评估血清甲状腺球蛋白升高且全身 131I 扫描阴性的分化型甲状腺癌患者的放射性碘治疗效果，强调这些亚组中的铊闪烁显像。

Evaluation of radioiodine therapy in differentiated thyroid cancer subjects with elevated serum thyroglobulin and negative whole body scan using 131I with emphasize on the thallium scintigraphy in these subgroups.

机构信息

Nuclear Medicine Department, Vali Asr Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Eur Rev Med Pharmacol Sci. 2011 Oct;15(10):1215-21.

PMID:22165686

Abstract

OBJECTIVE

Negative diagnostic 131I whole body scans with elevated serum thyroglobulin (Tg) levels are found in 20% of patients with differentiated thyroid cancer (DTC). Empirical radioiodine treatment has been advocated by some researchers, but has had with controversial outcomes. This anterospective study was performed to examine this dilemma and also to determine the capability of thallium (201TI) scintigraphy in these patients.

MATERIALS AND METHODS

A total of 21 patients who had a history of DTC and elevated serum Tg levels, together with a negative diagnostic 131I whole body scans (WBS), were included in the study. All patients underwent posttreatment 131I WBS. Patients with negative posttreatment 131I WBS then underwent 201TI scintigraphy.

RESULTS

The 21 included patients (9 women and 12 men) had a mean age of 53 +/- 14.17 years. The mean pretreatment and posttreatment Tg levels were 227.23 +/- 208.50 ng/ml and 163.43 +/- 282.57 ng/ml, respectively (p value <0.05). Eleven cases showed at least a 50% decrease in Tg value (remission group), 6 patients revealed less than a 50% decrease in Tg value (stable group), while 4 subjects demonstrated an increment in posttreatment Tg relative to pretreatment Tg value (progression group). The cumulative and last 131I doses in the remission, stable, and progression groups were not significantly different (p value >0.05). In the posttreatment 131I WBS, 10 patients showed abnormal findings in their images. In a follow-up scan after 201TI treatment, 7 out of 11 patients had positive scans.

CONCLUSION

The study indicates a positive effect of RAI therapy in DTC patients with elevated Tg and negative 131I WBS. In addition, 201TI scintigraphy can be useful as an alternative modality to improve tumoral detection in this situation and when access to a PET system is limited.

摘要

目的

在分化型甲状腺癌（DTC）患者中，有 20%的患者出现阴性诊断性 131I 全身扫描和血清甲状腺球蛋白（Tg）水平升高。一些研究人员主张进行经验性放射性碘治疗，但结果存在争议。本前瞻性研究旨在探讨这一难题，并确定铊（201TI）闪烁扫描在这些患者中的作用。

材料和方法

共纳入 21 例有 DTC 病史和血清 Tg 水平升高且阴性诊断性 131I 全身扫描（WBS）的患者。所有患者均行治疗后 131I WBS。治疗后 131I WBS 阴性的患者行 201TI 闪烁扫描。

结果

21 例纳入患者（9 名女性和 12 名男性）的平均年龄为 53 ± 14.17 岁。治疗前和治疗后 Tg 水平分别为 227.23 ± 208.50 ng/ml 和 163.43 ± 282.57 ng/ml（p 值<0.05）。11 例患者 Tg 值至少下降 50%（缓解组），6 例患者 Tg 值下降<50%（稳定组），4 例患者治疗后 Tg 值较治疗前升高（进展组）。缓解组、稳定组和进展组的累积和末次 131I 剂量无显著差异（p 值>0.05）。在治疗后 131I WBS 中，10 例患者的图像出现异常。在 201TI 治疗后的随访扫描中，11 例中有 7 例扫描阳性。