核医学在甲状腺癌中的临床应用.pptVIP

* * * * * * * 甲状腺偶发瘤定义：患者自身无明显临床症状，仅在B超、CT及PET检查时发现的病变。 * * * * * Figure1. (1) A 52y male patient with lymphoma, a focal FDG avid lesion with calcification was incidentally detected in right lobe of thyroid (A PET image, B CT image). After surgery, the nodule was confirmed to be papillary carcinoma. (2) A 53y female cancer screening patient, a nodule with abnormal FDG uptake was found in left lobe of thyroid (C PET image, D CT image), and it was identified to be adenoma after surgery. (3) A 53y male patient with esophagus cancer, the whole thyroid showed diffuse FDG uptake (E PET image), and metastatic squamous cancer was detected after FNA. (4) A 72y female cancer screening patient, we found diffuse FDG uptake in left lobe of thyroid (F PET image), and it was considered to be Hashimoto disease after surgery. * * 本院的相关数据 2006年11月~2010年9月 15,948例非甲状腺相关疾病患者 12,080例肿瘤转移灶寻找；3,868健康体检 检出率：2.5% (395/15948) 体检者(118/3,868; 3.1%) 转移灶寻找者(277/12,080; 2.3%) (P0.05) 146例进一步病理或临床证实 恶性检出率29.5% (43/146) 甲状腺偶发瘤的检出 甲状腺偶发瘤的检出 甲状腺偶发瘤的检出 甲状腺结节良恶性鉴别价值有限 主要用于甲状腺癌的辅助诊断 甲状腺癌治疗后复发、转移诊断价值较大 尤其对于多次131I治疗后的患者（失分化） 甲状腺髓样癌及未分化癌诊断有优势 甲状腺偶发瘤的检出 总结 Thanks for your attention * A 67-year-old woman with follicular thyroid carcinoma underwent total thyroidectomy and subsequent 131I ablation. The routine follow-up with 201Tl scintigraphy (a) demonstrated a thallium-avid lesion in the upper mediastinum (arrowhead). The diffuse lung uptake of 201Tl was a non-specific finding. The thallium-positive lesion in the mediastinum was removed by surgery and metastatic follicular thyroid carcinoma was confirmed by histopathologic examinations. Due to the persistent elevated serum Tg levels, a diagnostic 131I whole-body scan was performed and showed another lesion of distant metastasis. Bone metastasis to the left ilium was confirmed by subsequent bone scan and CT. 131I therapy for the iodine-positive lesion was done and the post-treatment 131I scan (b) showed intense uptake of radioiodine in the bone lesion (