摘要
目的探讨^(131)I-SPECT/CT断层显像指导分化型甲状腺癌(DTC)分期及诊疗的价值。方法选取我院2021年3月-2024年3月收治的210例首次接受^(131)I治疗患者为研究对象,于治疗后48~72 h完成^(131)I-SPECT/CT断层显像及^(131)I全身显像(WBS),分析^(131)I-SPECT/CT断层显像在DTC分期和诊疗中的应用价值。结果210例患者DTC经过^(131)I-W BS检查发现252个异常摄碘灶,其中甲状腺残留68个病灶(26.98%)、颈部淋巴结转移109个病灶(43.25%)、可疑病灶23个病灶(9.13%)、远处转移52个病灶(20.63%);经过^(131)I-SPECT/CT检查确定甲状腺残留49个病灶(19.44%)、颈部淋巴结转移135个病灶(53.57%)、颈部污染8个病灶(3.17%)、远处转移60个病灶(23.81%)。252个病灶经过半年以上的^(131)I-SPECT/CT、超声、CT结果随访及临床医生意见等综合判断,发现有197个转移灶,55个单纯残留病灶;^(131)I-WBS诊断184个转移灶,68个单纯残留病灶;^(131)I-SPECT/CT诊断195个转移灶,57个单纯残留病灶。^(131)I-SPECT/CT断层显像灵敏度、特异度、准确度、阳性预测值、阴性预测值高于^(131)I-WBS(P<0.05);且~(31)I-SPECT/CT断层显像诊断DTC转移灶与金标准一致性高于^(131)I-WBS(Kappa值分别为0.931、0.668)。根据^(131)I-SPECT/CT断层显像结果,210例DTC患者中有34例临床分期从M1期调整为M2期,有8例临床分期从M2期调整为M3期,共改变42例患者的术后分期。且基于临床分期及^(131)I-SPECT/CT断层显像结果我科共调整42例(20.00%)DTC患者^(131)I治疗方案。结论^(131)I-SPECT/CT断层显像可指导DTC患者术后分期,弥补^(131)I-WBS的不足,为DTC患者1311治疗方案制定提供可靠依据。
Objective To explore the value of^(131)I-SPECT/CT tomography on guiding the staging,diagnosis and treatment of differentiated thyroid carcinoma(DTC).Methods 210 patients who received^(131)I treatment for the first time in the hospital were selected from March 2021 to March 2024 as the research subjects.^(131)I-SPECT/CT tomography and^(131)I whole body scanning(WBS)were completed at 48-72hours after treatment.The application value of^(131)I-SPECT/CT tomography on DTC staging and diagnosis and treatment was analyzed.Results After^(131)I-WBS examination of 210 DTC patients,252 abnormal iodine uptake foci were found,including 68 residual thyroid lesions(26.98%),109 cervical lymph node metastases(43.25%),23 suspected lesions(9.13%)and 52 distant metastases(20.63%).After^(131)I-SPECT/CT examination,49 residual thyroid lesions(19.44%),135 cervical lymph node metastases(53.57%),8 ce rvical conta mination lesions(3.17%)a nd 60 dista nt metastases(23.81%)were identified.After more than half a year of follow-up with^(131)I-PECT/CT ultrasound and CT and clinicians'opinions,197 metastases and 55 simple residual lesions were found in 252 lesions.184 metastases and 68simple residual lesions were diagn osed by^(131)I-WBS,and 195 metastases and 57 simple residual lesions by^(131)I-SPECT/CT.The sensitivity.specificity,accuracy,positive predictive value a nd negative predictive value of^(131)I-SPECT/CT were higher than those of^(131)I-WBS(P<0.05).The consistency of^(131)I-SPECT/CT in the diagnosis of DTC metastases with gold standard was higher than that of^(131)I-WBS(Kappa=0.931,0.668).According to the results of^(131)I-SPECT/CT tomography,34 cases of 210 DTC patients were adjusted from M1 stage to M2 stage,and 8 cases were adjusted from M2 stage to M3 stage,which changed the postoperative staging of 42 patients.Based on the clinical staging and^(131)I-SPECT/CT imaging results,the department adjusted the^(131)I treatment regimen for 42 DTC patients(20.00%).Conclusion^(131)I-SPECT/CT tomography can guide the postoperative staging of DTC patients,make up for the deficiency of^(131)I-WBS,and provide a reliable basis for the formulation of^(131)I treatment regimen for DTC patients.
作者
李新经
武辰
孙策
路晓
董易航
孟姗
张中骥
LI Xin-jing;WU Chen;SUN Ce;LU Xiao;DONG Yi-hang;MENG Shan;ZHANG Zhong-Ji(Department of Nuclear Medicine,Nanyang First People's Hospital,Nanyang 473010,Henan Province,China;Department of Thyroid and Breast Surgery,Nanyang First People's Hospital,Nanyang 473010,Henan Province,China;Department of Immunology,Xixia County People's Hospital,Xixia 474500,Henan Province,China)
出处
《中国CT和MRI杂志》
2025年第1期38-40,共3页
Chinese Journal of CT and MRI
基金
河南省医学科技攻关计划省部共建项目立项(SBGJ202302059)。
作者简介
第一作者:李新经,男,副主任医师,主要研究方向:核医学SPECT-CT影像诊断、131碘甲亢及甲状腺癌治疗。E-mail:3169057280@qq.com;通讯作者:张中骥,男,副主任医师,主要研究方向:甲状腺恶性肿瘤的综合治疗、甲状腺恶性肿瘤的新技术新治疗方式探索及应用。E-mail:zzj7@hotmail.com。
