Do Negative 124I Pretherapy Positron Emission Tomography Scans in Patients with Elevated Serum Thyroglobulin Levels Predict Negative 131I Posttherapy Scans?
Do Negative 124I Pretherapy Positron Emission Tomography Scans in Patients with Elevated Serum Thyroglobulin Levels Predict Negative 131I Posttherapy Scans?
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DOI：
10.1089/thy.2013.0713
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发表时间：
2014-09-01
期刊：
影响因子：
6.6
通讯作者：
Wartofsky, Leonard
中科院分区：
文献类型：
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作者：
Khorjekar, Gauri R.;Van Nostrand, Douglas;Wartofsky, Leonard
背景资料：血清甲状腺球蛋白（Tg）水平升高且I-131或I-123扫描阴性的分化型甲状腺癌（DTC）患者的管理存在问题，关于是否给予I-131治疗（“盲”治疗）的决定也存在问题。虽然I-124正电子发射断层扫描（PET）成像已被证明比平面I-131图像检测到更多的残留甲状腺组织和/或继发于DTC的转移灶，但I-124 PET扫描阴性在决定是否考虑进行I-131盲态治疗中的效用尚不清楚。本研究的目的是确定血清Tg水平升高且I-131或I-123扫描阴性的患者治疗前I-124 PET扫描阴性是否预示治疗后I-131扫描阴性。已经进行了几项前瞻性研究，以比较I-124 PET与I-131平面成像在1）组织学证实的DTC患者中的放射性药理学作用，2）怀疑有转移性DTC（e.例如，在一个实施例中，Tg升高、近期细针穿刺细胞学检查阳性、可疑增大肿块），以及3）进行I-131平面和I-124 PET成像。使用这些标准，我们回顾性地确定了Tg升高、诊断性I-131/I-123扫描阴性、诊断性I-124 PET扫描阴性、I-131治疗、治疗后I-131扫描和既往I-131治疗且随后I-131治疗后扫描阳性的患者。对于每次扫描，两个读者分类的每一个焦点的I-131和I-124摄取为阳性甲状腺组织/转移或physical.Results：12例患者符合上述标准。这12例患者中有10例（83%）的I-131 posttherapeutic scanes.Conclusion阳性病灶：在我们选择的患者人群中，I-131 posttherapeutic scans经常是阳性的血清Tg水平升高的患者，阴性诊断I-131或I-123扫描，和阴性I-124 PET扫描。因此，对于血清Tg水平升高、诊断性I-131平面扫描呈阴性且既往I-131治疗后扫描呈阳性的患者，I-124 PET扫描阴性对I-131治疗后扫描阴性的预测值较低，不应用于排除I-131盲态治疗的选择。
Background: The management of patients with differentiated thyroid cancer (DTC) who have elevated serum thyroglobulin (Tg) levels and negative I-131 or I-123 scans is problematic, and the decision regarding whether or not to administer I-131 therapy (a "blind" therapy) is also problematic. While I-124 positron emission tomography (PET) imaging has been shown to detect more foci of residual thyroid tissue and/or metastases secondary to DTC than planar I-131 images, the utility of a negative I-124 PET scan in deciding whether or not to consider performing blind I-131 therapy is unknown. The objective of this study was to determine whether a negative I-124 pretherapy PET scan in patients with elevated serum Tg levels and negative I-131 or I-123 scans predicts a negative I-131 posttherapy scan.Methods: Several prospective studies have been performed to compare the radiopharmacokinetics of I-124 PET versus I-131 planar imaging in patients who 1) had histologically proven DTC, 2) were suspected to have metastatic DTC (e. g., elevated Tg, positive recent fine-needle aspiration cytology, suspicious enlarging mass), and 3) had I-131 planar and I-124 PET imaging performed. Using these criteria, we retrospectively identified patients who had an elevated Tg, a negative diagnostic I-131/I-123 scan, a negative diagnostic I-124 PET scan, therapy with I-131, a posttherapy I-131 scan, and a prior I-131 therapy with a subsequent positive post-I-131 therapy scan. For each scan, two readers categorized every focus of I-131 and I-124 uptake as positive for thyroid tissue/metastases or physiological.Results: Twelve patients met the above criteria. Ten of these 12 patients (83%) had positive foci on I-131 posttherapy scan.Conclusion: In our selected patient population, I-131 posttherapy scans are frequently positive in patients with elevated serum Tg levels, a negative diagnostic I-131 or I-123 scan, and a negative I-124 PET scan. Thus, for a patient with elevated serum Tg level, negative diagnostic I-131 planar scan, and a prior post-I-131 therapy scan that was positive, a negative I-124 PET scan will have a low predictive value for a negative post-I-131 therapy scan and should not be used to exclude the option of blind I-131 therapy.