RESUMO
Objective: The purpose of this study was to evaluate the use of SPECT-CT for the determination of the anatomical locations of the cervical 131Iodine uptake areas during 131Iodine-whole body (131I-WB) scans. Methods: One hundred fifty-four patients who had undergone total thyroidectomyfor differentiated thyroid carcinoma (DTC) and had 131I-WB scan with cervical uptake images were studied with SPECT-CT, from March 2003 to October 2006. Results: From the 154patients included, 124 were women (80.5%) and the mean age of 46.09 ± 14.77 years. 131I-WB was performed 1-2 months after surgery in 137 patients (89.0%). The percentage of cervical uptake found varied between 0.1 and 15.0% and its mean was 1.42 ± 2.05%. Using SPECT-CT, 223 foci of cervical 131Iodine uptake (CIU) were identified in 154 patients. CIU foci were localized to the thyroid bed in 17 patients, while 29 patients presented with CIU in the thyroid bed and the extra thyroid tissue and in both the thyroid bed and extra thyroid tissues in another 29 patients. Inthe remaining 108 subjects, the CIU were located outside of the thyroid bed, of which the most common locations were the sternothyroid muscle and the thyroid cartilage. Conclusions: The useof SPECT-CT demonstrated significant diversity in the anatomical locations of CIU foci observed during 131I-WB scans after thyroidectomy for DTC
Assuntos
Humanos , Iodo , Neoplasias da Glândula Tireoide , Radioisótopos , Tireoidectomia , Tomografia Computadorizada de Emissão , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
Os linfomas de Hodgkin e não Hodgkin são habitualmente estadiados através da associação do exame físico, exames de imagem, laboratoriais e biópsia de medula óssea (métodos convencionais). A Tomografia computadorizada (CT) dos diferentes segmentos corpóreos é o método de imagem mais utilizado para avaliar a extensão da doença. Com o recente advento do uso de imagens metabólicas do consumo celular de glicose com o FDG-F-18, associadas às imagens anatômicas da Tomografia por Raios X (PET-CT), tornou-se necessária a comparação deste método com os métodos convencionais na definição do estadiamento dos Linfomas, para o futuro entendimento do seu possível impacto no manejo destes pacientes. Objetivos: Avaliar a concordância estatística entre o PET-CT e os métodos convencionais na definição do estadiamento clínico (em estádios I a IV e em grupos de doenças localizada e avançada) dos pacientes com Linfomas, e, também, comparar os resultados quanto ao acometimento nodal, nos diferentes segmentos corpóreos, e extra-nodal, bem como, o número detectado de sítios de lesões. Material e métodos: 57 pacientes, 25 com LH e 32 com LNH, foram prospectivamente estadiados pelo PET-CT e métodos convencionais. Foram calculadas as concordâncias estatísticas entre os estadiamentos clínicos e os resultados dos métodos através da estatística Kappa e a comparação entre o número detectado de sítios de lesões foi feita através do teste de Wilcoxon. Resultados: Observou-se nos LH e LNH concordância estatística nos estádios I a IV. A adição de informações do PET-CT, resultaram em elevação do estadiamento em 24% dos LH e 37,5% nos LNH. Nas doenças localizadas e avançadas, observou-se concordância estatística nos LH, não observada nos LNH. As diferenças resultaram da redução do estadiamento pelo PET-CT em relação ao CT. Observou-se concordância estatística quanto ao acometimento nodal e extra-nodal nos diferentes segmentos corpóreos principalmente, no sentido de exclusão da doença. As discordâncias observadas predominararam no segmento torácico nos LNH deveram-se, à detecção de doença pelo PET-CT nos linfonodos de tamanho habitual. No grupo de LH e LNH o PET-CT detectou maior número de sítios nodais de lesões, mas não foram encontradas diferenças quando comparados segmento corpóreo ou acometimento extra-nodal. Conclusões: Para os LH e LNH observa-se concordância estatística quando utilizamos PET-CT na definição dos estadiamentos clínicos de I a IV e para a detecção do acometimento extra-nodal e acometimento nodal por segmento corpóreo. Nos LH observa-se concordância nos grupos de doenças localizada e avançada, que não é observada nos LNH. Nos LH e LNH o PET-CT detectou maior número de sítios nodais e elevou o estadiamento clínico em mais de um terço dos pacientes com LNH e em cerca de um quarto dos pacientes com LH.
Hodgkin and non-Hodgkin Lymphomas are usually staged with an association of physical, image and laboratory examinations and bone marrow biopsy (conventional methods). Computed Tomography (CT) is the most widely imaging method used to measure the extent of disease. With the recent advent of metabolic imaging with the 18F-FDG in association with anatomical images of CT (PET-CT), became necessary to compare this method with the conventional methods in the definition of staging of Lymphomas, to the future understanding of the clinical impact in these patients. Purpose: Evaluate the statistical agreement between the PET-CT and conventional methods in definition of clinical staging (stages I to IV) and groups of localized and advanced disease and also compare the results in the detection of nodal and extra nodal sites and lesion number. Material and methods: 57 patients, 25 with HL and 32 with NHL, were prospectively staged with PET-CT and conventional methods. Statistical agreement was calculated with Kappa method and the comparison between the number of lesions sites detected with the Wilcoxon test. Results: Statistical agreement was noted to clinical stages I to IV in LH and LNH, and additional information of PET-CT predominantly resulted in elevation of the staging in HL (24%) and NHL (37.5%). Statistical agreement was present in HL, regarding advanced and localized disease, but it was not observed in NHL. Disagreements were related to the reduction of staging by PET-CT compared to CT. There was statistical agreement regarding the nodal and extra-nodal disease detection, especially in sense of exclusion of the disease. Disagreements were observed principally on the thoracic segment, due to the PET-CT detection of disease in lymph nodes of usual size. Considering the group of HL and NHL, PET-CT detected a larger number of nodal lesions sites than CT, but no differences were found regarding body segments or extra- nodal sites. Conclusions: Statistical agreement is observed to HL and NHL when PETCT is used to define clinical stages I IV and to detect segmental nodal and extra-nodal disease. Statistical agreement is also observed in groups of localized and advanced disease of HL and is not seen in NHL. In HL and NHL PET-CT detected larger number of nodal lesion sites and also upstaged more than one third of patients with NHL and a quarter of the patients with HL.