¹³¹I全身显像、CT与Tg/TgAb诊断分化型甲状腺癌肺转移的研究

【作者】 李亚；

【导师】 左书耀；

【作者基本信息】 青岛大学 ， 放射医学， 2015， 硕士

【摘要】 目的研究分化型甲状腺癌(differentiated thyroid carcinoma,DTC)肺转移灶在131I全身显像、CT与Tg/Tg Ab中的表现,为诊断和鉴别诊断DTC肺转移及治疗该病灶提供较好的参考依据。方法选择2007年1月至2014年7月期间于青岛大学附属医院核医学科131I“清甲”治疗后的DTC肺转移患者55例,分为131I-WBS阳性组与131I-WBS阴性组,131I-WBS阳性组又分为弥漫性131I摄取与局灶性131I摄取两类。胸部CT表现分为小结节(结节直径≤10mm)、大结节(结节直径>10mm)及无结节三种类型。将三者分别与131I-WBS的表现对比分析,并对胸部CT与131I-WBS不同影像表现对应的Tg/Tg Ab水平进行分析比较。结果55例DTC肺转移患者中,41例131I-WBS显示放射性分布阳性,检查阳性率为74.5%(41/55)。42例胸部CT检查阳性,检查阳性率为76.4%(42/55),CT阳性的42例患者中,有33例表现为双肺多发小结节,另有9例表现为双肺多发大结节。血清Tg和Tg Ab检测55例DTC肺转移患者,Tg/Tg Ab联合检测阳性者50例,检测阳性率达90.9%(50/55)。131I-WBS与胸部CT诊断肺转移灶的阳性率比较差异无显著性意义(?2=0.05,P>0.05)。胸部CT显示肺转移呈大结节的患者与肺转移呈小结节的患者,其131I-WBS显像结果比较差异无显著性意义(?2=3.24,P>0.05)。131I-WBS与Tg/Tg Ab诊断肺转移灶的阳性率比较差异有显著性意义(?2=5.15,P<0.05)。胸部CT与Tg/Tg Ab诊断肺转移灶的阳性率比较差异有显著性意义(?2=4.25,P<0.05)。CT显示小结节、大结节以及无结节三种类型的患者,其Tg水平相比并无明显统计学差异(F=1.63,P>0.05)。结论1.131I-WBS、胸部CT与Tg/TgAb诊断DTC肺转移,均有较高的阳性率,其中Tg/Tg Ab检测DTC肺转移的阳性率高于131I-WBS与胸部CT。2.DTC肺转移灶在胸部CT表现的大结节影和小结影,对应的131I-WBS显像结果表现无差别,提示不能仅凭肺转移灶直径大小判断其是否对131I治疗敏感。更多还原

【Abstract】 Objective To investigate the results of131I-WBS、CT and Tg/TgAb in the patients of DTC with pulmonary metastasis. To provide a reference for the diagnosis and differential diagnosis of pulmonary metastasis, and solutions to the treatment of disease.Methods Observing 55 cases of DTC patients with pulmonary metastases who received 131 I treatment in course of Jan.2007 to Jul.2014 in Department of Nuclear Medicine of our hospital. 55 patients were divided into131I-WBS positive group and131I-WBS negative group, 131I-WBS positive group included 131 I diffuse uptake and131 I nodular uptake of two kinds. Chest CT were divided into three kinds, including small nodules(diameter of nodule less than 10mm) 、 large nodules(diameter of nodule large than 10mm) and no nodules. The three kinds of CT were compared with131I-WBS, and the Tg/Tg Ab level of the different images of chest CT and 131I-WBS was analyzed and compared.Results The sensitivity of 131I-WBS、CT and Tg/TgAb were 74.5%, 76.4% and90.9% respectively. There was no significant difference between the131I-WBS and chest CT( ?2=0.05, P > 0.05). Patients with large nodular metastasis and small nodular metastasis on CT, had different 131I-WBS( ?2=3.98,P<0.05). The sensitivity of Tg/Tg Ab was higher than the 131 I-WBS( ?2=5.15,P<0.05). There was significant difference in the CT and Tg/Tg Ab( ?2=4.25,P<0.05). CT showed no significant differences in Tg levels between three types nodules, large nodules and no nodules(F=1.63,P> 0.05). with 18.2% of DTC patients with pulmonary metastasis have only positive 131I-WBS.Conclude The sensitivity of131I-WBS 、CT and Tg/TgAb are all pretty high in the diagnosis of DTC pulmonary metastases. The sensitivity of Tg/Tg Ab is significantly higher than the131I-WBS and CT. Lung metastases, poorly differentiated or not differentiation, lower taken iodine ability, surface contamination, and lung benign disease can lead to the inconsistent between131I- WBS and chest CT. The combination of Tg/Tg Ab、 131 I SPECT/CT and PET/CT is necessary to make a better treatment.更多还原