Delorme Stefan, Raue Friedhelm, Beuthien-Baumann Bettina
Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld, Heidelberg, Germany.
Endocrine Practice, Heidelberg, Germany.
Recent Results Cancer Res. 2025;223:129-153. doi: 10.1007/978-3-031-80396-3_5.
Imaging plays an important role in the early detection and staging of medullary thyroid carcinoma (MTC), as well as in follow-up to locate early recurrence. MTC is a rare, calcitonin-secreting thyroid malignancy that is often diagnosed by ultrasound and calcitonin screening as part of the routine evaluation of any thyroid nodule. If serum calcitonin is elevated, imaging studies are needed for preoperative staging to guide surgical management. This may include ultrasound of the neck and abdomen. CT or MRI studies for more distant disease are performed preoperatively when calcitonin levels are greater than 500 pg/mL. Neither FDG-PET/CT nor F-DOPA-PET/CT is routinely being used for preoperative staging, but may be helpful in individual cases of doubt. Postoperative elevated calcitonin is associated with persistence or recurrence of MTC. Imaging studies to localize tumor tissue in postoperative follow-up include ultrasound, CT, MRI, and PET scans. However, they should be used judiciously, as the impact of treatment is often limited. In addition, even patients with persistent disease may survive long enough to accumulate significant radiation doses from CT or PET scans. Imaging studies are also useful in diagnosing associated components of hereditary MTC, such as pheochromocytoma and primary hyperparathyroidism.
影像学在甲状腺髓样癌（MTC）的早期检测、分期以及随访以发现早期复发方面发挥着重要作用。MTC是一种罕见的、分泌降钙素的甲状腺恶性肿瘤，通常在对任何甲状腺结节进行常规评估时，通过超声和降钙素筛查来诊断。如果血清降钙素升高，则需要进行影像学检查以进行术前分期，从而指导手术治疗。这可能包括颈部和腹部超声检查。当降钙素水平大于500 pg/mL时，术前需进行CT或MRI检查以评估更远处的病变。FDG-PET/CT和F-DOPA-PET/CT均未常规用于术前分期，但在个别疑难病例中可能有所帮助。术后降钙素升高与MTC的持续存在或复发相关。术后随访中用于定位肿瘤组织的影像学检查包括超声、CT、MRI和PET扫描。然而，应谨慎使用这些检查，因为治疗效果往往有限。此外，即使是患有持续性疾病的患者，也可能存活足够长的时间，从而因CT或PET扫描累积大量辐射剂量。影像学检查在诊断遗传性MTC的相关成分，如嗜铬细胞瘤和原发性甲状旁腺功能亢进方面也很有用。
