识别，但与甲状腺床的复发/残留疾病相比，其F-18 FDG摄取较低。PET/CT检查时的TSH水平似乎并未影响病灶中的FDG摄取或疾病检测能力。在Tg水平高或升高的情况下，我们的研究证实，在分化型甲状腺癌患者的管理中应纳入PET/CT检查。
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