The Korean Journal of Medicine

  • 제81권5호
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  • Pages.595-601
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  • 2011
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지

$^{18}F$-FDG PET상 관찰되는 미만성 갑상선섭취의 임상적 의의

Clinical Meaning of Diffuse $^{18}F$-FDG PET Thyroid Uptake

  • 김희경 (전남대학교 의과대학 내과학교실) ;
  • 윤지희 (전남대학교 의과대학 내과학교실) ;
  • 김수정 (전남대학교 의과대학 내과학교실) ;
  • 강호철 (전남대학교 의과대학 내과학교실)
  • Kim, Hee-Kyung (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Yoon, Jee-Hee (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kim, Soo-Jeong (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kang, Ho-Cheol (Department of Internal Medicine, Chonnam National University Medical School)
  • 발행 : 2011.11.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 다양한 암의 진단 및 병기 결정을 위해 $^{18}F$-FDG PET/CT (FDG PET)의 이용이 급증하면서 우연히 갑상선에 FDG 섭취 증가가 발견되는 경우가 증가하고 있다. 갑상선의 국소적 FDG 섭취 증가는 갑상선암의 위험이 높다는 사실이 알려져 있으나 미만성 FDG 섭취 증가의 임상적 의미는 불분명하다. 방법: 2004년 8월부터 2006년 3월까지 암에 대한 병기 평가(1,744예) 및 건강 검진(1,559예)을 목적으로 FDG PET을 시행한 총 3,303예 중 갑상선에 비정상적인 섭취 증가를 보인 56예(1.7%, 남 13, 여 53; 나이 $55.9\;{\pm}\;10.1$)를 대상으로 하였다. FDG 섭취 정도는 $SUV_{max}$로 평가하였다. 대상 환자에서 혈청 TSH, anti-TPO Ab와 갑상선초음파검사를 시행했으며 결절이 보이는 경우 미세침흡인세포검사를 시행하였다. 결과: FDG PET에서 갑상선 FDG 섭취 증가는 국소 섭취가 더 흔했으며(34 vs. 22) 악성의 빈도는 국소 섭취군에서 더 흔했으나 미만 섭취군과 유의한 차이는 없었다(12예[35.3%] vs. 3예[13.6%], p = 0.07). 미만 섭취군 22명 중 17예(77.3%)에서 자가면역갑상선질환이 있었고(원발성갑상선림프종 1명 포함), 3명은 정상 갑상선, 그리고 갑상선유두암과 전이성폐암이 각각 1예씩 확인되었다. 미만 섭취 군에서 TSH 증가 정도 및 anti-TPO Ab 역가와 $SUV_{max}$ 간에 상관관계는 없었으며(p = 0.086, p = 0.057) 악성소견을 보인 3예의 $SUV_{max}$는 높았으나 양성군에 비교하여 통계학적 차이는 없었다. 결론: FDG PET에서 미만성 갑상선 섭취는 대부분 자가 면역성갑상선질환을 시사했으나 암의 빈도에 있어 국소섭취와 차이가 없었고 FDG PET만으로는 암을 감별할 수 없었다. 갑상선에 미만성 FDG 섭취를 보이는 환자에서는 자가 면역갑상선질환을 진단하기 위한 혈액검사뿐만 아니라 암을 배제하기 위한 갑상선초음파검사 및 미세침흡인세포검사가 필요할 것으로 생각한다.

Background/Aims: Thyroid abnormalities are frequently detected in patients undergoing $^{18}F$-fludeoxyglucose positron emission tomography (FDG-PET). The clinical importance of diffuse thyroid FDG uptake (DU) has been controversial, although focal thyroid FDG uptake (FU) indicates a high probability for thyroid cancer. Methods: In total, 3,303 subjects underwent PET for cancer staging (n = 1,744) or a health screening (n = 1,559) between August 2004 and March 2006. Fifty-six (1.7%) subjects showed FU (n = 34) or DU (n = 22). Serum thyroid simulating hormone (TSH) and thyroid autoantibodies were measured with high-resolution thyroid ultrasonography (US). US-guided fine-needle aspiration cytology was performed when a nodular lesion was found. Results: Twelve of 34 (35.3%) patients with FU and 3 of 22 (13.6%) patients with DU had a malignancy. This difference in malignancy frequency was not significant between the two groups (p = 0.07). The US findings were consistent with chronic thyroiditis in 17 of 22 (77.3%) patients with DU. Three cases of DU had an apparently normal thyroid gland. In the three patients diagnosed with a malignancy in the DU group, the tumors included one papillary thyroid cancer, one primary thyroid lymphoma, and one metastatic squamous cell carcinoma from lung cancer. No correlation between TSH and $SUV_{max}$ (p = 0.086) was observed in the DU group, and the $SUV_{max}$ in patients with a malignancy was not different from that in the benign group. Conclusions: Most patients with DU had chronic autoimmune thyroiditis, but the frequency of malignancy was not different from that of the FU group. Further clinical examinations, including thyroid function tests, thyroid autoantibodies, and thyroid US are needed to diagnose chronic autoimmune thyroiditis and possible thyroid malignancy in subjects with DU.

키워드

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