Nuclear Medicine and Molecular Imaging

  • 제41권5호
  • /
  • Pages.350-358
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  • 2007
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  • 1869-3474(pISSN)
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  • 1869-3482(eISSN)
대한핵의학회 (The Korean Society of Nuclear Medicine)
권호 표지

분화성갑상선암에서 방사성요오드 SPECT/CT의 유용성 평가

Evaluation of Usefulness of Radio-iodine SPECT/CT in Differentiated Thyroid Cancer

  • 이정원 (국립암센터 연구소, 부속병원) ;
  • 이호영 (국립암센터 연구소, 부속병원) ;
  • 오소원 (국립암센터 연구소, 부속병원) ;
  • 김석기 (국립암센터 연구소, 부속병원) ;
  • 정기욱 (국립암센터 연구소, 부속병원) ;
  • 김선욱 (국립암센터 연구소, 부속병원) ;
  • 강건욱 (국립암센터 연구소, 부속병원)
  • Lee, Jeong-Won (Hospital and Research Institute, National Cancer Center) ;
  • Lee, Ho-Young (Hospital and Research Institute, National Cancer Center) ;
  • Oh, So-Won (Hospital and Research Institute, National Cancer Center) ;
  • Kim, Seok-Ki (Hospital and Research Institute, National Cancer Center) ;
  • Jeong, Ki-Wook (Hospital and Research Institute, National Cancer Center) ;
  • Kim, Seon-Wook (Hospital and Research Institute, National Cancer Center) ;
  • Kang, Keon-Wook (Hospital and Research Institute, National Cancer Center)
  • 발행 : 2007.10.31
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초록

목적 : 분화성갑상선암 환자의 추적 관찰에 사용되는 방사성요오드전신스캔(Radio-iodine whole body scan)은 해부학적인 정보가 부족하여, 갑상선암의 재발 및 전이와 위양성 병변을 감별하기 힘들며 재발 및 전이 병소의 정확한 해부학적인 위치를 파악하기 힘들다. 본 연구에서는 방사성요오드전신 평면스캔에서 관찰된 판별이 어려운 병변에 대해서 SPECT/CT를 시행하여, SPECT/CT의 임상적 유용성에 대해 평가하고자 하였다. 대상 및 방법 : 2006년 2월부터 7월까지 분화성갑상선암으로 방사성요오드전신스캔을 시행한 환자 253명 중, 정확한 해부학적 위치 파악이 필요하나 이를 정할 수 없는 병변이 있는 환자, 혹은 전이와 양성 병변을 판별하기 어려운 병변이 있는 환자에서 SPECT/CT를 시행하였다. 총 26명의 환자(남:여=8명:18명, 나이: $50.7{\pm}12.5$세)에서 SPECT/CT가 시행되었으며, 평면상의 영상과 SPECT/CT의 영상이 함께 평가되었다. 전이 유무는 방사성요오드전신 스캔, 방사성요오드 SPECT/CT의 결과와 혈액 검사, 그리고 추가적으로 시행한 영상 검사를 바탕으로 판단하였다. 결과 : 방사성요오드평면스캔에서는, 경부 부위에서 섭취를 보인 환자 16명 중 13명과 경부 이외 부위에서 섭취를 보인 환자 11명에서 전이가 의심되었다. SPECT/CT시행 후, 26명 중 16명의 환자(62%)에서 판정의 변화가 있었다. 경부 부위에서 SPECT/CT를 시행한 환자 16명 중 5명에서만 경부 림프절 전이가 의심되었으며, 경부 이외 부위에서 SPECT/CT를 시행한 환자 11명 중 3명에서 림프절 전이가 의심되었다. SPECT/CT상 전이가 의심된 8명 중 6명에서 추가적인 방사성요오드 치료가 시행되었으며, SPECT/CT를 시행한 26명 중 25명(58%)에서 진료방향이 변화하였다. 추적 관찰이 이루어진 25명의 환자 중 24명(96%)에서 SPECT/CT결과가 추가적인 영상 검사와 추적 관찰 결과와 부합하였다. 결론 : 방사성요오드 SPECT/CT를 통해서 갑상선암의 전이와 양성 병변을 보다 정확하게 감별할 수 있었으며, 재발 및 전이 부위의 해부학적 위치 파악에 도움이 되었다.

