Department of Nuclear Medicine, St James's Institute of Oncology, Leeds, UK.
Br J Radiol. 2012 Oct;85(1018):e805-13. doi: 10.1259/bjr/26733491.
The aim of this study was to assess the accuracy of recombinant thyroid-stimulating hormone (rTSH)-stimulated 2-(18-fluoride)-flu-2-deoxy-D-glucose ((18)F-FDG) positron emission tomography (PET)-CT in detecting recurrence in patients with differentiated thyroid cancer.
Consecutive (18)F-FDG PET-CT scans performed with rTSH stimulation between 2007 and 2010 in patients with a history of papillary or follicular thyroid carcinoma were reviewed. PET-CT findings were correlated with thyroglobulin levels, and histological, clinical and radiological follow-up.
58 rTSH PET-CT scans were performed in 47 patients with a previous thyroidectomy and radioiodine ablation. The only indication for PET-CT was a raised thyroglobulin level in 46 of 58 scans, with the remainder for characterisation of equivocal radiology or staging. 25 (43%) of PET-CT scans were positive for recurrent disease. Histological correlation was available for 21 (36%) scans. The overall sensitivity, specificity, positive predictive value and negative predictive value were 69%, 76%, 72% and 73%, respectively. Median unstimulated thyroglobulin in true-positive scans was 33 µg l(-1) and 2.2 µg l(-1) in the remainder (p=0.12). 4 of 35 (11%) patients with unstimulated thyroglobulin levels <10 µg l(-1) had true-positive scans. Median stimulated thyroglobulin in true-positive scans was 320 µg l(-1), and 10 µg l(-1) in the remainder (p=0.046), with no positive scans with a stimulated thyroglobulin <8 µg l(-1). PET-CT directly influenced patient management in 17/58 (29%) scans.
rTSH PET-CT is a useful imaging technique for detecting disease recurrence in patients with iodine-resistant differentiated thyroid cancer. Low stimulated thyroglobulin levels are potentially useful in identifying patients unlikely to benefit from a PET-CT scan.
本研究旨在评估重组促甲状腺激素（rTSH）刺激的 2-（18-氟）-氟-2-脱氧-D-葡萄糖（18F-FDG）正电子发射断层扫描（PET）-CT 在检测分化型甲状腺癌患者复发中的准确性。
回顾性分析了 2007 年至 2010 年间接受 rTSH 刺激的 18F-FDG PET-CT 扫描的病史为甲状腺乳头状或滤泡状癌的连续患者。将 PET-CT 结果与甲状腺球蛋白水平以及组织学、临床和影像学随访进行相关性分析。
47 例既往行甲状腺切除术和放射性碘消融术的患者进行了 58 次 rTSH PET-CT 扫描。46 次扫描的唯一指征是甲状腺球蛋白水平升高，其余 2 次扫描用于确定放射性影像学表现或分期。25 次（43%）PET-CT 扫描显示为复发性疾病。21 次（36%）扫描进行了组织学相关性分析。总体敏感性、特异性、阳性预测值和阴性预测值分别为 69%、76%、72%和 73%。真阳性扫描的未刺激甲状腺球蛋白中位数为 33μg/L，其余扫描为 2.2μg/L（p=0.12）。4 例未刺激甲状腺球蛋白水平<10μg/L 的患者中，有 3 例真阳性扫描。真阳性扫描的刺激甲状腺球蛋白中位数为 320μg/L，其余扫描为 10μg/L（p=0.046），刺激甲状腺球蛋白<8μg/L 的扫描无阳性。17/58（29%）次 PET-CT 直接影响了患者的管理。
rTSH PET-CT 是一种有用的影像学技术，可用于检测碘难治性分化型甲状腺癌患者的疾病复发。低刺激甲状腺球蛋白水平可能有助于识别不太可能从 PET-CT 扫描中获益的患者。
