[1]王深,孟召伟,贾强,等.MRI弥散加权成像、甲状腺摄碘率和血清指标测定鉴别Graves甲状腺功能亢进症和无痛性甲状腺炎的研究[J].国际放射医学核医学杂志,2014,38(6):392-397.[doi:10.3760/cma.j.issn.1673-4114.2014.06.011]
　Wang Shen,Meng Zhao-wei,Jia Qiang,et al.Differentiation between Graves disease and painless thyroiditis by diffusion-weighted imaging, thyroid radioactive iodine uptake and serum parameters measurement[J].International Journal of Radiation Medicine and Nuclear Medicine,2014,38(6):392-397.[doi:10.3760/cma.j.issn.1673-4114.2014.06.011]
点击复制

MRI弥散加权成像、甲状腺摄碘率和血清指标测定鉴别Graves甲状腺功能亢进症和无痛性甲状腺炎的研究(/HTML)
分享到：

《国际放射医学核医学杂志》[ISSN:1673-4114/CN:12-1381/R]

卷:
38
期数:
2014年第6期
页码:
392-397
栏目:
出版日期:
2014-11-25

文章信息/Info

Title:
Differentiation between Graves disease and painless thyroiditis by diffusion-weighted imaging, thyroid radioactive iodine uptake and serum parameters measurement
作者:
王深;  孟召伟;  贾强;  张富海;  谭建
天津医科大学总医院核医学科, 300052
Author(s):
Wang Shen;  Meng Zhao-wei;  Jia Qiang;  Zhang Fu-hai;  Tan Jian
Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
关键词:
格雷夫斯病; 甲状腺炎; 磁共振成像; 弥散; 表观弥散系数; 甲状腺摄131I率; 促甲状腺激素受体抗体
Keywords:
Graves disease; Thyroiditis; Diffusion magnetic resonance imaging; Apparent diffusion coefficient; Thyroid radioactive iodine uptake; Thyrotropin receptor antibody
DOI:
10.3760/cma.j.issn.1673-4114.2014.06.011
摘要:
目的 研究MRI弥散加权成像(DWI)的表观弥散系数(ADC)、甲状腺摄131I率(RAIU)和血清指标等在Graves甲状腺功能亢进症(简称甲亢)和无痛性甲状腺炎(PT)鉴别中的价值。方法 选取102例Graves甲亢患者和37例PT患者入组。测定所有患者的血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、TSH、甲状腺球蛋白抗体(TgAb)、甲状腺过氧化物酶抗体(TPOAb)和促甲状腺激素受体抗体(TRAb)水平。采用3.0T超导型MRI仪完成MRI检查,并获得ADC.测定甲状腺24 h RAIU,并进行甲状腺静态显像。Graves甲亢患者的病理组织从接受手术的患者中获取(6例),PT患者的病理组织从接受活检的患者中获取(2例).采用Pearson检验明确各指标间的相关性,用受试者工作特征曲线(ROC)分析各项指标的诊断价值,确定各项指标的切分点值,并判断各项指标的诊断灵敏度、特异度、准确率、阳性预测值和阴性预测值。结果 与PT患者比较,Graves甲亢患者的ADC、TRAb和RAIU显着升高(t=15.126、7.226和31.574,P均<0.01).ADC、TRAb和RAIU之间存在显着的正相关性。ROC显示,RAIU、ADC和TRAb的曲线下面积大于0.900.其中,RAIU具有最好的诊断价值,当最佳切分点值确定为24.500%时,灵敏度、特异度、准确率、阳性预测值和阴性预测值均为100%.ADC比TRAb的诊断价值更高,当最佳切分点值分别确定为1.837×10-3 mm2/s和1.350 IU/ml时,ADC的上述统计指标分别为96.078%、91.892%、95.000%、97.059%和89.474%,TRAb的上述统计指标分别为88.235%、75.676%、84.892%、90.909%和70.000%.病理组织学结果显示:Graves甲亢以滤泡增生、滤泡上皮细胞增生以及血管扩张和充血为主要表现;PT以淋巴细胞浸润、淋巴滤泡形成以及滤泡破坏为主要表现。结论 对于Graves甲亢和PT的鉴别,RAIU、ADC和TRAb均有价值,RAIU最佳、ADC次之。ADC的显像原理是基于不同疾病细胞密度差异的病生理变化,而RAIU的测定原理是反映不同疾病对碘摄取能力差异的病生理变化。
Abstract:
Objective To assess the value of apparent diffusion coefficient (ADC)in diffusion-weighted imaging (DWI),thyroid radioactive iodine uptake (RAIU)and serum parameters in differential diagnosis between Graves disease (GD)and painless thyroiditis (PT).Methods One hundred and two patients with GD and 37 patients with PT were enrolled.Serum thyroid hormones and antibodies were measured,including free triiodothyronine (FT3),free thyroxine (FT4),TSH,thyroid globulin antibody (TgAb),thyroid peroxidase antibody (TPOAb)and thyrotropin receptor antibody (TRAb).DWI was obtained with a 3.0 T MR scanner,and ADC values were calculated.24 h later RAIU and thyroid scintigraphy were conducted.Tissue samples were obtained in GD patients (6 cases)after thyroidectomy and in PT patients (2 cases)after biopsy.Pearson bivariate correlation was made.Receiver operating characteristic curves (ROC)were drawn and diagnostic efficacies were determined.Optimal cut-off values were selected,and then sensitivity,specificity,accuracy,positive predictive value and negative predictive value were assessed.Results ADC,TRAb and RAIU were significantly higher in GD than in PT (t=15.126,7.226 and 31.574,with all P<0.01).And they were closely and positively correlated.ROC showed areas under the curves for RAIU,ADC and TRAb were higher than 0.900.RAIU was the best method to differentiate GD from PT.When cutoff value of RAIU was determined as 24.500%,sensitivity,specificity,accuracy,positive predictive value and negative predictive value were all 100%.The above statistical data were 96.078%,91.892%,95.000%,97.059% and 89.474% for ADC,and 88.235%,75.676%,84.892%,90.909% and 70.000% for TRAb,when the optimal thresholds of 1.837×10-3 mm2/s and 1.350 IU/ml were determined respectively.ADC was better than TRAb.Histopathology results showed that for GD,follicle hyperplasia,follicular epithelial cells hyperplasia,hyper-vascularity and congestive perfusion were characteristic features; while for PT,massive lymphocytic infiltration with hyperplastic germinal center formation and follicle disruption were characteristic features.Conclusions RAIU,DWI and TRAb were all of diagnostic values for differentiation between GD and PT,RAIU was the best method and DWI followed.DWI has great potential for thyroid pathophysiological imaging because it reflects tissue cellularity differences between GD and PT.The principle for RAIU is that it reflects the iodine uptake changes in different diseases.

