한국방사선학회논문지 (Journal of the Korean Society of Radiology)

  • 제8권5호
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  • Pages.241-248
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  • 2014
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  • 1976-0620(pISSN)
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  • 2384-0633(eISSN)
한국방사선학회 (The Korean Society of Radiology)
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자가 면역 갑상선 질환에 대한 최대 표준섭취계수와 갑상선 자가 항체의 임상적 상관관계: 하시모토 갑상선염과 그레이브스병 중심으로

Clinical Correlation between the Autoimmune Thyroid Disease for the Thyroid Autoimmune Antibodies and the Maximum Standardized Uptake Value: Base on the Hashimoto's Thyroiditis and the Graves' Disease

  • 우민선 (동의대학교 방사선학과) ;
  • 백철인 (동의대학교 방사선학과) ;
  • 유주은 (동의대학교 방사선학과) ;
  • 송종우 (동의대학교 방사선학과) ;
  • 임인철 (동의대학교 방사선학과) ;
  • 손주철 (동남권원자력의학원 핵의학과) ;
  • 조수동 (부산보훈병원 영상의학과) ;
  • 이재승 (동의대학교 방사선학과)
  • Woo, Minsun (Department of Radiological Science, Dongeui University) ;
  • Baek, Chulin (Department of Radiological Science, Dongeui University) ;
  • Yoo, Jueun (Department of Radiological Science, Dongeui University) ;
  • Song, Jongwoo (Department of Radiological Science, Dongeui University) ;
  • Im, Inchul (Department of Radiological Science, Dongeui University) ;
  • Son, Juchul (Department of Nuclear Medicine, Southeastern Institute of Radiological Hospital) ;
  • Cho, Soodong (Department of Radiology, Busan Veterans Hospital) ;
  • Lee, Jaeseung (Department of Radiological Science, Dongeui University)
  • 투고 : 2014.05.26
  • 심사 : 2014.08.25
  • 발행 : 2014.08.30
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초록

본 연구는 미만성 $^{18}F-FDG$ 갑상선 섭취를 보이는 PET/CT 영상에서 최대 표준섭취계수($SUV_{max}$)와 갑상선 자가 항체(anti-TPO Ab, anti-TG Ab, TSH)들 사이의 임상적 상관관계를 하시모토 갑상선염과 그레이브스병 중심으로 분석하였다. 이를 위하여 2010년 5월부터 2013년 4월까지 건강검진에서 PET/CT 검사를 시행한 환자 1,097명을 대상으로 미만성 FDG 갑상선 섭취 여부를 분석하여 갑상선 기능 검사와 초음파 검사를 추가적으로 시행하였다. 결과적으로 미만성 $^{18}F-FDG$ 갑상선 섭취를 보이는 자가 면역 갑상선 질환 환자는 39명(3.6%)이 발견되었으며 하시모토 갑상선염은 43.6%, 그레이브스병은 23.1% 이었다. 하시모토 갑상선염은 anti-TPO Ab와 anti-TG 수준이 높은 역가의 양성 반응을 보였으며 $SUV_{max}$와 anti-TPO Ab간 상관계수가 통계적으로 유의하였다(r>0.4, p<0.05). 또한 그레이브스병은 대부분의 갑상선 자가 항체의 수준이 높은 역가의 양성 반응을 보였으며 $SUV_{max}$와 TSH간 상관계수가 통계적으로 유의하였다(r>0.5, p<0.01). 따라서 미만성 18F-FDG 갑상선 섭취 증가에 따른 $SUV_{max}$ 수준이 높을수록 하시모토 갑상선염은 anti-TPO Ab 수준이, 그레이브스병은 TSH 수준이 비례적으로 증가됨을 알 수 있었고 이러한 상관관계는 자가 면역 갑상선 질환에 대한 부대 징후를 판단할 수 있는 가장 영향력 있는 척도로서 임상적 적용이 가능할 것으로 판단하였다.

