CAJ | 학술논문

目的探讨分化型甲状腺癌(DTC)手术及131I治疗后患者全身扫描(RxWBS)示纵隔浓聚131I的影像学特征.方法收集1998-2004年收治的331例DTC术后患者共1183次131I治疗后5～7 d的RxWBS图像,所有患者至少接受2次131I治疗,结合甲状腺球蛋白(Tg)测定、其他影像学检查及临床随访结果分析纵隔浓聚131I的影像学特征及原因.结果 331例患者中最终诊断为纵隔浓聚131I者共34例,其RxWBS主要表现为纵隔点状、团块状、哑铃状或弥漫性放射性浓聚灶.其中甲状腺癌转移者21例,残留甲状腺组织8例,其余5例胸腺摄取131I患者年龄均＜45岁.结论 DTC术后患者纵隔浓聚131I可归因于甲状腺癌转移灶、甲状腺组织及胸腺摄取等.胸腺摄取131I是45岁以下甲状腺癌术后患者RxWBS假阳性的重要原因之一,血清Tg测定及131I SPECT/CT、CT增强扫描、MRI等有助于明确诊断.
목적 탐토분화형갑상선암(DTC)수술급131I치료후환자전신소묘(RxWBS)시종격농취131I적영상학특정.방법 수집1998-2004년수치적331례DTC술후환자공1183차131I치료후5～7 d적RxWBS도상,소유환자지소접수2차131I치료,결합갑상선구단백(Tg)측정、기타영상학검사급림상수방결과분석종격농취131I적영상학특정급원인.결과 331례환자중최종진단위종격농취131I자공34례,기RxWBS주요표현위종격점상、단괴상、아령상혹미만성방사성농취조.기중갑상선암전이자21례,잔류갑상선조직8례,기여5례흉선섭취131I환자년령균＜45세.결론 DTC술후환자종격농취131I가귀인우갑상선암전이조、갑상선조직급흉선섭취등.흉선섭취131I시45세이하갑상선암술후환자RxWBS가양성적중요원인지일,혈청Tg측정급131I SPECT/CT、CT증강소묘、MRI등유조우명학진단.
Objective To analyze the mechanisms of mediastinal accumulation of131I in post-operative patients with thyroid cancer,a retrospective study of patients with differentiated thyroid cancer(DTC) was performed.Methods Three hundred and thirty-one consecutive patients with DTC during the period of 1998-2004 were reviewed.Each patient received at least two therapeutic doses of131 I.Mediastinal accumulation of131 I on post treatment whole body scans(RxWBS)taken 5～7 d post therapy was analysed and correlated with serum thyroglobulin,other imaging findings and clinical follow-up.Results Radioiodine accumulation in mediastinum was noted in 34 patients.The pattern of mediastinal activity was classified as"focal"."mass-like","diffuse"or"dumbbell"configuration.The mediastinal131 I activity was attributed to metastasis in 21 patients,functioning thyroid tissue in 8 patients,and thymus in 5 patients.All 5 patients with thymus uptake were under 45 years of age.Conclusions Differential possibilities of mediastinal accumulation of131I include metastasis.ectopic thyroid tissue.and thymus uptake.It is important to recognize that uptake of131I by the thymus in patients under 45 years of age can be a potential cause of false-positive therapy scans.Serum thyroglobulin measurement and other imaging modalities,including 131I SPECT/CT,contrasted CT and MRI,are helpful ancillary findings for further differentiation.