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Standardization of ~(131)I treatment following thyroidectomy for DTC patients tends to be compulsory in clinical practice. However, many remains controversies concerning with the indications for ~(131)I treatment since it takes definitive effects mostly in parts of DTC patients with unresectable lesions or metastases. Standardization of ~(131)I treatment also requires proper management of radiation protection for in-patients taking high dose ~(131)I,objective and complete evaluation of treatment outcomes as well as side effects related with ~(131)I therapy, and above all, the establishment of long-term follow-up database.
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Objective To evaluate the efficacy of 131I treatment for bone metastases from DTC and analyze the survival rates after 131I treatment and prognostic factors. Methods One hundred and six DTC patients with bone metastases treated by 131I during January 1991 and January 2009 were retrospectively analyzed. Treatment efficacy was assessed based on serum Tg change, bone pain palliation and changes on medical imaging. Univariate analysis was performed for defining the factors affecting 131I treatment efficacy. Survival curves were estimated using the life table method. Survival analysis was performed using Kaplan-Meier method. Results Serum Tg decreased dramatically in 37/106 (34.9%) patients treated with131I. Thirty-nine of 61 patients (63.9%) with bone pain had pain relief. Age, tumor subtype and presence of non-osseous distant metastases were significant factors affecting 131I treatment efficacy based on serum Tg change (χ2=6.443, 11.455, 6.756, all P0.05). There were no imaging changes of bone metastases in 77.4% of patients after 131I treatment. The overall 5-year and 10-year survival rates from initial diagnosis of bone metastases was 86.47% and 57.90%, respectively. Univariate analysis showed that number of metastases, presence of non-osseous distant metastases and pre-131I treatment surgery were significant factors for survival (Log-rank values were 4.05, 5.98, 4.22, all P<0.05). Conclusions 131I treatment for bone metastases from DTC is effective for lowering serum Tg and palliation of bone pain. Single metastasis, absence of non-osseous distant metastases and pre-131I therapy surgery are favorable predictors of prognosis.
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Objective To evaluate the clinical value of 131 Ⅰ SPECT/CT in the differentiation of indeterminate 131Ⅰ uptake on planer whole body scan (WBS) for patients with DTC after 131Ⅰ treatment. Methods Fifty-six DTC patients ( male: 19, female: 37, mean age: 45 ± 15 years, ranging from 20 to 85 years) underwent 131Ⅰ treatment. 131Ⅰ WBS was performed five days after 131 Ⅰ treatment, followed by regional 131Ⅰ SPECT/CT for the indeterminate foci with abnormal uptake on 131Ⅰ WBS. The diagnostic difference of the two imaging modalities was compared by x2 test. Results There were 288 foci with abnormal uptake on 131 Ⅰ WBS, including 108 indeterminate foci (37.5%). Subsequent 131Ⅰ SPECT/CT identified 27 foci as DTC metastases (25.0%) and 71 foci as non-metastases such as benign lesions at nose, oral cavity, salivary gland, maxillary cyst, thyroid remnant, thymus, gallbladder, gastrointestinal tract, and uterus, or non-specific uptake of body contaminations (65.7%). However, the remaining 10 foci (9.3%) remained indeterminate on 131 Ⅰ SPECT/CT imaging. The diagnostic accuracy of 131 Ⅰ SPECT/CT was significantly higher than that of 131Ⅰ WBS (x2 = 102.35, P＜0. 01). Conclusion 131Ⅰ SPECT/CT could significantly improve the diagnostic accuracy for the differentiation of indeterminate foci with abnormal uptake on 131Ⅰ WBS.
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Objective To analyze the characteristics of bone scintigraphy in 117 cases with primary hyperparathyroidism (PHPT).Methods Of these 117 cases (50 males and 67 females),there were 116 parathyroid adenomas and 1 parathyroid cancer.Mean age was 61.1(12-86) years old.All had ~(99)Tc~m-methylene diphosphonate (MDP) bone scintigraphy.The bone images could be classified into 4 categories.Category Ⅰ:normal;category Ⅱ:localized abnormal,which could be subcategorized as Ⅱ A with skull and mandible involvement,and Ⅱ B with Ⅱ A characteristics plus metabolic derangement;category Ⅲ:systemic,whole-body incmased tracer uptake;category Ⅳ:systemic plus localized metabolic derangement.Data were analyzed statistically with X~2 and t-test (isolated samples).Results According to the scintigraphic findings,there were 47 cases(40.17%)of category Ⅰ,35 cases(29.91%) category Ⅱ (21/35cases Ⅱ A and 14/35 cases Ⅱ B),30 cases (25.64%) category Ⅲ,and 5 cases (4.27%) category Ⅳ.Combining categories Ⅱ、Ⅲ and Ⅳ together,there were 70 abnormal cases.These patients had history of abnormal bone images such as bone fracture (39 cases,55.71%),calculus (8 cases,11.43%),bone fracture plus calculus(7 cases,10.00%),osteoporosis (51 cases,72.86%) or ostalgia(26 cases,37.14%);however,in the 47 cases of category Ⅰ,only 1 (2.13%),0,0,10(21.28%)and 10 cases (21.28%),respectively,were found.Therefore.these case history characteristics were statistically significant (X~2=11.152,P=0.01).The tumor size,parathyroid hormone (PTH),blood calcium,blood phosphorus in the patients of abnormal PHPT categories Ⅱ to Ⅲ were(14.52±13.72)cm~3,(731.67±618.40)ng/L,(3.05±0.29) mmol/L and (0.71±0.14) mmol/L,respectively.with statistically significant difference compared to category Ⅰ:(0.78±1.33) cm~3,(112.04±62.98)ng/L,(2.56±0.42) mmol/L and (1.03±0.36)mmol/L(t=-5.724,-5.741,-7.274 and -6.451;all P＜0.01).Conclusions (1)Bone scintigraphy was normal in 40% of PHPT patients.(2)The bone images of PHPT could be classified into 4 categories and each could reflect the duration and severity of the disease status on bone.(3)The bone imaging characteristic could be useful for differential diagnostic purposes.