Giovanella Luca, Avram Anca M, Ovčariček Petra Petranović, Clerc Jerome
Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland.
Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA; Division of Endocrinology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Presse Med. 2022 Jun;51(2):104116. doi: 10.1016/j.lpm.2022.104116. Epub 2022 Feb 4.
Radioiodine uptake (RAIU) test with iodine-123 (Na[I]I) or iodine-131 (Na[I]I) enables accurate evaluation and quantification of iodine uptake and kinetics within thyroid cells. Thyroid Scintigraphy (TS) employing Na[I]I or Tc-pertechnetate (Na[Tc]TcO) provides information regarding the function and topographical distribution of thyroid cells activity, including detection and localization of ectopic thyroid tissue. Destructive thyrotoxicosis is characterized by low RAIU with scintigraphically reduced radiotracer activity in the thyroid tissue, while productive thyrotoxicosis (i.e. hyperthyroidism "stricto sensu") is characterized by high RAIU with scintigraphically diffuse (i.e. Graves' Disease, GD and diffuse thyroid autonomy) or focal (i.e. autonomously functioning thyroid nodules, AFTN) overactivity. Accordingly, RAIU and/or TS are widely used to differentiate different causes of thyrotoxicosis. In addition, several radiopharmaceuticals are also available to help differentiate benign from malignant thyroid nodules and inform clinical decision-making: scintigraphic identification of AFTNs obviate fine-needle aspiration (FNA) biopsy, and [Tc]Tc-hexakis-(2‑methoxy-2-isobutyl isonitrile ([Tc]Tc-MIBI) and/or F-fluoro-d-glucose ([F]FDG) may complement the work-up of cytologically indeterminate "cold" nodules for reducing the need for diagnostic lobectomies/thyroidectomies. Finally, RAIU studies are also useful for calculating the administered therapeutic activity of Na[I]I to treat hyperthyroidism and euthyroid multinodular goiter. All considered, thyroid molecular imaging allows functional characterization of different thyroid diseases, even before clinical symptoms become manifest, and remains integral to the management of such conditions. Our present paper summarizes basic concepts, clinical applications, and potential developments of thyroid molecular imaging in patients affected by thyrotoxicosis and thyroid nodules.
使用碘-123（碘化钠[I]）或碘-131（碘化钠[I]）进行的放射性碘摄取（RAIU）试验能够准确评估和量化甲状腺细胞内的碘摄取及动力学情况。采用碘化钠[I]或高锝酸盐（高锝酸钠[Tc]）的甲状腺闪烁扫描（TS）可提供有关甲状腺细胞活性的功能和地形分布信息，包括异位甲状腺组织的检测和定位。破坏性甲状腺毒症的特征是RAIU降低，甲状腺组织中闪烁扫描显示放射性示踪剂活性降低，而增生性甲状腺毒症（即“狭义的甲状腺功能亢进症”）的特征是RAIU升高，闪烁扫描显示弥漫性（即格雷夫斯病、GD和弥漫性甲状腺自主性）或局灶性（即自主功能性甲状腺结节，AFTN）活性增强。因此，RAIU和/或TS被广泛用于区分甲状腺毒症的不同病因。此外，还有几种放射性药物可用于帮助区分甲状腺良性和恶性结节，并为临床决策提供依据：AFTN的闪烁扫描识别可避免细针穿刺（FNA）活检，锝[Tc]六甲基丙烯胺肟（锝[Tc]MIBI）和/或氟-脱氧葡萄糖[F]（[F]FDG）可补充对细胞学检查结果不确定的“冷”结节的检查，以减少诊断性叶切除术/甲状腺切除术的需求。最后，RAIU研究对于计算用于治疗甲状腺功能亢进症和甲状腺功能正常的多结节性甲状腺肿的碘化钠[I]的给药治疗活性也很有用。综上所述，甲状腺分子成像能够在临床症状出现之前对不同甲状腺疾病进行功能特征描述，并且仍然是此类疾病管理中不可或缺的一部分。我们目前的论文总结了甲状腺分子成像在甲状腺毒症和甲状腺结节患者中的基本概念、临床应用和潜在发展。
