Sisson James C, Dewaraja Yuni K, Wizauer Eric J, Giordano Thomas J, Avram Anca M
Division of Nuclear Medicine and Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan 48109-0028, USA.
Thyroid. 2009 Mar;19(3):297-303. doi: 10.1089/thy.2008.0426.
Infringement by differentiated thyroid carcinoma on the brain is rare but, when suspected, the patient deserves special attention. A patient with an enlarging metastasis of thyroid carcinoma to the skull that was impinging on the brain illustrates diagnostic and therapeutic strategies applicable to the treatment of metastatic carcinoma.
A case study was performed. Computed tomography (CT) and magnetic resonance imaging (MRI) were done, serum thyroglobulin was measured, and tumor responses to thyroxine and (131)I treatments were monitored. Tumor dosimetry, enabled by scintigraphy with (131)I employing single photon emission tomography fused with CT (SPECT-CT), was performed.
The metastasis was from a follicular variant of papillary thyroid carcinoma. During thyrotropin stimulation the tumor enlarged. The tumor decreased in volume after each of two (131)I therapies. Dosimetry indicated delivery of 1970 and 2870 cGy to the tumor and 35 and 42 cGy to the brain, respectively, in the two treatments. The patient has survived for more than 11 years since diagnosis.
A metastasis from a follicular variant of papillary carcinoma increased in volume during hypothyroidism producing more infringement on the brain. Beyond the effects of thyroxine therapy, (131)I treatments induced recession of tumor volume. In patients with metastases that concentrate (131)I, dosimetry with SPECT-CT can predict absorbed doses of radiation to the tumor and to the adjacent organs and thus lay a basis for data-based decisions on (131)I therapies. Therapy may induce prolonged survival in patients with metastases infringing on the brain.
分化型甲状腺癌侵犯脑部的情况罕见，但一旦怀疑，患者应予以特别关注。一名甲状腺癌转移至颅骨并压迫脑部且转移灶不断增大的患者，展示了适用于转移性癌治疗的诊断和治疗策略。
进行了一项病例研究。进行了计算机断层扫描（CT）和磁共振成像（MRI）检查，测量了血清甲状腺球蛋白，并监测了肿瘤对甲状腺素和（131）I治疗的反应。采用单光子发射断层扫描与CT融合（SPECT-CT）的（131）I闪烁显像进行了肿瘤剂量测定。
转移灶来自乳头状甲状腺癌的滤泡变体。促甲状腺素刺激期间肿瘤增大。两次（131）I治疗后肿瘤体积均减小。剂量测定表明，两次治疗中肿瘤分别接受了1970和2870 cGy的辐射剂量，脑部分别接受了35和42 cGy的辐射剂量。自诊断以来，该患者已存活超过11年。
乳头状癌滤泡变体的转移灶在甲状腺功能减退期间体积增大，对脑部造成更多侵犯。除甲状腺素治疗的效果外，（131）I治疗可使肿瘤体积缩小。对于能摄取（131）I的转移灶患者，SPECT-CT剂量测定可预测肿瘤及邻近器官的辐射吸收剂量，从而为基于数据的（131）I治疗决策奠定基础。治疗可能会延长脑部受侵犯转移患者的生存期。
