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核医学分子影像在放射性碘难治性分化型甲状腺癌评估中的独特价值与争议
The unique value and controversy of nuclear medicine molecular imaging in the evaluation of radioiodine-refractory differentiated thyroid cancer
- 中国癌症杂志 2025年35卷第1期 页码：49-57
- 作者机构：
同济大学附属第十人民医院核医学科，上海 200072
- 作者简介：
[ "王任飞，医学博士，主任医师、硕士研究生导师，同济大学附属第十人民医院核医学科副主任。中华医学会核医学分会治疗学组专家指导委员会专家，中华医学会核医学分会放射性粒子介入治疗工作委员会副主任委员，中国医师协会核医学医师分会诊疗一体化学组委员，中国临床肿瘤学会核医学专委会常务委员兼秘书长。专业方向为甲状腺疾病诊治和核素靶向诊疗一体化。主持及参与国家级课题4项、省部级课题2项。以第三完成人荣获天津市科技进步二等奖一项。参编《甲状腺癌全程管理》《核素治疗病例荟萃》等专著。牵头或参与多部相关指南或共识的编写、发布与解读工作。近5年以第一作者或通信作者发表论著21篇，其中在SCI收录期刊上发表16篇。" ]
- 基金信息：
DOI：10.19401/j.cnki.1007-3639.2025.01.006
中图分类号： R736.1收稿：2024-12-13，
修回：2025-01-21，
纸质出版：2025-01-30
- 稿件说明：
移动端阅览
王任飞, 卢改霞. 核医学分子影像在放射性碘难治性分化型甲状腺癌评估中的独特价值与争议[J]. 中国癌症杂志, 2025,35(1):49-57.
Renfei WANG, Gaixia LU. The unique value and controversy of nuclear medicine molecular imaging in the evaluation of radioiodine-refractory differentiated thyroid cancer[J]. China Oncology, 2025, 35(1): 49-57.
王任飞, 卢改霞. 核医学分子影像在放射性碘难治性分化型甲状腺癌评估中的独特价值与争议[J]. 中国癌症杂志, 2025,35(1):49-57. DOI： 10.19401/j.cnki.1007-3639.2025.01.006.
Renfei WANG, Gaixia LU. The unique value and controversy of nuclear medicine molecular imaging in the evaluation of radioiodine-refractory differentiated thyroid cancer[J]. China Oncology, 2025, 35(1): 49-57. DOI： 10.19401/j.cnki.1007-3639.2025.01.006.
摘要
核医学分子影像具有无创、高灵敏度、时空动态可视化、可定性及定量分析等特点，借助融合影像技术的优势，兼备了反映功能代谢和解剖结构的特点。核医学分子影像评估贯穿于放射性碘难治性分化型甲状腺癌（radioactive iodine-refractory differentiated thyroid cancer，RAIR-DTC）诊治管理的全流程，包括界定、探查病灶、指导治疗决策、评价疗效及评估预后等。
131
I全身显像
（
131
I-whole body scan，
131
I-WBS）是判断RAIR-DTC的重要依据。其中诊断性
131
I-WBS可在
131
I治疗前探查术后残留甲状腺及可疑摄碘性转移灶，有助于后续
131
I治疗决策。治疗后
131
I-WBS可进一步明确病灶摄碘特征，以及探查诊断性WBS未能显示的病灶，为明确患者临床分期、制订随访管理方案提供参考依据。治疗后
131
I-WBS显示的病灶摄碘能力还可预判
131
I治疗效果。
131
I-WBS结合血清学及其他影像学检查还可用于评价
131
I治疗效果。
18
F-FDG正电子发射计算机体层成像（positron emission tomography and computed tomography，PET/CT）主要用于血清甲状腺球蛋白（thyroglobulin，Tg）或Tg抗体（Tg antibody，TgAb）水平持续增高而
131
I-WBS阴性的高危DTC患者，可辅助寻找和定位病灶。
18
F-FDG PET/CT与
131
I-WBS结合有助于全面评估全身肿瘤负荷。DTC转移灶摄取
18
F-FDG预示着
131
I治疗效果不佳，患者生存预后较差，是疾病快速进展及肿瘤特异性死亡风险增高的预测因素。RAIR-DTC病灶接受局部或系统治疗后，可通过治疗前后的早期代谢反应预测患者的临床获益，以便及时调整治疗方案。此外，靶向反映新生血管生成的RGD肽及前列腺特异性膜抗原、靶向成纤维细胞激活蛋白、靶向生长抑素受体等的多种新型核素显像可作为
18
F-FDG PET/CT阴性时的补充手段，探查RAIR-DTC病灶，还可根据对显像剂的摄取能力筛选适合行靶向性核素治疗的患者，为多线治疗后疾病仍进展的RAIR-DTC患者提供有效的核素诊疗一体化新选择。
Abstract
Nuclear medicine molecular imaging has the characteristics of non-invasiveness
high sensitivity
spatiotemporal dynamic visualization
qualitative and quantitative analysis
and by virtue of the advantages of fusion imaging technology
it combines the features of functional metabolism and anatomical structure. Nuclear medicine molecular imaging evaluation is integrated throughout the management of radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC)
including defining RAIR
exploring the lesions
guiding treatment decisions
evaluating efficacy
and assessing prognosis.
131
I-whole body scan (
131
I-WBS) is critical for determining RAIR-DTC. Diagnostic
131
I-WBS can be used to explore postoperative residual thyroid and suspected iodine-avid metastases before
131
I treatment
which is helpful for subsequent
131
I treatment decisions. Post-treatment
131
I-WBS can further clarify the iodine uptake characteristics of lesions and explore lesions not sh
own by diagnostic WBS
providing a reference for clarifying the clinical stage of patients and formulating follow-up management plans. The iodine uptake ability of lesions shown by post-treatment
131
I-WBS can also predict the therapeutic efficacy of
131
I treatment.
131
I-WBS combined with biochemical changes and other imaging examinations can also be used to evaluate the therapeutic efficacy of
131
I treatment.
18
F-FDG positron emission tomography and computed tomography (PET/CT) is mainly used for high-risk DTC patients with persistently elevated serum thyroglobulin (Tg) or Tg antibody (TgAb) levels and negative 131I-WBS
and can explore and locate lesions. Combining
18
F-FDG PET/CT with
131
I-WBS provides a thorough evaluation of the overall tumor burden. The uptake of
18
F-FDG by DTC metastases indicates poor
131
I treatment response and poor prognosis for patients
and is a predictor of rapid disease progression and an increased risk of tumor-specific death. After local or systemic treatment of RAIR-DTC lesions
the early metabolic response to treatment can predict the clinical benefit of patients
allowing for timely adjustment of treatment strategies. In addition
various new radionuclide imaging techniques targeting angiogenesis (such as RGD peptides and prostate specific membrane antigen)
fibroblast activation protein and somatostatin receptor can be used as supplementary means when
18
F-FDG PET/CT is negative to detect RAIR-DTC lesions. They can also screen patients who qualify for targeted radionuclide therapy based on the uptake ability of imaging agents. These novel theranostics provide new options for progressive RAIR-DTC patients after multiline treatment.
关键词
Keywords
references
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