参考文献/References:

[1] Bahn RS,Burch HB,Cooper DS,et al.Hyperthyroidism and other causes of thyrotoxicosis:management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists[J].Endocr Pract,2011,17(3):456-520,593-646.
[2] 蒋宁一,林岩松,关海霞,等.131I治疗格雷夫斯甲亢指南(2013版)[J].中华核医学与分子影像杂志,2013,33(2):83-94.
[3] 蒋宁一,匡安仁,谭建,等.131I治疗Graves甲亢专家共识(2010年)[J].中华核医学杂志,2010,30(5):346-351.[4] 张永学,黄钢.核医学[M].2版.北京:人民卫生出版社,2010:211-219.
[5] Kubota S,Tamai H,Ohye H,et al.Transient hyperthyroidism after withdrawal of antithyroid drugs in patients with Graves’ disease[J].Endocr J,2004,51(2):213-217.
[6] Ho SC,Eng PH,Fok AC,et al.Thyrotoxicosis due to the simultaneous occurrence of silent thyroiditis and Graves’ disease[J].Thyroid,1999,9(11):1127-1132.
[7] Padhani AR,Liu G,Koh DM,et al.Diffusion-weighted magnetic resonance imaging as a cancer biomarker:consensus and recommendations[J].Neoplasia,2009,11(2):102-125
[8] Nakajo M,Nakajo M,Kajiya Y,et al.FDG PET/CT and diffusion-weighted imaging of head and neck squamous cell carcinoma:comparison of prognostic significance between primary tumor standardized uptake value and apparent diffusion coefficient[J].Clin Nucl Med,2012,37(5):475-480.
[9] Choi SH,Paeng JC,Sohn CH,et al.Correlation of 18F-FDG uptake with apparent diffusion coefficient ratio measured on standard and high b value diffusion MRI in head and neck cancer[J].J Nucl Med,2011,52(7):1056-1062.
[10] Hiraiwa T,Ito M,Imagawa A,et al.High diagnostic value of a radioiodine uptake test with and without iodine restriction in Graves’ disease and silent thyroiditis[J].Thyroid,2004,14(7):531-515.
[11] Osaki Y,Sakurai K,Arihara Z,et al.Prediction of late(24-hour) radioactive iodine uptake using early(3-hour) uptake values in Japanese patients with Graves’ disease[J].Endocr J,2012,59(2):173-177.
[12] Liu Z,Xiao X.The use of multi b values diffusion-weighted imaging in patients with acute stroke[J].Neuroradiology,2013,55(3):371-376.
[13] Tezuka M,Murata Y,Ishida R,et al.MR imaging of the thyroid:correlation between apparent diffusion coefficient and thyroid gland scintigraphy[J].J Magn Reson Imaging,2003,17(2):163-169.