Purpose: Localizing and differentiating a metastatic lesion of differentiated thyroid cancer (DTC) by using radio iodine whole body scan could be difficult because a whole body scan (WBS) lacks anatomic information. This study was performed to evaluate the usefulness of radio-iodine SPECT/CT for differentiating equivocal lesions. Materials & Methods: Among 253 patients with DTC who had undergone radio-iodine scan between February and July 2006, 26 patients were enrolled (M:F = 8:18, Age $50.7{\pm}12.5$ years) in this study. The patients had abnormal uptakes in the WBSs that necessitated precise anatomical localization for differentiating between a metastatic lesion and a false-positive lesion. SPECT/CT was performed for the region with abnormal uptake in the WBS. WBS and SPECT/CT were evaluated visually. Metastases were diagnosed based on the results of the radio-iodine scan along with the results of other radiological examinations and serological tests. Results: Based on the WBS images, 13 were suspected with cervical lymph node (LN) metastases in 16 patients with abnormal neck uptake, and in the 11 patients with abnormal extra-cervical uptakes, extra-cervical metastases were doubtful in all. After SPECT/CT was performed, the diagnostic results were altered for 16 patients (62%). SPECT/CT revealed that only 5 patients had cervical LN metastases, while 3 patients had extra-cervical (mediastinal) LN metastases. Overall, there was a 58% (15/26) change in diagnoses and plans for treatment due to SPECT/CT. Among 8 patients suspected with metastases on SPECT/CT, 6 patients underwent another radio-iodine therapy. In 96% (24/25) of the patients, the results of SPECT/CT corresponded with those of further radiological examinations and with other clinical information. Conclusion: Radio-iodine SPECT/CT images permitted the differentiation of abnormal radio-iodine uptake and improved anatomical interpretation in DTC.