The purpose of this study were to analyze the clinical correlation between the thyroid autoimmune antibodies (anti-TPO Ab, anti-TG Ab, and TSH) and the maximum standardized uptake value ($SUV_{max}$) base on the Hashimoto's thyroiditis and the Graves' disease in diffusely $^{18}F-FDG$ uptake of the thyroid gland to the PET/CT image. To achieve this, we was performed the PET/CT examination for the 1,097 subjects from May 2010 to April 2013 in the health screening, and was detected the diffused FDG thyroid uptake, and was additionally performed the thyroid function test (TFT) and the ultrasound (US). As a results, the autoimmune thyroid disease with the diffused FDG thyroid uptake were discovered 39 patients (3.9%), of this, the Hashimoto's thyroiditis was 43.6% and the Graves' disease was 23.1%. Hashimoto's thyroiditis was shown the positive reaction of high titer between the anti-TPO Ab and the anti-TG Ab level, and the correlation coefficient between the $SUV_{max}$ and the anti-TPO Ab was a statistically significant (r>04, p<0.05). Also, Graves' disease was shown the positive reaction of high titer most of the thyroid autoimmune antibodies, and the correlation coefficient between the $SUV_{max}$ and the anti-TPO Ab was a statistically significant (r>05, p<0.01). Therefor, when have a high standard of the $SUV_{max}$ due to the diffusely $^{18}F-FDG$ uptake of the thyroid gland, Hashimoto's thyroiditis and Graves' disease were proportionally increased the anti-TPO Ab and TSH level, respectively. The correlation coefficient between the $SUV_{max}$ and the thyroid autoimmune antibodies will be the most influential criterion that was a standard of judgment for the epihpenomenon of the autoimmune thyroid disease, and it will be available for the clinical application.

