Sandu Nora, Pöpperl Gabriele, Toubert Marie-Elisabeth, Arasho Belachew, Spiriev Toma, Orabi Mikael, Schaller Bernhard J
Department of Neurological Surgery, Lariboisiere Hospital, Universities of Paris, Paris, France.
J Med Case Rep. 2011 Oct 23;5:522. doi: 10.1186/1752-1947-5-522.
Molecular imaging of the spine is a rarely used diagnostic method for which only a few case reports exist in the literature. Here, to the best of our knowledge we present the first case of a combination of molecular imaging by single photon emission computer tomography and positron emission tomography used in post-operative spinal diagnostic assessment.
We present the case of a 50-year-old Caucasian woman experiencing progressive spinal cord compression caused by a vertebral metastasis of a less well differentiated thyroid cancer. Following tumor resection and vertebral stabilization, total thyroidectomy was performed revealing follicular thyroid carcinoma pT2 pNxM1 (lung, bone). During follow-up our patient underwent five radioiodine therapy procedures (5.3 to 5.7 GBq each) over a two-year period. Post-therapeutic I-131 scans showed decreasing uptake in multiple Pulmonary metastases. However, following an initial decrease, stimulated thyroglobulin remained at pathologically increased levels, indicating further neoplastic activity. F18 Fludeoxyglucose positron emission tomography, which was performed in parallel, showed remaining hypermetabolism in the lungs but no hypermetabolism of the spinal lesions correlating with the stable neurological examinations. While on single photon emission computer tomography images Pulmonary hyperfixation of I-131 disappeared (most likely indicating dedifferentiation), there was persistent spinal hyperfixation at the operated level and even higher fixation at the spinal process of L3. Based on the negative results of the spinal F18 fludeoxyglucose positron emission tomography, a decision was made not to operate again on the spine since our patient was completely asymptomatic and the neurological risk seemed to be too high. During further follow-up our patient remained neurologically stable.
Molecular imaging by F18 fludeoxyglucose positron emission tomography helps to exclude metabolically active spinal metastases and to spare further risky surgery.
脊柱的分子成像作为一种诊断方法很少被使用，文献中仅有少数病例报告。在此，据我们所知，我们首次报告了在脊柱术后诊断评估中联合使用单光子发射计算机断层扫描和正电子发射断层扫描进行分子成像的病例。
我们报告了一名50岁的白种女性患者，患有低分化甲状腺癌椎体转移导致进行性脊髓压迫。肿瘤切除及椎体稳定术后，进行了全甲状腺切除术，结果显示为滤泡状甲状腺癌pT2 pNxM1（肺、骨转移）。在随访期间，我们的患者在两年内接受了5次放射性碘治疗（每次5.3至5.7GBq）。治疗后的I-131扫描显示多个肺转移灶的摄取减少。然而，在最初下降之后，刺激后的甲状腺球蛋白仍处于病理性升高水平，表明存在进一步的肿瘤活性。同时进行的F18氟脱氧葡萄糖正电子发射断层扫描显示肺部仍有高代谢，但脊柱病变无高代谢，这与神经系统检查稳定相符。在单光子发射计算机断层扫描图像上，I-131的肺部高摄取消失（最可能表明去分化），但手术部位的脊柱仍持续存在高摄取，甚至在L3棘突处摄取更高。基于脊柱F18氟脱氧葡萄糖正电子发射断层扫描的阴性结果，由于我们的患者完全无症状且神经学风险似乎过高，决定不再对脊柱进行再次手术。在进一步随访期间，我们的患者神经学状态保持稳定。
F18氟脱氧葡萄糖正电子发射断层扫描分子成像有助于排除代谢活跃的脊柱转移瘤，并避免进一步的高风险手术。
