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目的回顾性分析分化型甲状腺癌患者外科手术后治疗剂量的~(131)I全身显像检查发现的假阳性显像的分布及摄取原因,希望为临床工作提供有利的帮助。方法收集2007~2012年四川大学华西医院核医学科237例分化型甲状腺癌患者术后因~(131)I全身显像检查出现不能定性的显像,行单光子发射型计算机断层显像(SPECT)/CT融合显像者的资料,由两名有经验的核医学医师独立阅片,结合临床特点、生化及其他影像学资料,术后病理或随访证实为假阳性显像进行部位分布及常见原因分析。结果 237例SPECT/CT融合显像中证实为假阳性显像的病例共132例(55.7%),男性27例,女性105例;通过病理结果证实5例(鼻息肉1例,异位支气管囊肿1例,脂肪瘤1例,肾错构瘤1例,胆囊炎胆囊肿大1例),通过SPECT/CT发现放射性分布灶位于体外从而判定为污染13例,通过3~8年长时间临床随访证实为假阳性显像114例。其中头颈部出现假阳性摄取共计77例(58.3%)、盆腹部34例(25.8%)、胸部21例(15.9%)。按照摄取原理分类,假阳性显像与钠、碘同向转运子(NIS)表达有关的摄取有87例,无关的有45例。在与NIS表达有关的显像病例中43例为异位甲状腺组织,44例为非甲状腺组织。与NIS表达无关的摄取45例中,24例为炎症,13例为污染,7例为体液滞留(5例囊肿、1例脑血管畸形、1例肾错构瘤),1例为肿瘤样病变(脂肪瘤)。结论 ~(131)I全身显像中假阳性显像有一定的规律可遵循,合理利用SPECT/CT融合显像可减少误诊,避免因假阳性显像导致患者重复治疗。
Objective To retrospectively analyze the distribution and uptake of false-positive imaging revealed by ~ (131) I scintigraphy after surgery in patients with differentiated thyroid cancer and hope to provide favorable help for the clinical work. Methods A total of 237 patients with differentiated thyroid cancer from Department of Nuclear Medicine, West China Hospital of Sichuan University from 2007 to 2012 were enrolled in this study. Undefinite imaging was performed by ~ (131) I whole body imaging. Single photon emission computed tomography (SPECT) ) / CT fusion imaging data were independently read by two experienced nuclear medicine physicians and were combined with clinical features, biochemical and other imaging data, postoperative pathology or follow-up confirmed false positive imaging for site distribution and common Cause Analysis. Results A total of 132 cases (55.7%) were confirmed false-positive imaging in 237 cases of SPECT / CT fusion imaging. There were 27 males and 105 females. Pathological results confirmed 5 cases (1 case of nasal polyps, ectopic bronchial cysts 1 case of lipoma, 1 case of lipoma, 1 case of renal hamartoma, and 1 case of cholecystitis gallbladder). According to the SPECT / CT findings, 13 cases were found to be contaminated by radioactive foci located in vitro. After 3 to 8 years of long-term clinical follow-up Confirmed as false positive imaging in 114 cases. There were 77 cases (58.3%) of false positives in head and neck, 34 cases (25.8%) in pelvic abdomen and 21 cases (15.9%) in chest. According to the principle of ingestion, there were 87 cases of false-positive imaging related to the expression of sodium and iodine symporter (NIS), 45 cases unrelated. Among the imaging cases associated with NIS expression, 43 were ectopic thyroid tissue and 44 were non-thyroid tissue. Of the 45 cases unrelated to NIS expression, 24 were inflammatory, 13 were contaminated, 7 were fluid retention (5 cysts, 1 cerebral vascular malformation, 1 renal hamartoma) and 1 was tumor-like (Lipoma). Conclusion There is a certain pattern of false positive imaging in ~ (131) I scintigraphy. The rational use of SPECT / CT fusion imaging can reduce misdiagnosis and avoid repeated treatment of patients with false positive imaging.