核医学在甲状腺癌中的临床应用课件.ppt
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1、核医学在甲状腺癌中的临床应用,1,核医学在甲状腺癌诊断中的临床应用,核医学在甲状腺癌中的临床应用,2,内容,甲状腺癌的诊断及鉴别诊断甲状腺癌治疗后复发、转移的监测甲状腺偶发瘤的检出,核医学在甲状腺癌中的临床应用,3,甲状腺癌的诊断及鉴别诊断,甲状腺结节发病率高触诊:3%8%高分辨率B超:20%30%,甚至可达50%甲状腺癌发病率不断升高 1/100000-男性 2.6/100000女性 女性恶性肿瘤第七位约80%为乳头状癌早期发现、预后较好,核医学在甲状腺癌中的临床应用,4,手术治疗,可明确诊断手术治疗的并发症 术后呼吸困难和窒息 喉返、喉上神经损伤 甲状旁腺功能减退 甲状腺危象未经选择的手术
2、治疗存在风险,核医学在甲状腺癌中的临床应用,5,甲状腺结节的鉴别诊断,触诊B超CTMRIFNA单光子核素显像(SPECT)正电子核素显像(PET),核医学在甲状腺癌中的临床应用,6,触诊,灵敏度最差操作者手法、经验,核医学在甲状腺癌中的临床应用,7,B超,无创价廉、性价比高灵敏度高、适合初筛 任一恶性特征诊断( 灵敏度83.3%,特异性74.0% ,准确率78.0%) 恶性特征(灵敏度、特异性),P0.05: 形状(40.0%,91.4%) 边缘毛刺( 48.3%,91.4% ) 显著低回声( 41.4%,92.2% ) 微小钙化( 44.2%,90.8% ) 巨大钙化( 9.7%,96.1%
3、 ) 良性特征(灵敏度、特异性),P0.01: 等回声(56.6%,88.1%) 海绵状( 10.4%,99.7% )操作者手法,Moon WJ, Jung SL, Lee JH, et al. Benign and malignant thyroid nodules: US differentiation-multicenter retrospective study. Radiology. 2008;247(3):762-770.,核医学在甲状腺癌中的临床应用,8,CT,价值有限灵敏度78.6%(CT)vs 85.7%(B超) 进展期病例的诊断价值高于B超,Ishigaki S, Shim
4、amoto K, Satake H, et al. Multi-slice CT of thyroid nodules: comparison with ultrasonography.Radiat Med. 2004 Sep-Oct;22(5):346-353.,腺瘤,侵犯气管,核医学在甲状腺癌中的临床应用,9,MRI,报道较少MR弥散加权 灵敏度:97.5% 特异性:91.7% 准确率:98.9%,Razek AA, Sadek AG, Kombar OR, et al. Role of apparent diffusion coefficient values in differenti
5、ation between malignant and benign solitary thyroid nodules. AJNR Am J Neuroradiol. 2008 Mar;29(3):563-8.,腺瘤,乳头状癌,囊肿,核医学在甲状腺癌中的临床应用,10,FNA,有创操作 并发症:出血、血肿 继发感染;虚脱或晕厥等灵敏度存在争议 不同学者研究差异大 Tee等综合统计后仅66% 漏诊恶性病变1/3FNA阴性者需长期随访,Tee YY, Lowe AJ, Brand CA, et al. Fine-needle aspiration may miss a third of all m
6、alignancy in palpable thyroid nodules: a comprehensive literature review.Ann Surg. 2007;246(5):714-720.,核医学在甲状腺癌中的临床应用,11,FNA,Layfield LJ, Cibas ES, Gharib H, et al. Thyroid aspiration cytology: current status. CA Cancer J Clin. 2009;59(2):99-110.,核医学在甲状腺癌中的临床应用,12,单光子核素显像,99mTc甲状腺结节功能、良恶性筛查123I、131
7、I分化型甲状腺癌转移灶寻找201Tl未分化甲状腺癌转移灶寻找99mTc(V)-DMSA髓样癌111In-Octreotide髓样癌99mTc-MIBI99mTc-tetrofosmin,Sisson JC. Thyroid. Selection of the optimal scanning agent for thyroid cancer.1997;7(2):295-302.,核医学在甲状腺癌中的临床应用,13,99mTcO4-显像,核医学在甲状腺癌中的临床应用,14,123I和131I显像,A 23-year-old patient with thyroid papillary carci
8、noma and multiple metastatic lesions to the lungs was examined with both 123I and 131I. More lesions are seen on the 123I scans (a) because of the superior spatial resolution of the images generated with this radiotracer compared to that of the post-therapy 131I scans (b),Eur J Nucl Med Mol Imaging.
