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2024-04-16 星期二
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邓惠兴,吉婷,王岐,杨路路,杨爱民.⁹⁹Tc^mO₄^- SPECT/CT评估¹³¹I治疗格雷夫斯病效果[J].中国医学影像技术,2021,37(12):1885~1889

⁹⁹Tc^mO₄^- SPECT/CT评估¹³¹I治疗格雷夫斯病效果

⁹⁹Tc^mO₄^- SPECT/CT for evaluating the therapeutic efficacy of ¹³¹I in treatment of Graves disease

投稿时间：2020-07-12 修订日期：2021-09-24

DOI：10.13929/j.issn.1003-3289.2021.12.030

中文关键词: 格雷夫斯病锝体层摄影术,发射型计算机,单光子体层摄影术,X线计算机

英文关键词:Graves disease technetium tomography, emission-computed, single-photon tomography, X-ray computed

基金项目:

作者	单位	E-mail
邓惠兴	西安交通大学第一附属医院核医学科, 陕西西安 710061
吉婷	西安交通大学第一附属医院核医学科, 陕西西安 710061
王岐	西安交通大学第一附属医院核医学科, 陕西西安 710061
杨路路	西安交通大学第一附属医院核医学科, 陕西西安 710061
杨爱民	西安交通大学第一附属医院核医学科, 陕西西安 710061	yangaimin@mail.xjtu.edu.cn

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中文摘要:

目的观察⁹⁹Tc^mO₄^- SPECT/CT评估¹³¹I治疗格雷夫斯病（GD）效果的价值。方法根据随访结果将44例接受¹³¹I治疗的GD患者分为治愈组（n=20）、未愈组（n=9）和甲减组（n=15），观察各组治疗前、后⁹⁹Tc^mO₄^- SPECT/CT定量参数的差异，包括甲状腺体积、平均标准摄取值（SUV_mean）、最大标准摄取值（SUV_max）、锝摄取率及功能甲状腺质量（FTM），及其与总三碘甲腺原氨酸（TT₃）、总甲状腺素（TT₄）、游离三碘甲腺原氨酸（FT₃）、游离甲状腺素（FT₄）及促甲状腺素（TSH）水平的关系，并观察各参数评估¹³¹I疗效的效能。结果治疗前，3组甲状腺体积及SUV_mean差异均有统计学意义（P均<0.05），而SUV_max、锝摄取率及FTM间差异无统计学意义（P均>0.05）。治疗后，3组甲状腺体积、SUV_mean、SUV_max、锝摄取率及FTM差异均有统计学意义（P均<0.05）；且所有患者治疗后甲状腺体积、SUV_mean、SUV_max、锝摄取率及FTM均较治疗前明显减小（P均<0.001）。其中，治愈组和甲减组治疗后甲状腺体积、SUV_mean、SUV_max、锝摄取率和FTM均较治疗前明显减小（P均<0.001），而未愈组则无明显变化（P均>0.05）。治疗前、后甲状腺24 h摄碘率差值与SUV_mean差值及SUV_max差值均呈极强正相关（r=0.86、0.84，P均<0.05），与FTM差值呈中度正相关（r=0.46，P<0.05），而与锝摄取率差值呈弱正相关（r=0.38，P<0.05）。治疗前、后甲状腺体积差值与TT₃差值呈弱正相关（r=0.37，P<0.05），而与FT₃差值呈中度正相关（r=0.43，P<0.05）。治疗前SUV_mean、SUV_max和锝摄取率判断¹³¹I治疗有效的曲线下面积（AUC）分别为0.84、0.74和0.85；治疗后，甲状腺体积、SUV_mean、SUV_max、锝摄取率及FTM较治疗前变化百分比的AUC分别为0.76、0.92、0.94、0.95及0.96，最佳截断值分别为34.50%、18.50%、24.50%、55.00%和53.00%。结论 ⁹⁹Tc^mO₄^- SPECT/CT定量参数甲状腺体积、SUV_mean、SUV_max、锝摄取率和FTM评估¹³¹I治疗GD效果具有一定价值。

英文摘要:

Objective To observe the value of ⁹⁹Tc^mO₄^- SPECT/CT for evaluating the therapeutic efficacy of ¹³¹I in treatment of Graves disease (GD). Methods Totally 44 GD patients who received ¹³¹I treatment were enrolled and divided into cured group (n=20), non-cured group (n=9) and hypothyroidism group (n=15) according to follow-up results after treatments. ⁹⁹Tc^mO₄^- SPECT/CT quantitative parameters, including the thyroid volume, the average standard uptake value (SUV_mean) and the maximum standard uptake value (SUV_max), the technetium uptake rate and functional thyroid mass (FTM) and their relationships with total triiodothyronine (TT₃), total thyroxine (TT₄), free triiodothyronine (FT₃), free thyroxine (FT₄) and thyroid stimulating hormone (TSH) were observed before and after treatment and compared among 3 groups. The efficacies of the above quantitative parameters for evaluating the efficacy of ¹³¹I treatment were observed. Results Before treatment, there were significant differences of thyroid volume and SUV_mean among 3 groups (both P<0.05), but not of SUV_max, technetium uptake rate nor FTM (all P>0.05). After treatment, significant differences of thyroid volume, SUV_mean, SUV_max, technetium uptake rate and FTM were observed among 3 groups (all P<0.05). After treatment The thyroid volume, SUV_mean, SUV_max, technetium uptake rate and FTM of all 44 patients were significantly lower than those before treatment (all P<0.001). The thyroid volume, SUV_mean, SUV_max, technetium uptake rate and FTM decreased significantly after treatment in cured group and hypothyroidism group (all P<0.001), but no significant change of the above parameters in non-cured group was found (all P>0.05). The difference of 24 h thyroid iodine uptake rate before and after treatment was strongly positively correlated with differences of SUV_mean and SUV_max (r=0.86, 0.84, both P<0.05), moderately positively correlated with the difference of FTM (r=0.46, P<0.05), and weakly positively correlated with the difference of Technetium uptake rate (r=0.38, P<0.05). The difference of thyroid volume before and after treatment was weakly positively correlated with the difference of TT₃ (r=0.37, P<0.05), moderately positively correlated with the difference of FT₃ (r=0.43, P<0.05). The area under the curve (AUC) of SUV_mean, SUV_max and technetium uptake rate before treatment for evaluating the efficacy of ¹³¹I was 0.84, 0.74 and 0.85, respectively, of percentage change of thyroid volume, SUV_mean, SUV_max, technetium uptake rate and FTM was 0.76, 0.92, 0.94, 0.95 and 0.96, respectively, with the best cut-off value of 34.50%, 18.50%, 24.50%, 55.00% and 53.00%, respectively. Conclusion ⁹⁹Tc^mO₄^- SPECT/CT quantitative parameters, including thyroid volume, SUV_mean, SUV_max, technetium uptake rate and FTM had certain value for evaluating the efficacy of ¹³¹I in treatment of GD.

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