Sassolas G, Houzard C, Sigartau C, Borson-Chazot F
Centre de Médecine Nucléaire, Hôpital Neuro-Cardiologique, Lyon.
Ann Endocrinol (Paris). 1997;58(1):55-63.
Radioiodine scintigraphy is the gold standard exploration for imaging metastases of differentiated thyroid cancer and enables the decision of therapy with 131 radioactive iodine to be made. However, other approaches may be of use for diagnosis when there is no visible uptake after the administration of 131I, while elevated thyroblobulin levels suggest the presence of metastatic tissue in one third of metastatic patients. In order to detect recurrences or metastases, in conjunction with conventional imaging techniques (cervical and hepatic ultrasonography, lung CT scan..), other scintigraphic explorations with various radiopharmaceutics may be used, although none of them has any specificity towards thyroid cancer. Tl201 and MIBI which are used as perfusion tracers for myocardial explorations, are also used for detection of various tumors and for metastatic thyroid cancer. The performances of both radiopharmaceutics in imaging metastases are differently evaluated between investigators with a sensitivity ranging from 45 to 94% while the specificity varies less (82-97%). 18-Fluoro-deoxyglucose is retained in malignant tissue depending on the grade of malignancy. It has been shown to accumulate in thyroid cancer and metastases. Its detection by whole body PETscan represents a limitation for use which will be modified by new techniques. 111In-octreotide which binds to somatostatin receptors located on tumor cell membranes is able to show thyroid cancer metastases in some instances. We report on the very preliminary results of these combined scintigraphic approaches, performed in a limited number of patients who had no radioiodine uptake and elevated Tg levels, in order to determine the most appropriate exploration in terms of performance and cost.
放射性碘闪烁扫描是分化型甲状腺癌转移灶成像的金标准检查方法，可用于决定是否采用131放射性碘进行治疗。然而，当给予131I后未见摄取时，其他方法可能有助于诊断，而甲状腺球蛋白水平升高提示三分之一的转移患者存在转移组织。为了检测复发或转移，除了传统成像技术（颈部和肝脏超声、肺部CT扫描等）外，还可使用其他用各种放射性药物进行的闪烁扫描检查，尽管它们对甲状腺癌均无特异性。用于心肌检查的灌注示踪剂Tl201和MIBI也用于检测各种肿瘤及甲状腺癌转移灶。不同研究者对这两种放射性药物在转移灶成像方面的表现评估不同，敏感性范围为45%至94%，而特异性变化较小（82% - 97%）。18 - 氟 - 脱氧葡萄糖根据恶性程度在恶性组织中潴留。已证明它在甲状腺癌及其转移灶中蓄积。通过全身PET扫描检测它存在一定局限性，新技术将会对此进行改进。111In - 奥曲肽与位于肿瘤细胞膜上的生长抑素受体结合，在某些情况下能够显示甲状腺癌转移灶。我们报告了这些联合闪烁扫描方法的初步结果，这些检查是在少数无放射性碘摄取且甲状腺球蛋白水平升高的患者中进行的，目的是从性能和成本方面确定最合适的检查方法。