9、 2007 Jul;34(7):1012-7.,核医学在甲状腺癌中的临床应用,15,201Tl显像,Nucl Med Commun. 2007 Sep;28(9):681-7.,核医学在甲状腺癌中的临床应用,16,99mTc-DMSA显像,Tc-99m DMSA (V) scan shows neck and superior mediastinal metastases in a patient with elevated postoperative serum calcitonin.,Singapore Med J. 2008 Jan;49(1):19-22.,核医学在甲状腺癌中的临床应用
10、,17,111In-DTPA-Octreotide显像,111In-DTPA-octreotide anterior scintigraphy of the lung in a 58-y-old man with metastatic MTC; pre-treatment A and post-treatment B with 90Y-DOTATOC, reveals that the number of lesions and tracer accumulation in the metastatic lesion are mainly unchanged,J Cancer Res Clin
11、 Oncol. 2004 Nov;130(11):649-56.,核医学在甲状腺癌中的临床应用,18,2,Fig. 1 Anterior view of 99mTc-methoxyisobutyl isonitrile (MIBI) (a) and 131I (b) scans, both showing thyroid remnants (white and blue arrows). The patient had undergone near-total throidectomy for papillary thyroid cancer. Thyreoglobulin value was
12、 19.7 ng/ml. MIBI scan showed mild uptake in the thyroid bed. 131I scan confirmed the presence of thyroid remnants.,99mTc-MIBI显像,Nucl Med Commun. 2010 Apr;31(4):274-9.,核医学在甲状腺癌中的临床应用,19,2,Fig. 2 Anterior view of 99mTc-methoxyisobutyl isonitrile (MIBI) (a) and 131I (b) scans in a patient who had prev
13、iously undergone near-total thyroidectomy for follicular thyroid cancer (thyreoglobulin: 2334 ng/ml). MIBI images showed abnormal uptake in the upper mediastinum (red arrows). 131I scan (b) was positive, and confirmed the presence of metastatic foci (red arrows). In this case, MIBI scan (a) revealed
14、 no area of focal tracer uptake in the thyroid bed, whereas 131I scan (b) showed residual thyroid uptake (blue arrow).,99mTc-MIBI显像,核医学在甲状腺癌中的临床应用,20,2,99mTc-tetrofosmin显像,(a) 99mTc-Tetrofosmin scan in a patient with a solitary cold nodule in the right lobe of the thyroid, showing avid tracer concen
15、tration at 30 min (left-hand image). Delayed images at 120 min show persistence of radiotracer in the region of the thyroid nodule (right-hand image). The 120/30 min radio uptake ratio was 1.24. After surgery, the histopathological report was consistent with a papillary carcinoma of the thyroid. (b)
16、 Transverse color Doppler image of the nodule illustrated in (a), showing an extensive increase in the internal central vascular flow.,Nucl Med Commun. 2007 Nov;28(11):847-51.,核医学在甲状腺癌中的临床应用,21,2,Fig. 2 (a) 99mTc-Tetrofosmin scan in a patient with a cold nodule in the left lobe of the thyroid, showi
17、ng tracer concentration at 30 min (left-hand image). Delayed images at 120 min show significant washout from the thyroid nodule (right-hand image). The 120/30 min radio uptake ratio was 0.34. The histopathology reported a colloid goiter. (b) Transverse color Doppler image of the nodule illustrated i
18、n (a), showing increased vascular flow along the periphery of the nodule.,99mTc-tetrofosmin显像,核医学在甲状腺癌中的临床应用,22,PET/CT分子影像诊断地位,PET/CT 灵敏度高、特异性强、定位精确正电子标记药物 18F-脱氧葡萄糖(FDG)是目前PET/CT最常用的药物,它能显示有氧酵解增强的肿瘤并用于疗效和预后分析。早期研究表明其对甲状腺结节鉴别诊断价值有限 灵敏度 58% 特异性100% 准确率73% SUVmax: 正常腺体 1.00.2 腺瘤 2.1 0.4 乳头状癌 4.73.2 滤泡
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