Somboonporn Charoonsak, Simthamnimit Pannipa, Puttharak Warinthorn, Tumsatan Panaya, Ngamjarus Chetta, Roysri Krisana
Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
J Med Assoc Thai. 2010 Mar;93 Suppl 3:S52-60.
Post-treatment I-131 whole body scan (WBS) is known to be a very sensitive test in detecting metastasis in differentiated thyroid cancer (DTC). Therefore, in the presence of this sensitive method, the role of chest radiography (CXR) in the diagnosis of pulmonary metastasis has been questioned.
The present study aimed to find the prevalence of pulmonary metastasis found on CXR in DTC patients who had negative post-treatment WBS.
Retrospective comparison was undertaken of CXR and post-treatment WBS routinely performed in 300 DTC patients during the time of I-131 treatment from January 2003 to December 2006 in the Department of Radiology. Radiographic patterns of pulmonary metastasis classified as single nodule, multiple nodules, lymphangitic metastasis and pleural metastasis were also recorded.
Of the 300 DTC patients, 36 pulmonary metastases (12.0%) were diagnosed based on CXR and post-treatment I-131 WBS. Of these 36 cases, 11 (30.6%) were detected by both CXR and WBS, whereas 16 (44.4%) were detected by WBS alone and 9 (25.0%) by CXR alone. Seven of these 9 cases (77.8%) had lymphangitic pattern of pulmonary metastasis.
Although routine CXR has a limited role in the diagnosis of pulmonary metastasis in DTC patients being treated with I-131, it is helpful in detecting pulmonary metastasis in patients with negative post-treatment WBS.
治疗后I-131全身扫描（WBS）在检测分化型甲状腺癌（DTC）转移方面是一项非常敏感的检查。因此，在存在这种敏感方法的情况下，胸部X线摄影（CXR）在肺转移诊断中的作用受到了质疑。
本研究旨在确定治疗后WBS阴性的DTC患者中CXR发现的肺转移发生率。
对2003年1月至2006年12月在放射科进行I-131治疗期间对300例DTC患者常规进行的CXR和治疗后WBS进行回顾性比较。还记录了分类为单个结节、多个结节、淋巴管转移和胸膜转移的肺转移的影像学表现。
在300例DTC患者中，根据CXR和治疗后I-131 WBS诊断出36例肺转移（12.0%）。在这36例病例中，11例（30.6%）通过CXR和WBS均检测到，而16例（44.4%）仅通过WBS检测到，9例（25.0%）仅通过CXR检测到。这9例中的7例（77.8%）有肺转移的淋巴管样表现。
尽管常规CXR在接受I-131治疗的DTC患者肺转移诊断中的作用有限，但它有助于检测治疗后WBS阴性患者的肺转移。
