Slavikova K, Montravers F, Treglia G, Kunikowska J, Kaliska L, Vereb M, Talbot J N, Balogova S
Radiology, Comenius University, Bratislava, Slovakia.
Curr Radiopharm. 2013 Jun 6;6(2):96-105. doi: 10.2174/1874471011306020006.
Among thyroid malignancies, medullary thyroid carcinoma (MTC) has some very specific features. Production and secretion of large amounts of peptides occur in malignant transformed C cells with few exceptions, leading to high serum levels of calcitonin (Ctn) and carcinoembryonic antigen (CEA), that act after thyroidectomy as tumour markers warning for the presence of persistent or metastatic MTC. The availability of those serum biomarkers with an excellent sensitivity challenges medical imaging to localise the recurrent cancer tissue, since surgery is a major therapeutic option. The aims of this article are (i) to review literature evidence about the efficacy and tolerance of radiopharmaceuticals for 3 targets of PET/CT imaging (glucose metabolism, bioamines metabolism and somatostatin receptors) and also bone scintigraphy which is recommended in the Guidelines of European Society for Medical Oncology (ESMO; (ii) to compare the availability and the costs in relation with those radiopharmaceuticals, (iii) and to discuss a possible sequence of those examinations, in order to optimise spending and to minimise the overall radiation dose. In this context of recurrent MTC suspected on rising tumour markers levels after thyroidectomy, this survey of literature confirms that FDOPA is the best radiopharmaceutical for PET/CT with significant diagnostic performance if Ctn>150 pg/mL; an early image acquisition starting during the first 15 min is advised. In negative cases, FDG should be the next PET radiopharmaceutical, in particular if Ctn and CEA levels are rapidly rising, and PET with a somatostatin analogue labelled with gallium-68 when neither FDOPA nor FDG PET are conclusive. Bone scintigraphy could complement FDG-PET/CT if FDOPA is not available.
在甲状腺恶性肿瘤中，甲状腺髓样癌（MTC）具有一些非常特殊的特征。除极少数情况外，恶性转化的C细胞会产生和分泌大量肽类，导致血清降钙素（Ctn）和癌胚抗原（CEA）水平升高，甲状腺切除术后，这些物质可作为肿瘤标志物，提示持续性或转移性MTC的存在。由于手术是主要的治疗选择，这些具有出色敏感性的血清生物标志物的存在，对医学成像定位复发性癌组织提出了挑战。本文的目的是：（i）回顾关于用于PET/CT成像3个靶点（葡萄糖代谢、生物胺代谢和生长抑素受体）的放射性药物以及欧洲医学肿瘤学会（ESMO）指南中推荐的骨闪烁显像的疗效和耐受性的文献证据；（ii）比较这些放射性药物的可及性和成本；（iii）讨论这些检查的可能顺序，以优化费用支出并使总体辐射剂量最小化。在甲状腺切除术后因肿瘤标志物水平升高而怀疑为复发性MTC的情况下，这项文献调查证实，如果Ctn>150 pg/mL，FDOPA是PET/CT的最佳放射性药物，具有显著的诊断性能；建议在最初15分钟内开始早期图像采集。在阴性病例中，FDG应作为下一个PET放射性药物，特别是如果Ctn和CEA水平迅速升高，而当FDOPA和FDG PET均无定论时，应使用用镓-标记的生长抑素类似物进行PET检查。如果没有FDOPA，骨闪烁显像可作为FDG-PET/CT的补充。
