在正电子发射断层扫描-计算机断层扫描时代，探索锝-99m二巯基丁二酸（V）扫描在甲状腺髓样癌术后持续性降钙素血症患者中的作用。

Exploring the role of technitium-99m dimercaptosuccinyl acid (V) scan in medullary carcinoma thyroid patients with postoperative persistent hypercalcitoninemia in the era of positron emission tomography-computerized tomography.

作者信息

Krishnamurthy Arvind, Kumar Ramachandran Krishna, Ravishankaran Praveen, Ramshankar Vijayalaksmi, Balkis Begum Ahamed Sultan, Rangarajan Gomadam Kuppuswamy

机构信息

Department of Surgical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.

Department of Nuclear Medicine, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.

出版信息

Indian J Nucl Med. 2014 Jul;29(3):146-50. doi: 10.4103/0972-3919.136562.

DOI:10.4103/0972-3919.136562

PMID:25210279

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4157187/

Abstract

BACKGROUND

Many radio-pharmaceuticals have been used over the years to localize the recurrences in patients with medullary carcinoma thyroid (MCT), including iodine-131-metaiodobenzylguanidine, thallium-201, technitium-99m dimercaptosuccinyl acid [Tc-99m DMSA (V)], Tc-99m methoxyisobutylisonitril, Tc-99 ethylenediamine diacetic acid/hydrazinonicotinyl-Tyr (3)-octreotide, and In-111 diethylenetriaminepenta-acetic acid-octreotide with varying sensitivities and specificities.

AIMS

The aim of this study is to explore the role of Tc-99m DMSA (V) scan in MCT patients with postoperative persistent hypercalcitoninemia in the positron emission tomography-computerized tomography (PET-CT) era.

MATERIALS AND METHODS

A retrospective review of 53 patients with proven sporadic MCT, who presented to our institution over a period 28 years from 1985 to 2012, was performed. Patients with persistently elevated levels of serum calcitonin (>150 pg/ml) were initially evaluated by a DMSA scan if conventional imaging failed to localize any focus of disease.

RESULTS AND CONCLUSIONS

Our study showed that the postoperative levels of serum calcitonin significantly correlated with the overall survival of our patients and can possibly serve as a good prognostic marker. Tc-99m DMSA (V) scans demonstrated a sensitivity of 75%, specificity of 56%, a positive predictive value of 50%, and a negative predictive value of 80% in detecting metastasis in postoperative persistent hypercalcitoninemia. Our study showed that Tc-99m DMSA (V) scanning is an affordable and a reasonably sensitive imaging agent for localization of recurrent/metastatic disease. PET-CT seems to be a useful complementary tool and needs to be kept in the armamentarium for diagnosis of recurrence especially in cases of discordance between Tc-99m DMSA (V) scan and the serum calcitonin levels.

摘要

背景

多年来，许多放射性药物被用于定位甲状腺髓样癌（MCT）患者的复发灶，包括碘-131-间碘苄胍、铊-201、锝-99m二巯基丁二酸[Tc-99m DMSA（V）]、Tc-99m甲氧基异丁基异腈、Tc-99乙二胺二乙酸/肼基烟酰基-Tyr（3）-奥曲肽以及铟-111二乙三胺五乙酸-奥曲肽，其敏感性和特异性各不相同。

目的

本研究旨在探讨在正电子发射断层扫描-计算机断层扫描（PET-CT）时代，Tc-99m DMSA（V）扫描在术后持续性降钙素血症的MCT患者中的作用。

材料与方法

对1985年至2012年28年间在本机构就诊的53例经证实的散发性MCT患者进行回顾性研究。如果传统影像学检查未能定位任何病灶，血清降钙素水平持续升高（>150 pg/ml）的患者首先通过DMSA扫描进行评估。

结果与结论

我们的研究表明，术后血清降钙素水平与患者的总生存期显著相关，可能是一个良好的预后指标。Tc-99m DMSA（V）扫描在检测术后持续性降钙素血症转移灶方面，敏感性为75%，特异性为56%，阳性预测值为50%，阴性预测值为80%。我们的研究表明，Tc-99m DMSA（V）扫描是一种经济且具有一定敏感性的成像剂，可用于定位复发/转移病灶。PET-CT似乎是一种有用的辅助工具，在诊断复发时，尤其是在Tc-99m DMSA（V）扫描与血清降钙素水平不一致的情况下，应保留在诊断手段中。