Zhu Hui, Shen Wei, Zhu Yuan, Liu Zhao, Li Zhiyong, Hou Xiancun, Wang Yuetao
Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu Province, China.
Hell J Nucl Med. 2025 May-Aug;28(2):96-114. doi: 10.1967/s002449912801. Epub 2025 Aug 4.
To evaluate whether pre-treatment salivary gland scintigraphy (SGS) with technetium-99m pertechnetate (TcO) can predict the risk of moderate to severe salivary gland dysfunction and xerostomia in differentiated thyroid cancer (DTC) patients following their first radioiodine-131 (I) therapy.
We retrospectively enrolled 149 DTC patients (107 females, 42 males; mean age 46.6±12.7 years) who underwent total thyroidectomy between October 2022 and March 2024. All subjects received pre-treatment SGS to measure the uptake index (UI) and excretion fraction (EF) of bilateral parotid and submandibular glands. Patients then underwent I therapy (1.85-5.55GBq) and repeat SGS 6-12 months later under identical conditions. Xerostomia severity was assessed using the xerostomia inventory (XI) score, categorizing patients into no/mild (XI 11-23) versus moderate-extreme xerostomia (XI 24-55).
Post-therapy, all glands exhibited significant declines in UI (parotid and submandibular glands, P<0.001) and EF (P≤0.004). There was no significant correlation between administered I dose and percentage changes in UI (ΔUI%) or EF (ΔEF). However, higher I doses were associated with increased rates of moderate-severe xerostomia (P=0.015) and higher mean XI scores (P=0.008). Receiver operating characteristic (ROC) analysis demonstrated that pre-treatment UI reliably predicted moderate to severe functional decline (ΔUI% >20%) with areas under the curve (AUC) of 0.866 for the right parotid, 0.793 for the left parotid, 0.769 for the right submandibular, and 0.816 for the left submandibular glands (all P<0.001). Additionally, ΔUI% in both submandibular glands differed significantly between patients with no/mild and moderate-extreme xerostomia (right: P=0.004; left: P=0.012).
Pretreatment TcO SGS uptake index is a dependable predictor of moderate to severe salivary gland dysfunction and xerostomia following I therapy in DTC patients, enabling early identification of individuals at high risk and guiding tailored preventive strategies.
评估用高锝酸盐-99m（TcO）进行治疗前唾液腺闪烁扫描（SGS）能否预测分化型甲状腺癌（DTC）患者首次放射性碘-131（I）治疗后发生中重度唾液腺功能障碍和口干症的风险。
我们回顾性纳入了2022年10月至2024年3月期间接受全甲状腺切除术的149例DTC患者（107例女性，42例男性；平均年龄46.6±12.7岁）。所有受试者均接受治疗前SGS，以测量双侧腮腺和颌下腺的摄取指数（UI）和排泄分数（EF）。患者随后接受I治疗（1.85 - 5.55GBq），并在6 - 12个月后在相同条件下重复进行SGS。使用口干症量表（XI）评分评估口干症严重程度，将患者分为无/轻度（XI 11 - 23）与中重度口干症（XI 24 - 55）。
治疗后，所有腺体的UI（腮腺和颌下腺，P<0.001）和EF（P≤0.004）均显著下降。给予的I剂量与UI百分比变化（ΔUI%）或EF（ΔEF）之间无显著相关性。然而，较高的I剂量与中重度口干症发生率增加（P = 0.015）和较高的平均XI评分（P = 0.008）相关。受试者工作特征（ROC）分析表明，治疗前UI能够可靠地预测中重度功能下降（ΔUI%>20%），右侧腮腺曲线下面积（AUC）为0.866，左侧腮腺为0.793，右侧颌下腺为0.769，左侧颌下腺为0.816（均P<0.001）。此外，无/轻度和中重度口干症患者的双侧颌下腺ΔUI%存在显著差异（右侧：P = 0.004；左侧：P = 0.012）。
治疗前TcO SGS摄取指数是DTC患者I治疗后中重度唾液腺功能障碍和口干症的可靠预测指标，能够早期识别高危个体并指导制定针对性的预防策略。