키워드

참고문헌

  1. O. Warburg, F. Wind, E. Negelein, "The metabolism of tumors in the body", J. Gen. Physiol., Vol. 8, No. 6, pp.519-530, 1927. https://doi.org/10.1085/jgp.8.6.519
  2. G. W. Gould, H. M. Thomas, T. J. Jess, G. I. Bell, "Expression of human glucose transporters in Xenopus oocytes: kinetic characterization and substrate specificities of the erythrocyte, liver, and brain isoforms", Biochemistry, Vol. 30, No. 21, pp.5139-5145, 1991. https://doi.org/10.1021/bi00235a004
  3. Y. Hosaka, M. Tawata, A. Kurihara, M. Ohtaka, T. Endo, T. Onaya, "The regulation of two distinct glucose transporter (GLUT1 and GLUT4) gene expressions in cultured rat thyroid cells by thyrotropin", Endocrinology, Vol. 131, No. 1, pp.159-165, 1992. https://doi.org/10.1210/endo.131.1.1319316
  4. J. W. Fletcher, B. Djulbegovic, H. P. Soares, et al., "Recommendations on the use of 18F-FDG PET in oncology", J. Nucl. Med., Vol. 49, No. 3, pp.480-508, 2008. https://doi.org/10.2967/jnumed.107.047787
  5. N. Federman, S. A. Feig, "PET/CT in evaluating pediatric malignancies: a clinician's perspective", J. Nucl. Med., Vol. 48, No. 12, pp.1920-1922, 2007. https://doi.org/10.2967/jnumed.107.046045
  6. R. Lavayssiere, A. E. Cabee, J. E. Filmont, "Positron Emission Tomography (PET) and breast cancer in clinical practice", Eur. J. Radiol., Vol. 69, No. 1, pp.50-58, 2009. https://doi.org/10.1016/j.ejrad.2008.07.039
  7. Y. Nakamoto, M. Tatsumi, D. Hammoud, C. Cohade, M. M. Osman, R. L. Wahl, "Normal FDG distribution patterns in the head and neck: PET/CT evaluation", Radiology, Vol. 234, No. 3, pp.879-885, 2005. https://doi.org/10.1148/radiol.2343030301
  8. C. Are, J. F. Hsu, H. Schoder, J. P. Shah, S. M. Larson, A. R. Shaha, "FDG-PET detected thyroid incidentalomas: need for further investigation?", Ann. Surg. Oncol., Vol. 14, No. 1, pp.239-247, 2007.
  9. P. D. Shreve, Y. Anzai, R. L. Wahl, "Pitfalls in oncologic diagnosis with FDG PET imaging: physiologic and benign variants", Radiographics, Vol. 19, No. 1, pp.150-151, 1999.
  10. S. Yasuda, A. Shohtsu, M. Ide, S. Takagi, W. Takahashi, Y. Suzuki, M. Horiuchi, "Chronic thyroiditis: diffuse uptake of FDG at PET", Radiology, Vol. 207, No. 3, pp.775-778, 1998. https://doi.org/10.1148/radiology.207.3.9609903
  11. B. A. Gordon, F. L. Flanagan, F. Dehdashti, "Whole-body positron emission tomography: normal variations, pitfalls, and technical considerations", AJR Am. J. Roentgenol., Vol. 169, No. 6, pp.1675-1680, 1997. https://doi.org/10.2214/ajr.169.6.9393189
  12. M. Lin, C. Wong, P. Lin, I. H. Shon, R. Cuganesan, S. Som, "The prevalence and clinical significance of (18)F-2-fluoro-2-deoxy-D-glucose (FDG) uptake in the thyroid gland on PET or PET-CT in patients with lymphoma", Hematol. Oncol., Vol. 29, No. 2, pp.67-74, 2011. https://doi.org/10.1002/hon.955
  13. Y. Liu, "Clinical significance of thyroid uptake on F18-fluorodeoxyglucose positron emission tomography", Ann. Nucl. Med., Vol. 23, No. 1, pp.17-23, 2009. https://doi.org/10.1007/s12149-008-0198-0
  14. M. Salvatori, L. Melis, P. Castaldi, M. L. Maussier, V. Rufini, G. Perotti, D. Rubello, "Clinical significance of focal and diffuse thyroid diseases identified by (18)F-fluorodeoxyglucose positron emission tomography", Biomed. Pharmacother., Vol. 61, No. 8, pp.488-493, 2007. https://doi.org/10.1016/j.biopha.2007.05.001
  15. D. Karantanis, T. V. Bogsrud, G. A. Wiseman, B. P. Mullan, R. M. Subramaniam, M. A. Nathan, P. J. Peller, R. S. Bahn, V. J. Lowe, "Clinical significance of diffusely increased 18F-FDG uptake in the thyroid gland", J. Nucl. Med., Vol. 48, No. 6, pp.896-901, 2007. https://doi.org/10.2967/jnumed.106.039024
  16. J. Y. Choi, K. S. Lee, H. J. Kim, Y. M. Shim, O. J. Kwon, K. Park, C. H. Baek, J. H. Chung, K. H. Lee, B. T. Kim, "Focal thyroid lesions incidentally identified by integrated 18F-FDG PET/CT: clinical significance and improved characterization", J. Nucl. Med., Vol. 47, No. 4, pp.609-615, 2006.
