Diferansiye Tiroid Kanserlerinde ablasyon sonrası görüntülemede boyun ve toraks bölgesindeki odakların ayırıcı tanısında SPECT-BT'nin Planar görüntülemeye katkısı ve klinik önemi

Year 2022, , 281 - 286, 01.08.2022

Farise Yılmaz , Hasan Önner , Gonca Kara Gedik

https://doi.org/10.54005/geneltip.1084572

Abstract

Amaç: Bu çalışmanın amacı, diferansiye tiroid kanserli (DTC) hastalarda I-131 ablasyon tedavisi sonrası odakların benign-malign ayrımını ve hasta yönetimini ayırt etmede Tek Foton Emisyonlu Bilgisayarlı Tomografi-Bilgisayarlı Tomografi’nin (SPECT-CT) planar görüntülemeye (WBS) göre üstünlüğünü göstermeyi amaçlamaktadır.
Gereç ve Yöntem: Tiroid kanseri nedeniyle I-131 tedavisi alan 80 hastanın, planar WBS ve SPECT-CT bulguları retrospektif olarak incelendi. Planar görüntülerdeki boyun ve torakstaki olası odaklar SPECT-CT ile karşılaştırıldı. 2015 Amerikan Tiroid Birliği (ATA) yönergelerine göre hastalar üç gruba ayrıldı: Yüksek, orta ve düşük risk grupları. Her iki görüntüleme arasındaki yorum değişiklikleri downstage ve upstage olarak kaydedildi. Bulgular: 53 kadın ve 27 erkek hasta vardı. Hastaların yaşları 21 ile 88 arasında değişmekte olup, ortalama yaş 47 ±14.2 idi. 80 hastada planar ve SPECT görüntülerinde (boyun: 118, toraks: 21) 139 odak tespit edildi. SPECT-CT, lateral boyun odaklarının %50'sinin malign patolojilerle, %50'sinin de benign patolojilerle uyumlu olduğunu ortaya koydu. Boyun orta kısmındaki odakların sadece tiroid kalıntısı (%56) değil, önemli oranda tiroglossal kanal kalıntısı (%40) odakları olduğu saptandı. Toraks bölgesindeki odakların %66'sının akciğer metastazı olduğu belirlendi. %34'ü ise kemik metastazıydı. Mediastinal bölgedeki odakların %33'ünün lenf düğümleri olduğu tespit edildi. Geriye kalan hastaların sadece birinde patolojik tanı olmasına rağmen diğerlerinin de timus patolojisi olabileceği düşünüldü. SPECT-CT, 5'i (%6.25) upstage ve 13'ü (%16.25) downstage olmak üzere 18 hastanın (%22.5) yorumunu değiştirdi.
Sonuç: Özellikle şüpheli fokal lezyonları olan orta/yüksek riskli hastalarda SPECT-CT kullanımı hasta yönetimini kolaylaştırmış olup gereksiz invazif işlemlerden kaçınılmasında etkili olmuştur. Boyunda tiroid kalıntısı dışında iyot tutulumu gösteren benign iyot tutulumu olan odakların (tiroglossal kanal kalıntısı vb.) varlığı düşük riskli hastalarda ablasyon kararı vermede etkili olabilir.
Anahtar Kelimeler: I-131, Diferansiye Tiroid Kanseri, Tüm Vücut Taraması (Whole Body Scanning), SPECT-CT

Keywords

: 131I, Diferansiye Tiroid Kanseri, Tüm Vücut Taraması (Whole Body Scanning), SPECT-CT

Contribution of SPECT-CT to planar imaging in post-ablation imaging in different thyroid cancers, the clinical significance of the differential diagnosis of neck and thorax uptakes

Abstract

Background: The aim of this study is to demonstrate the superiority of Single Photon Emission Computed Tomography-Computed Tomography (SPECT-CT) over planar imaging in distinguishing benign from malignant foci and patient management after 131I ablation therapy in patients with differentiated thyroid cancer (DTC).
Material and Methods: Planar and SPECT-CT imaging findings were retrospectively analyzed in 80 patients who received I-131 therapy for thyroid cancer. Possible foci in whole body scanning (WBS), neck, and thorax were compared with SPECT-CT. Anatomical localization of the foci and differential diagnosis of the benign and malignant lesion was made with SPECT-CT. Those without anatomical counterparts were recorded as equivocal foci. According to the 2015 American Thyroid Association (ATA) guidelines, patients were divided into three groups: High, intermediate, low-risk groups. Interpretation changes between both scannings were recorded as downstage and upstage.
Results: There were 53 female and 27 male patients. The patients' age ranged from 21 to 88 years with a mean age of 47 ±14.2. In 80 patients, 139 foci were detected in planar images and SPECT-CT images (neck: 118, thorax: 21). SPECT-CT revealed that 50% of the lateral neck foci were compatible with pathologies in malignant nature and 50% with pathologies in benign nature. Foci in the middle part of the neck were found to be not only thyroid remnant (56%), but also thyroglossal duct remnant (40%) foci at a significant rate It was determined that 66% of the foci in the thorax region were lung metastases and 34% were bone metastases. It was proved that 33% of the foci in the mediastinal region were lymph nodes. Although only one of the remaining patients had a pathological diagnosis, it was thought that all of them might have thymus pathologies. SPECT-CT images changed the interpretation of 18 patients (22.5%), of which 5 (6.25%) were upstage and 13 (16.25%) were downstage.
Conclusions: The use of SPECT-CT will be very effective, facilitating patient management and avoiding unnecessary procedures, especially in moderate/high-risk patients with suspicious focal lesions. The presence of benign iodine avid foci (thyroglossal duct residue, etc.) in the neck showing iodine uptake other than the thyroid remnant may be effective in making ablation decisions in low-risk patients.

Keywords

131I, Differentiated Thyroid Cancer, Whole Body Scanning, SPECT-CT

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