Pachón-Garrudo V M, Cuenca-Cuenca J I, Ruiz-Franco-Baux J, Borrego-Dorado I, Tirado-Hospital J L, Navarro-González E, Vázquez-Albertino R
Unidad de Diagnóstico por la Imagen, Medicina Nuclear, Hospital Universitario Virgen del Rocío, Seville, Spain.
Rev Esp Med Nucl Imagen Mol. 2012 Nov-Dec;31(6):315-21. doi: 10.1016/j.remn.2011.12.002. Epub 2012 Mar 21.
This study has aimed to analyze the evolution of patients diagnosed with differentiated thyroid carcinoma (DTC) with a negative (131)I-Na whole body scan (WBS), high levels of serum thyroglobulin (Tg) and negative (18F)fluorodeoxyglucose positron emission tomography (PET-FDG) study.
Twenty-three patients diagnosed and treated for DTC were studied retrospectively. Patients were aged between 23 and 83 and had shown, between January 2001 and December 2002, negative WBS, Tg values in a range of suspected recurrence or metastasis (Tg>2 ng / mL with thyroid hormone withdrawal) and a negative PET-FDG study. The patients were monitored clinically, radiologically and analytically for a minimum period of 4 years. After this, a new evaluation was made of their state of disease with a control WBS, also observing the evolution of Tg. All WBS were performed with a 185 MBq diagnostic dose of (131)I-Na.
In 18/23 patients, Tg decreased and in 5 it increased. Four patients (17%) were free of active disease (negative WBS Tg<2 ng / mL). A total of 16 patients (70%) were free of disease according to the WBS but had elevated Tg. Three patients (13%) had disease and high levels of Tg, two of them with positive WBS and the third with (99m)Tc-MIBI scan and CT positive.
Most patients with a negative WBS, high Tg serum levels and negative FDG PET had good evolution, with descending Tg levels, normal levels even being reached in a significant percentage of them.
本研究旨在分析分化型甲状腺癌（DTC）患者的病情演变情况，这些患者的碘-131（¹³¹I）-钠全身扫描（WBS）结果为阴性、血清甲状腺球蛋白（Tg）水平较高且氟代脱氧葡萄糖正电子发射断层扫描（PET-FDG）检查结果为阴性。
对23例诊断为DTC并接受治疗的患者进行回顾性研究。患者年龄在23至83岁之间，在2001年1月至2002年12月期间，WBS结果为阴性，在怀疑复发或转移的范围内Tg值（甲状腺激素撤药后Tg>2 ng/mL），且PET-FDG检查结果为阴性。对患者进行了至少4年的临床、放射学和分析监测。此后，通过对照WBS对其疾病状态进行了新的评估，同时观察Tg的变化情况。所有WBS均使用185 MBq的诊断剂量¹³¹I-钠进行。
23例患者中，18例Tg下降而5例Tg升高。4例患者（17%）无活动性疾病（WBS阴性且Tg<2 ng/mL）。根据WBS，共有16例患者（70%）无疾病但Tg升高。3例患者（13%）患有疾病且Tg水平较高，其中2例WBS阳性，第3例锝-99m（⁹⁹ᵐTc）-甲氧基异丁基异腈（MIBI）扫描和CT检查呈阳性。
大多数WBS结果为阴性、血清Tg水平较高且FDG PET结果为阴性的患者病情演变良好，Tg水平下降，相当比例的患者甚至达到正常水平。