  17. T. Kotani, K. Umeki, K. Hirai, S. Ohtaki, "Experimental murine thyroiditis induced by porcine thyroid peroxidase and its transfer by the antigen-specific T cell line", Clin. Exp. Immunol., Vol. 80, No. 1, pp.11-18, 1990.
  18. R. Finke, P. Seto, "Rapoport B.Evidence for the highly conformational nature of the epitope(s) on human thyroid peroxidase that are recognized by sera from patients with Hashimoto's thyroiditis", J. Clin. Endocrinol. Metab., Vol. 71, No. 1, pp.53-59, 1990. https://doi.org/10.1210/jcem-71-1-53
  19. A. P. Weetman, "Graves's disease", N. Engl. J. Med., Vol. 343, No. 17, pp.1236-1248, 2000. https://doi.org/10.1056/NEJM200010263431707
  20. C. M. Dayan, G. H. Daniels, "Chronic autoimmune thyroiditis", N. Engl. J. Med., Vol. 335, No. 2, pp.99-107, 1996. https://doi.org/10.1056/NEJM199607113350206
  21. U. Tateishi, C. Gamez, S. Dawood, H. W. Yeung, M. Cristofanilli, T. Inoue, H. A. Macapinlac, "Chronic thyroiditis in patients with advanced breast carcinoma: metabolic and morphologic changes on PET-CT", Eur. J. Nucl. Med. Mol. Imaging, Vol. 36, No. 6, pp.894-902, 2009. https://doi.org/10.1007/s00259-008-1048-y
  22. J. I. Kim, J. S. Oh, K. T. Suh, T. Y. Moon, I. S. Lee, K. U. Choi, S. J. Kim, "The value of 18FDG PET/CT in soft tissue sarcoma", J. Korean Orthop. Assoc., Vol. 45, No. 3, pp.216-224, 2010. https://doi.org/10.4055/jkoa.2010.45.3.216
  23. S. Filetti, G. Damante, D. Foti, "Thyrotropin stimulates glucose transport in cultured rat thyroid cells", Endocrinology, Vol. 120, No. 6, pp.2576-2581, 1987. https://doi.org/10.1210/endo-120-6-2576
  24. F. Bertagna, G. Treglia, A. Piccardo, E. Giovannini, G. Bosio, G. Biasiotto, K. Bahij, R. Maroldi, R. Giubbini, "F18-FDG-PET/CT thyroid incidentalomas: a wide retrospective analysis in three Italian centres on the significance of focal uptake and SUV value", Endocrine, Vol. 43, No. 3, pp.678-685, 2013. https://doi.org/10.1007/s12020-012-9837-2
  25. I. N. Rothman, L. Middleton, B. C. Stack, T. Bartel, A. T. Riggs, D. L. Bodenner, "Incidence of diffuse FDG uptake in the thyroid of patients with hypothyroidism", Eur. Arch. Otorhinolaryngol., Vol. 268, No. 10, pp.1501-1504, 2011. https://doi.org/10.1007/s00405-011-1512-3
  26. T. Ieiri, "Review of thyroid disease and recent progress in thyroid research", Rinsho. Byori., Vol.49 , No. 4, pp.311-318, 2001.
  27. E. M. Jacobson, Y. Tomer, "The genetic basis of thyroid autoimmunity", Thyroid, Vol. 17, No. 10, pp.949-961, 2007. https://doi.org/10.1089/thy.2007.0153
  28. A. A. Zeitlin, M. J. Simmonds, S. C. Gough, "Genetic developments in autoimmune thyroid disease: an evolutionary process", Clin. Endocrinol., Vol. 68, No. 5, pp.671-682, 2008. https://doi.org/10.1111/j.1365-2265.2007.03075.x
  29. T. Y. Kim, W. B. Kim, J. S. Ryu, G. Gong, S. J. Hong, Y. K. Shong, "18F-fluorodeoxyglucose uptake in thyroid from positron emission tomogram (PET) for evaluation in cancer patients: high prevalence of malignancy in thyroid PET incidentaloma", Laryngoscope, Vol. 115, No. 6, pp.1074-1078, 2005. https://doi.org/10.1097/01.MLG.0000163098.01398.79
  30. Y. K. Chen, Y. L. Chen, R. H. Cheng, C. C. Lee, C. H. Hsu, "The significance of FDG uptake in bilateral thyroid glands", Nucl. Med. Commun., Vol. 28, No. 2, pp.117-122, 2007. https://doi.org/10.1097/MNM.0b013e328013eaf7
  31. Y. M. Han, Y. C. Kim, E. K. Park, J. G. Choe, "Diagnostic value of CT density in patients with diffusely increased FDG uptake in the thyroid gland on PET/CT images",AJR. Am. J. Roentgenol., Vol.195 , No. 1, pp.223-228, 2010. https://doi.org/10.2214/AJR.09.3319
  32. S. Bonabi, F. Schmidt, M. A. Broglie, S. R. Haile, S. J. Stoeckli, "Thyroid incidentalomas in FDG-PET/CT: prevalence and clinical impact", Eur. Arch. Otorhinolaryngol., Vol. 269, No. 12, pp.2555-1560, 2012. https://doi.org/10.1007/s00405-012-1941-7