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99mTc-MIBI甲状腺显像在胺碘酮所致甲状腺毒症鉴别诊断中的价值

王俊起   

  1. 天津市第一中心医院核医学科
  • 收稿日期:2010-02-04 修回日期:2010-06-09 出版日期:2010-11-15 发布日期:2010-11-15
  • 通讯作者: 王俊起

The value of 99mTc-MIBI thyroid imaging in the differential diagnosis of amiodarone-induced thyrotoxicosis

  • Received:2010-02-04 Revised:2010-06-09 Published:2010-11-15 Online:2010-11-15

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摘要： 目的 研究99mTc-MIBI甲状腺显像在胺碘酮所致甲状腺毒症（amiodarone-induced thyrotoxicosis，AIT）鉴别诊断上的价值。材料和方法 15例AIT患者在一周内均进行甲状腺吸碘率测定、甲状腺彩色多普勒超声和甲状腺99mTcO4-显像等常规检查，按照这些常规检查结果将AIT进行初始诊断分型（1型和2型），1型AIT给予甲巯咪唑治疗，2型AIT给予强的松治疗。AIT分型的最终诊断按照患者的甲状腺毒症状态对治疗反应确定。所有患者在开始进行治疗前进行99mTc-MIBI甲状腺早期（15min）和延迟（60min）显像。结果 按照甲状腺常规检查，15例AIT患者的初始诊断分型分别为1型5例，2型10例。AIT最终诊断分型为1型4例，2型8例，另外3例患者按照初始分型（1型1例，2型2例）进行治疗的效果较差，在甲巯咪唑和强的松联合治疗后甲状腺功能恢复正常，因此归为混合型AIT。99mTc-MIBI 显像对于各型AIT均能正确区分，4例1型AIT患者的甲状腺都有明显的MIBI摄取和滞留，8例2型AIT患者甲状腺没有明显的MIBI摄取，3例混合型AIT的甲状腺有轻度的MIBI摄取。单独的CFDS将3例2型AIT和1例混合型AIT归为1型AIT。1型AIT均有可测量到的RAIU，但3例2型AIT和2例混合型AIT也有可测量到的RAIU。即使在RAIU和CFDS联合应用时，3例混合型AIT患者的分型仍不准确。结论 99mTc-MIBI甲状腺显像是有价值的AIT鉴别诊断工具，对于不同类型的AIT都能准确区分，特别是对于难治性的混合型AIT。

关键词: 胺碘酮, 甲状腺毒症, 彩色多普勒超声, 吸碘率, 99mTc-MIBI

Abstract: Object To investigate the value of 99mTc-MIBI (MIBI) thyroid imaging in the differential diagnosis of amiodarone-induced thyrotoxicosis (AIT). Material and methods 15 consecutive AIT patients were performed with thyroid color-flow Doppler sonography (CFDS) , thyroid 99mTcO4- imaging and thyroid radioiodine uptake (RAIU)) within 1 week, as the standard criteria for initially classified. The final diagnosis of AIT was based on the response to different treatments for the thyrotoxicosis. All patients were submitted to thyroid MIBI imaging before any treatment was initiated. Results According to standard criteria, 15 patients were initially classified as having type 1 AIT (n=5) or type 2 AIT (n=10). In the final analysis, 12 of 15 patients could be subdivided into four with type 1 AIT, eight with type 2 AIT. For the other three patients, required the combination of methimazole and glucocorticoids to restore euthyroidism, who had the resistant response to initially therapy, met a posteriori criteria for the diagnosis of a mixed form of AIT. Assessment of MIBI scan results showed that MIBI diffuse retention was present in all four patients with a final diagnosis of type 1 AIT, while no significant uptake, was found in the 8 patients with a final diagnosis of type 2 AIT. Of the other three patients whose final diagnosis was mixed AIT, had a faint persistent MIBI uptake. CFDS was suggestive of type 1 AIT in three patients with type 2 AIT and in one patient with mixed AIT. RAIU was measurable in all patients with type 1 AIT, but also in three out of the eight with type 2 AIT as well as two of three mixed AIT patients. Even in the combination of RAIU and CFDS, 3 of 15(20%) patients were unable to make a clear-cut diagnosis of type 1 or type 2 AIT and propended for a diagnosis of mixed form of AIT. Conclusion Thyroid MIBI imaging may represent a useful tool in the differential diagnosis of different forms of AIT, particularly for the identification of mixed forms, the most resistant to medical treatment.

Key words: amiodarone, thyrotoxicosis, color-flow Doppler sonography, radioiodine uptake, 99mTc-MIBI