Division of Nuclear Medicine.
Division of Body Imaging, Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Curr Opin Endocrinol Diabetes Obes. 2022 Oct 1;29(5):456-465. doi: 10.1097/MED.0000000000000740. Epub 2022 Jul 2.
Thyroid cancers are endocrine neoplasms with diverse gene expression and behavior, for which constantly evolving anatomic and functional imaging/theranostic agents have an essential role for diagnosis, staging, and treatment.
To achieve definitive diagnosis, neck ultrasound and associated risk stratification systems, notably Thyroid Imaging Reporting and Data System (TI-RADS), allow improved thyroid nodule characterization and management guidance. Radioactive iodine-131 (RAI) has long played a role in management of differentiated thyroid cancer (DTC), with recent literature emphasizing its effectiveness for intermediate-high risk cancers, exploring use of dosimetry for personalized medicine, and potential for retreatment with RAI following tumor redifferentiation. Iodine-124 positron emission tomography/computed tomography (PET/CT) has promising application for DTC staging and dosimetry. F18-fluorodeoxyglucose (FDG) PET/CT is used for staging of high risk DTC and identification of noniodine-avid disease recurrences, with metabolic uptake consistently portending poor prognosis. Poorly differentiated and anaplastic thyroid cancers are best assessed with anatomic imaging and F18-FDG PET/ CT, though recent studies show a potential theranostic role for Ga68/Lu177-prostate-specific membrane antigen. Medullary thyroid cancers are evaluated with ultrasound, CT, magnetic resonance imaging, and various positron-emitting radiotracers for PET imaging (F18-DOPA, F18-FDG, and recently Ga68-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)-octreotate (DOTATATE)); the latter may enable treatment with Lu177-DOTATATE.
Multidisciplinary collaboration is essential to streamline appropriate management, given the wide array of available imaging and new therapies for metabolic and genetically complex cancers.
甲状腺癌是内分泌肿瘤，具有不同的基因表达和行为，对于其诊断、分期和治疗，不断发展的解剖和功能成像/治疗性制剂具有重要作用。
为了明确诊断，颈部超声和相关的风险分层系统，特别是甲状腺影像报告和数据系统（TI-RADS），可以改善甲状腺结节的特征描述和管理指导。放射性碘-131（RAI）在分化型甲状腺癌（DTC）的治疗中一直发挥着作用，最近的文献强调了其对中高危癌症的有效性，探索了使用剂量测定法进行个体化治疗，以及在肿瘤重新分化后用 RAI 进行再治疗的可能性。碘-124 正电子发射断层扫描/计算机断层扫描（PET/CT）在 DTC 分期和剂量测定方面具有广阔的应用前景。18F-氟脱氧葡萄糖（FDG）PET/CT 用于高危 DTC 的分期和非碘摄取性疾病复发的识别，代谢摄取一直预示着预后不良。未分化和间变性甲状腺癌最好通过解剖成像和 18F-FDG PET/CT 进行评估，尽管最近的研究表明 Ga68/Lu177-前列腺特异性膜抗原在治疗方面具有潜在的作用。髓样甲状腺癌通过超声、CT、磁共振成像和各种正电子发射放射性示踪剂进行 PET 成像（18F-DOPA、18F-FDG 和最近的 Ga68-1,4,7,10-四氮环十二烷-1,4,7,10-四乙酸（DOTA）-奥曲肽（DOTATATE））；后者可使 Lu177-DOTATATE 治疗成为可能。
鉴于代谢和遗传复杂癌症的大量可用成像和新疗法，多学科合作对于简化适当的管理至关重要。
