Grünwald F, Schomburg A, Bender H, Klemm E, Menzel C, Bultmann T, Palmedo H, Ruhlmann J, Kozak B, Biersack H J
Department of Nuclear Medicine, University of Bonn, Sigmund-Freud-Strasse 25, D-53127 Bonn, Germany.
Eur J Nucl Med. 1996 Mar;23(3):312-9. doi: 10.1007/BF00837630.
Whole-body fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging was performed during the follow-up of 33 patients suffering from differentiated thyroid cancer. Among them there were 26 patients with papillary and seven with follicular tumours. Primary tumour stage (pT) was pT1 in six cases, pT2 in eight cases, pT3 in three cases and pT4 in 14 cases. FDG PET was normal in 18 patients. In three patients a slightly increased metabolism was observed in the thyroid bed, assumed to be related to remnant tissue. In one case local recurrence, in ten cases lymph node metastases (one false-positive, caused by sarcoidosis) and in three cases distant metastases were found with FDG PET. In comparison with whole-body scintigraphy using iodine-131 (WBS) there were a lot of discrepancies in imaging results. Whereas three patients had distant metastases (proven with 131I) and a negative FDG PET, in four cases 131I-negative lymph node metastases were detectable with PET. Even in the patients with concordant "staging", differences between 131I and FDG were observed as to the exact lesion localization. Therefore, a coexistence of 131I-positive/FDG-negative, 131I-negative/FDG-positive and 131I-positive/FDG-positive malignant tissue can be assumed in these patients. A higher correlation of FDG PET was observed with hexakis (2-methoxyisobutylisonitrile) technetium-99m (I) (MIBI) scintigraphy (performed in 20 cases) than with WBS. In highly differentiated tumours 131I scintigraphy had a high sensitivity, whereas in poorly differentiated carcinomas FDG PET was superior. The clinical use of FDG PET can be recommended in all cases of suspected or proven recurrence and/or metastases of differentiated thyroid cancer and is particularly useful in cases with elevated serum thyroglobulin levels and negative WBS.
对33例分化型甲状腺癌患者进行随访期间，进行了全身氟-18氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）成像。其中26例为乳头状肿瘤，7例为滤泡状肿瘤。原发肿瘤分期（pT）：pT1 6例，pT2 8例，pT3 3例，pT4 14例。18例患者的FDG PET检查结果正常。3例患者甲状腺床代谢略有增加，推测与残留组织有关。FDG PET检查发现1例局部复发，10例淋巴结转移（1例假阳性，由结节病引起），3例远处转移。与使用碘-131的全身闪烁扫描（WBS）相比，成像结果存在很多差异。3例患者有远处转移（经131I证实）且FDG PET检查结果为阴性，而PET检查可发现4例131I阴性的淋巴结转移。即使在“分期”一致的患者中，131I和FDG在确切病变定位方面也存在差异。因此，可以假定这些患者中存在131I阳性/FDG阴性、131I阴性/FDG阳性和131I阳性/FDG阳性的恶性组织并存。与WBS相比，FDG PET与99m锝（I）-六甲基丙烯胺肟（MIBI）闪烁扫描（20例患者进行了该项检查）的相关性更高。在高分化肿瘤中，131I闪烁扫描具有较高的敏感性，而在低分化癌中，FDG PET更具优势。对于所有怀疑或已证实的分化型甲状腺癌复发和/或转移病例，均建议临床使用FDG PET，尤其适用于血清甲状腺球蛋白水平升高且WBS检查结果为阴性的病例。
