Kim Hyun Joo, Bang Ji-In, Kim Ji-Young, Moon Jae Hoon, So Young, Lee Won Woo
Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea.
Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Suwon 16229, Korea.
Korean J Radiol. 2017 May-Jun;18(3):543-550. doi: 10.3348/kjr.2017.18.3.543. Epub 2017 Apr 3.
Since Graves' disease (GD) is resistant to antithyroid drugs (ATDs), an accurate quantitative thyroid function measurement is required for the prediction of early responses to ATD. Quantitative parameters derived from the novel technology, single-photon emission computed tomography/computed tomography (SPECT/CT), were investigated for the prediction of achievement of euthyroidism after methimazole (MMI) treatment in GD.
A total of 36 GD patients (10 males, 26 females; mean age, 45.3 ± 13.8 years) were enrolled for this study, from April 2015 to January 2016. They underwent quantitative thyroid SPECT/CT 20 minutes post-injection of Tc-pertechnetate (5 mCi). Association between the time to biochemical euthyroidism after MMI treatment and %uptake, standardized uptake value (SUV), functional thyroid mass (SUVmean × thyroid volume) from the SPECT/CT, and clinical/biochemical variables, were investigated.
GD patients had a significantly greater %uptake (6.9 ± 6.4%) than historical control euthyroid patients (n = 20, 0.8 ± 0.5%, < 0.001) from the same quantitative SPECT/CT protocol. Euthyroidism was achieved in 14 patients at 156 ± 62 days post-MMI treatment, but 22 patients had still not achieved euthyroidism by the last follow-up time-point (208 ± 80 days). In the univariate Cox regression analysis, the initial MMI dose ( = 0.014), %uptake ( = 0.015), and functional thyroid mass ( = 0.016) were significant predictors of euthyroidism in response to MMI treatment. However, only %uptake remained significant in a multivariate Cox regression analysis ( = 0.034). A %uptake cutoff of 5.0% dichotomized the faster responding versus the slower responding GD patients ( = 0.006).
A novel parameter of thyroid %uptake from quantitative SPECT/CT is a predictive indicator of an early response to MMI in GD patients.
由于格雷夫斯病（GD）对抗甲状腺药物（ATD）耐药，因此需要准确的甲状腺功能定量测量来预测对ATD的早期反应。研究了源自新技术单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）的定量参数，以预测GD患者接受甲巯咪唑（MMI）治疗后甲状腺功能正常的实现情况。
2015年4月至2016年1月，共纳入36例GD患者（男10例，女26例；平均年龄45.3±13.8岁）进行本研究。他们在注射高锝酸盐（5mCi）后20分钟接受甲状腺定量SPECT/CT检查。研究了MMI治疗后达到生化甲状腺功能正常的时间与SPECT/CT的摄取百分比、标准化摄取值（SUV）、功能性甲状腺质量（SUVmean×甲状腺体积）以及临床/生化变量之间的关联。
与采用相同定量SPECT/CT方案的历史对照甲状腺功能正常患者（n = 20，0.8±0.5%，P<0.001）相比，GD患者的摄取百分比（6.9±6.4%）显著更高。14例患者在MMI治疗后156±62天实现甲状腺功能正常，但22例患者在最后随访时间点（208±80天）仍未实现甲状腺功能正常。在单变量Cox回归分析中，初始MMI剂量（P = 0.014）、摄取百分比（P = 0.015）和功能性甲状腺质量（P = 0.016）是MMI治疗后甲状腺功能正常的显著预测指标。然而，在多变量Cox回归分析中，只有摄取百分比仍然显著（P = 0.034）。摄取百分比临界值为5.0%可将反应较快的GD患者与反应较慢的患者区分开来（P = 0.006）。
定量SPECT/CT的甲状腺摄取百分比这一新参数是GD患者对MMI早期反应的预测指标。
