Department of Nuclear Medicine, West China Hospital, Sichuan University, No 37. Guoxue Alley, Chengdu, 610041, China.
Pediatr Radiol. 2021 Aug;51(9):1724-1731. doi: 10.1007/s00247-021-05039-2. Epub 2021 Mar 24.
The utility of integrated single-photon emission computed tomography/computed tomography (SPECT/CT) in children and young adults with differentiated thyroid carcinoma is incompletely studied.
To determine the value of adding SPECT/CT to conventional whole-body scintigraphy in post-ablation iodine-131 (I) scintigraphy for children and young adults with differentiated thyroid carcinoma.
Planar scintigraphy and SPECT/CT were performed on 42 post-surgical children and young adults (32 female, 10 male; mean age 14.3±4.9 years, range 7-20 years) with differentiated thyroid carcinoma (39 papillary, 2 follicular, 1 mixed) 5 days after the therapeutic administration of 1.9-7.4 GBq of I. Planar and SPECT/CT images were interpreted independently, and sites of uptake were categorized as positive or equivocal with respect to thyroid bed, lymph node and distant metastasis uptake. An experienced thyroid endocrinologist used a combination of surgical histopathology and scintigraphic findings to determine whether the addition of SPECT/CT would change patient management.
Planar scintigraphy evidenced 88 radioiodine-avid foci and SPECT/CT confirmed all foci. No additional foci were disclosed by SPECT/CT. SPECT/CT correctly classified 16/88 (18%) foci that were unclear or wrongly classified at planar scintigraphy. Globally, SPECT/CT showed an incremental value over planar scintigraphy in 9 (21.4%) patients and changed therapeutic management in 3 (7.1%; 95% confidence interval, 2-20%) patients.
SPECT/CT improved localization and characterization of focal I uptake on post-ablation whole-body scintigraphy in children and young adults with differentiated thyroid carcinoma. Further prospective evaluation in a larger series is justified to prove the effect of post-ablation SPECT/CT-based management decisions.
在儿童和青年分化型甲状腺癌患者中，整合单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）的应用尚未得到充分研究。
确定在分化型甲状腺癌患者碘-131（I）清除后全身闪烁显像中添加 SPECT/CT 的价值。
对 42 例手术后的儿童和青年（32 名女性，10 名男性；平均年龄 14.3±4.9 岁，范围 7-20 岁）进行了平面闪烁显像和 SPECT/CT 检查，这些患者在接受 1.9-7.4GBq 的 I 治疗后 5 天进行。平面和 SPECT/CT 图像分别进行解释，并根据甲状腺床、淋巴结和远处转移摄取的情况将摄取部位分类为阳性或不确定。一位经验丰富的甲状腺内分泌学家综合手术组织病理学和闪烁成像结果来确定 SPECT/CT 的添加是否会改变患者的管理。
平面闪烁显像显示 88 个放射性碘摄取灶，SPECT/CT 证实了所有的摄取灶。SPECT/CT 未发现其他摄取灶。SPECT/CT 正确分类了 16/88（18%）在平面闪烁显像中不明确或分类错误的摄取灶。总体而言，SPECT/CT 在 9 例（21.4%）患者中比平面闪烁显像具有更高的价值，并改变了 3 例（7.1%；95%置信区间，2-20%）患者的治疗管理。
SPECT/CT 改善了儿童和青年分化型甲状腺癌患者碘清除后全身闪烁显像中局灶性 I 摄取的定位和特征。需要进一步在更大的系列中进行前瞻性评估，以证明基于 SPECT/CT 的管理决策在碘清除后的效果。