키워드

참고문헌

  1. Ministry of health and welfare. 2002 Annual report of the Korea central cancer registry (2003)
  2. Edwa rds BK, Howe HL, Ries, LA, Thun MJ, Rosenberg HM, Yancik R, et al. Annual report to the nation on the status of cancer, 1973.1999, featuring implications of age and aging on U.S. cancer burden. Cancer 2002:94; 2766-92 https://doi.org/10.1002/cncr.10593
  3. Lupoli GA, Fonderico F, Colarusso S, Panico A, Cavallo A, Micco L et al. Current management of differentiated thyroid carcinoma. Med Sci Monit 2005;11:368-73
  4. Weber T, Schilling T, Buchler MW. Thyroid carcinoma. Curr Opin Oncol 2006;18:30-5
  5. Sawka AM, Thephamongkhol K, Brouwers M, Thabane L, Browman G, Gerstein HC. A systemic review and metaanalysis of the effectiveness of radioactive iodine remnant ablation for well-differentiated thyroid cancer. J Clin Endocrinol Metab 2004;89:3668-76 https://doi.org/10.1210/jc.2003-031167
  6. Mazzaferri EL, Kloos RT. Current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab 2001;86:1447-63 https://doi.org/10.1210/jc.86.4.1447
  7. Shapiro B, Rufini V, Jarwan A, Geatti O, Kearfott KJ, Fig LM, et al. Artifacts, anatomical and physiologic variants, and unrelated disease that might cause false-positive whole-body 131-I scans in patients with thyroid cancer. Semin Nucl Med 2000;30:115-32 https://doi.org/10.1053/nm.2000.5414
  8. Unal S, Menda Y, Adalet I. Boztepe H, Ozbey N, Alagol F, et al. Thallium-201, technetium-99m-tetrofosmin and iodine-131 in detecting differentiated thyroid carcinoma metastases. J Nucl Med 1998;39:1897-902
  9. Intenzo CM, Jabbour S, Dam HQ, Capuzzi DM. Changing concepts in the management of differentiated thyroid cancer. Semin Nucl Med 2005;35:257-65 https://doi.org/10.1053/j.semnuclmed.2005.05.003
  10. Mitchell G, Pratt BE, Vini L, McCready VR, Harmer CL. False positive I-131 whole body scans in thyroid cancer. Br J Radiol 2000;73:627-35 https://doi.org/10.1259/bjr.73.870.10911786
  11. Tharp K, Israel O, Hausmann J, Bettman L, Martin WH, Daitzchman M et al. Impact of I-131 SPECT/CT images obtained with an integrated system in the follow-up of patients with thyroid carcinoma. Eur J Nucl Med Mol Imaging 2004;31:1435-42
  12. Townsend DW, Cherry SR. Combining anatomy and function: the path to true image fusion. Eur Radiol 2001;31:191-205
  13. Even-sapir E, Keidar Z, Sachs J, Engel A, Bettman L, Gaitini D, et al. The new technology of combined transmission and emission tomography in evaluation of endocrine neoplasm. J Nucl Med 2001;42:998-1004
  14. Pfannenberg AC, Eschmann SM, Horger M, Lamberts R, Vonthein R, Claussen CD, et al. Benefit of anatomical-functional image fusion in the diagnostic work-up of neuroendocrine neoplasm. Eur J Nucl Med Mol Imaging 2003;30:835-43 https://doi.org/10.1007/s00259-003-1160-y
  15. Yamamoto Y, Nishiyama Y, Monden T, Matsumura Y, Satoh K, Ohkawa M. Clinical usefulness of fusion of I-131 SPECT and CT images in patients with differentiated thyroid carcinoma. J Nucl Med 2003;44:1905-10
  16. Ruf J, Lehmkuhl L, Bertram H, Sandrock D, Amthauer H, Humplik B, et al. Impact of SPECT and integrated low-dose CT after radioiodine therapy on the management of patients with thyroid carcinoma. Nucl Med Commun 2004;25:1177-82 https://doi.org/10.1097/00006231-200412000-00004
  17. Sherman S. Thyroid carcinoma. Lancet 2003;361:501-11 https://doi.org/10.1016/S0140-6736(03)12488-9
  18. Robbins RJ, Chon JT, Fleisher M, Larson SM, Tuttle RM. Is the serum thyroglobulin response to recombinant human thyrotropin sufficient, by itself, to monitor for residual thyroid carcinoma. J Clin Endocrinol Metab 2002;87:3242-47 https://doi.org/10.1210/jc.87.7.3242
  19. Bryan RH, Furio P, Christoph R, Martin S, Paul WL, Steven IS, et al. A comparison of recombinant human thyrotropin and thyroid hormone withdrawal for the detection of thyroid remnant or cancer. J Clin Endocrinol Metab 1999;84:3877-85 https://doi.org/10.1210/jc.84.11.3877
  20. Mandel SJ, Shankar LK, Benard F, Yamamoto A, Alavi A. Superiority of iodine-123 compared with iodine-131 scanning for thyroid remnants in patients with differentiated thyroid cancer. Clin Nucl Med 2001; 26(1): 6-9 https://doi.org/10.1097/00003072-200101000-00002
  21. Anderson GS, Fish S, Nakhoda K, Zhuang H, Alavi A, Madel SJ. Comparison of I-123 and I-131 for whole-body imaging after stimulation by recombinant human thyrotropin: a preliminary report. Clin Nucl Med 2003; 28(2): 93-6 https://doi.org/10.1097/00003072-200302000-00001
  22. Amthauer H, Denecke T, Rohlfing T, Ruf J, Bohmig M, Gutberlet M, et al. Value of image fusion using single photon emission computed tomography with integrated low dose computed tomography in comparison with a retrospective voxel-based method in neuroendocrine tumours. Eur Radiol 2005; 15: 1456-62 https://doi.org/10.1007/s00330-004-2590-z