Sager Sait, Vatankulu Betul, Erdogan Ezgi, Mut Sanem, Teksoz Serkan, Ozturk Tulin, Sonmezoglu Kerim, Kanmaz Bedii
Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University, Cerrahpasa, Fatih, Istanbul, Turkey,
Endocrine. 2015 Sep;50(1):138-45. doi: 10.1007/s12020-015-0580-3. Epub 2015 Mar 21.
Recent studies have reported that standardized uptake values of FDG-PET imaging might predict malignant thyroid nodules and can be used in the preoperative evaluation of thyroid lesions. The aim of our study was to evaluate FDG-PET imaging in patients with cold thyroid nodules and to compare the imaging findings with Tc-99m MIBI scans and with post-op histopathology results. Twenty-three patients (18F, 5M) with 24 nodules that were suspicious in ultrasound and cold in Tc-99m pertechnetate scan, were included in the study. Each nodule underwent sonographically guided fine-needle aspiration biopsy. FDG-PET and MIBI scans were performed with an interval of 3-5 days. All patients underwent thyroidectomy and their FDG-PET, and MIBI thyroid scan results were compared with post-thyroidectomy pathology results. Post-op histopathology results found 7 malignant and 17 benign nodules. Six of the seven malignant nodules had increased uptake, which were positive for malignancy in both PET and MIBI scans. Each imaging method used different radiopharmaceuticals but showed one false-negative result in two different patients. FDG-PET produced false positives in eight nodules and MIBI scans found false positives in four nodules. FDG-PET imaging and MIBI scan showed the same sensitivity in malignant nodule evaluation, but their specificity differed. As a result, we suggest that FDG-PET imaging is not superior to MIBI scanning in differentiating malignant from benign thyroid nodules. MIBI imaging should be the first choice in the preoperative evaluation of patients with cold thyroid nodules as an adjunct procedure to FNAB because of its low cost and availability. This imaging technique can be used routinely in patients who are reluctant to undergo FNAB.
近期研究报告称，氟代脱氧葡萄糖正电子发射断层显像（FDG-PET）的标准化摄取值可能有助于预测甲状腺恶性结节，并可用于甲状腺病变的术前评估。本研究的目的是评估FDG-PET成像在冷甲状腺结节患者中的应用，并将成像结果与锝-99m甲氧基异丁基异腈（Tc-99m MIBI）扫描及术后组织病理学结果进行比较。本研究纳入了23例患者（18例女性，5例男性），共24个结节，这些结节在超声检查中可疑，且在Tc-99m高锝酸盐扫描中为冷结节。每个结节均接受超声引导下细针穿刺活检。FDG-PET和MIBI扫描间隔3至5天进行。所有患者均接受甲状腺切除术，并将其FDG-PET和MIBI甲状腺扫描结果与甲状腺切除术后病理结果进行比较。术后组织病理学结果发现7个恶性结节和17个良性结节。7个恶性结节中有6个摄取增加，在PET和MIBI扫描中均为恶性阳性。每种成像方法使用不同的放射性药物，但在两名不同患者中均出现了1例假阴性结果。FDG-PET在8个结节中产生假阳性，MIBI扫描在4个结节中发现假阳性。FDG-PET成像和MIBI扫描在恶性结节评估中显示出相同的敏感性，但特异性不同。因此，我们认为在区分甲状腺良恶性结节方面，FDG-PET成像并不优于MIBI扫描。由于MIBI成像成本低且易于获得，作为细针穿刺抽吸活检（FNAB）的辅助检查，MIBI成像应作为冷甲状腺结节患者术前评估的首选。这种成像技术可常规用于不愿接受FNAB的患者。
