GIÁ TRỊ CỦA XẠ HÌNH SPECT/CT VỚI I-131 TRÊN BỆNH NHÂN UNG THƯ TUYẾN GIÁP THỂ BIỆT HÓA CÓ NGUY CƠ TÁI PHÁT CAO

Abstract

Objective: This study aims to assess the added value of I-131 SPECT/CT scintigraphy compared to planar whole-body scintigraphy (WBS) in detecting recurrent disease and guiding treatment decisions in high-risk differentiated thyroid carcinoma (DTC) patients. Materials and Methods: A prospective descriptive study was conducted on 125 patients diagnosed with DTC who had undergone total thyroidectomy and were classified as high risk for recurrence according to the 2015 American Thyroid Association (ATA) guidelines. These patients underwent both planar WBS and SPECT/CT imaging before and after I-131 therapy. Results: Compared to pre-therapeutic WBS, pre-therapeutic SPECT/CT provided additional diagnostic information, leading to the detection of lymph node and distant metastases in 38 patients (30.4%) and the exclusion of previously suspected lesions in 5 patients (4.0%). The combination of pre-therapeutic WBS and SPECT/CT resulted in treatment modifications in 34 out of 125 patients (27.2%) and dose adjustments in 47 out of 125 patients (37.6%). Post-therapeutic SPECT/CT, compared to post-therapeutic WBS, identified additional lymph node and distant metastatic lesions in 7 patients (29.2%) and ruled out suspected lesions in 3 patients (12.5%). Moreover, post-therapeutic SPECT/CT led to staging revisions, upgrading 1 case from N0 to N1 and 4 cases from M0 to M1, resulting in stage modifications in 8 out of 125 patients (6.4%). Conclusion: I-131 SPECT/CT scintigraphy enhances the detection of lymph node and distant metastases in high-risk recurrent DTC patients, leading to significant changes in treatment planning and therapeutic dosing following total thyroidectomy.