¹³¹I 全身显像、¹³¹I SPECT/CT 和 ¹⁸F-FDG PET/CT 在检测转移性甲状腺癌中的比较。
Comparison of ¹³¹I whole-body imaging, ¹³¹I SPECT/CT, and ¹⁸F-FDG PET/CT in the detection of metastatic thyroid cancer.
机构信息
Department of Nuclear Medicine, Clinical Medicine Research Center, Chonnam National University Hospital, 671 Jebongno, Gwangju 501-757, Republic of Korea.
出版信息
Eur J Nucl Med Mol Imaging. 2011 Aug;38(8):1459-68. doi: 10.1007/s00259-011-1809-x. Epub 2011 Apr 20.
PURPOSE
The aim of this study was to compare (131)I whole-body scintigraphy (WBS), WBS with (131)I single photon emission computed tomography/computed tomography (SPECT/CT), and (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT in the detection of distant metastases of differentiated thyroid cancer (DTC).
METHODS
A total of 140 patients with 258 foci of suspected distant metastases were evaluated. (131)I WBS, (131)I SPECT/CT, and (18)F-FDG PET/CT images were interpreted separately. The final diagnosis was obtained from histopathologic study, serum thyroglobulin level, other imaging modalities, and/or clinical follow-up.
RESULTS
Of the 140 patients with 258 foci, 46 patients with 166 foci were diagnosed as positive for distant metastasis. The sensitivity, specificity, and diagnostic accuracy of each imaging modality were 65, 55, and 59%, respectively, for (131)I WBS; 65, 95, and 85% for (131)I SPECT/CT, respectively; and 61, 98, and 86%, respectively, for (18)F-FDG PET/CT in patient-based analyses. Lesion-based analyses demonstrated that both SPECT/CT and PET/CT were superior to WBS (p<0.001) in all patient groups. SPECT/CT was superior to WBS and PET/CT (p<0.001) in patients who received a single challenge of radioiodine therapy, whereas PET/CT was superior to WBS (p=0.005) and SPECT/CT (p=0.013) in patients who received multiple challenges.
CONCLUSION
Both SPECT/CT and PET/CT demonstrated high diagnostic performance in detecting metastatic thyroid cancer. SPECT/CT was highly accurate in patients who underwent a single challenge of radioiodine therapy. In contrast, (18)F-FDG PET/CT presented the highest diagnostic performance in patients who underwent multiple challenges of radioiodine therapy.
目的
本研究旨在比较（131）I 全身闪烁扫描（WBS）、（131）I 单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）和（18）F-氟代脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/CT 在诊断分化型甲状腺癌（DTC）远处转移中的作用。
方法
对 140 例 258 个可疑远处转移病灶的患者进行评估。（131）I WBS、（131）I SPECT/CT 和（18）F-FDG PET/CT 图像分别进行解读。最终诊断通过组织病理学研究、血清甲状腺球蛋白水平、其他影像学检查和/或临床随访获得。
结果
在 140 例 258 个病灶的患者中，46 例 166 个病灶被诊断为远处转移阳性。在患者层面分析中，每种影像学方法的敏感性、特异性和诊断准确性分别为 65%、55%和 59%；（131）I SPECT/CT 为 65%、95%和 85%；（18）F-FDG PET/CT 为 61%、98%和 86%。基于病灶的分析表明，SPECT/CT 和 PET/CT 在所有患者组中的诊断性能均优于 WBS（p<0.001）。SPECT/CT 在接受单次放射性碘治疗挑战的患者中优于 WBS 和 PET/CT（p<0.001），而在接受多次放射性碘治疗挑战的患者中，PET/CT 优于 WBS（p=0.005）和 SPECT/CT（p=0.013）。
结论
SPECT/CT 和 PET/CT 均在诊断转移性甲状腺癌方面具有较高的诊断性能。SPECT/CT 在接受单次放射性碘治疗挑战的患者中准确性较高。相比之下，（18）F-FDG PET/CT 在接受多次放射性碘治疗挑战的患者中表现出最高的诊断性能。
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