Schmidt Daniela, Szikszai Attila, Linke Rainer, Bautz Werner, Kuwert Torsten
Clinic of Nuclear Medicine, Institute of Radiology, University of Erlangen-Nürnberg, Erlangen, Germany.
J Nucl Med. 2009 Jan;50(1):18-23. doi: 10.2967/jnumed.108.052746. Epub 2008 Dec 17.
The purpose of this study was to determine the diagnostic value of 131I SPECT/spiral CT (SPECT/CT) on nodal staging of patients with thyroid carcinoma at the first ablative radioiodine therapy.
Fifty-seven patients were studied using SPECT/CT 3-4 d after receiving 3.96+/-0.5 GBq of 131I for radioablation of thyroid remnants after a thyroidectomy for differentiated thyroid carcinoma. In addition to planar whole-body scintigraphy, SPECT/CT of the neck was performed using a hybrid camera combining a double-head SPECT camera with either a 2-slice (n=23) or a 6-slice (n=34) spiral CT scanner. The planar scans and the SPECT/CT images were evaluated for cervical tracer uptake independently of each other and of the clinical findings.
SPECT/CT led to a revision of the original diagnosis in 28 of 143 cervical foci of radioiodine uptake seen on planar imaging. In particular, SPECT/CT reclassified as benign 6 of 11 lesions considered to be lymph node metastases and 11 of 15 lesions considered to be indeterminate. Furthermore, SPECT/CT allowed the identification of 11 lymph node metastases classified as thyroid remnant or as indeterminate on planar imaging. Based on this revision, SPECT/CT yielded a gain in information on nodal stage in 20 of the 57 patients studied (35%, P<0.03). SPECT/CT altered nodal stage from N0 to N1 in 2 of 20 patients and from indeterminate (Nx) to N1 in 6 of 30 patients. The result was a change in risk stratification conforming to the classification proposed by the International Union Against Cancer in 14 patients (25%).
SPECT/CT determines lymph node involvement at radioablation performed for thyroid cancer more accurately than does planar imaging. SPECT/CT may alter management in roughly one quarter of patients with thyroid carcinoma by upstaging or downstaging their disease.
本研究的目的是确定131I单光子发射计算机断层扫描/螺旋计算机断层扫描（SPECT/CT）在分化型甲状腺癌患者首次消融性放射性碘治疗时对淋巴结分期的诊断价值。
57例接受甲状腺切除术后残留甲状腺组织放射性消融的患者，在给予3.96±0.5GBq的131I后3 - 4天使用SPECT/CT进行研究。除了平面全身闪烁显像外，使用将双头SPECT相机与2层（n = 23）或6层（n = 34）螺旋CT扫描仪相结合的混合型相机对颈部进行SPECT/CT检查。平面扫描和SPECT/CT图像分别独立于彼此及临床检查结果进行颈部示踪剂摄取情况评估。
在平面显像所见的143个颈部碘摄取灶中，SPECT/CT使28个病灶的原诊断得以修正。特别是，SPECT/CT将11个被认为是淋巴结转移的病灶中的6个以及15个被认为不确定的病灶中的11个重新分类为良性。此外，SPECT/CT能够识别出11个在平面显像上被分类为甲状腺残留或不确定的淋巴结转移灶。基于这一修正，SPECT/CT在57例研究患者中的20例（35%，P < 0.03）中提供了关于淋巴结分期的信息增益。SPECT/CT使20例患者中的2例淋巴结分期从N0变为N1，30例患者中的6例从不确定（Nx）变为N1。结果是14例患者（25%）的风险分层发生了符合国际抗癌联盟提出的分类的变化。
SPECT/CT在甲状腺癌放射性消融时确定淋巴结受累情况比平面显像更准确。SPECT/CT可能会使大约四分之一的甲状腺癌患者的疾病分期上调或下调，从而改变其治疗方案。
