Nuclear Medicine and Molecular Imaging

The Korean Society of Nuclear Medicine (대한핵의학회)
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Evaluation of Usefulness of Radio-iodine SPECT/CT in Differentiated Thyroid Cancer

분화성갑상선암에서 방사성요오드 SPECT/CT의 유용성 평가

  • 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)
  • 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)
  • Published : 2007.10.31
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Abstract

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.

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.

Keywords

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