相似文献/References:

[1]梁雯丽,郑艳,李娜,等.Graves甲亢患者131I治疗后早期TRAb及TSAb变化的研究分析[J].国际放射医学核医学杂志,2016,40(1):13.[doi:10.3760/cma.j.issn.1673-4114.2016.01.003]
　Liang Wenli,Zheng Yan,Li Na,et al.Analysis of the changes in early TRAb and TSAb after 131I treatment for patients with Graves hyperthyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(6):13.[doi:10.3760/cma.j.issn.1673-4114.2016.01.003]
[2]田琦,蒋宁一,郑丽.265例精细个体化131I治疗Graves甲亢的疗效观察[J].国际放射医学核医学杂志,2016,40(4):259.[doi:10.3760/cma.j.issn.1673-4114.2016.04.004]
　Tian Qi,Jiang Ningyi,Zheng Li.Therapeutic effect of fine individual 131I treatment on Graves disease hyperthyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(6):259.[doi:10.3760/cma.j.issn.1673-4114.2016.04.004]
[3]王越,晋建华,李思进,等.甲状腺24h摄碘率与131I治疗Graves甲亢疗效相关性研究[J].国际放射医学核医学杂志,2015,39(6):442.[doi:10.3760/cma.j.issn.1673-4114.2015.06.002]
　Wang Yue,Jin Jianhua,Li Sijin,et al.Correlation between thyroid 24 h of radioactive iodine uptake and clinical efficacy of 131I therapy for Graves’ hyperthyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2015,39(6):442.[doi:10.3760/cma.j.issn.1673-4114.2015.06.002]
[4]张丽花,蒋宁一.131I治疗Graves甲亢合并肝功能损害或血细胞减少的优势与风险[J].国际放射医学核医学杂志,2015,39(6):483.[doi:10.3760/cma.j.issn.1673-4114.2015.06.010]
　Zhang Lihua,Jiang Ningyi.The advantage and risk of 131I treatment in hyperthyroidism combined with liver injury or blood cell reduction[J].International Journal of Radiation Medicine and Nuclear Medicine,2015,39(6):483.[doi:10.3760/cma.j.issn.1673-4114.2015.06.010]
[5]胡小春,蒋宁一,李敬彦,等.硒对经131I治疗Graves病患者血清甲状腺过氧化物酶抗体水平的影响[J].国际放射医学核医学杂志,2015,39(2):140.[doi:10.3760/cma.j.issn.1673-4114.2015.02.008]
　Hu Xiaochun,Jiang Ningyi,Li Jingyan,et al.Effect of additional selenium on the levels of serum thyroid peroxidase antibody in patients with Graves disease treated with 131I[J].International Journal of Radiation Medicine and Nuclear Medicine,2015,39(6):140.[doi:10.3760/cma.j.issn.1673-4114.2015.02.008]
[6]查金顺,蒋艳,徐源,等.131I辅以短期小剂量碳酸锂治疗Graves甲亢的研究[J].国际放射医学核医学杂志,2014,38(1):10.[doi:10.3760/cma.j.issn 1673-4114.2014.01.003]
　Zha Jinshun,Jiang Yah,Xu Yuan,et al.Clinical research on radioiodine addition of low-doses of lithium carbonate in short-term treatment of Graves hyperthyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2014,38(6):10.[doi:10.3760/cma.j.issn 1673-4114.2014.01.003]
[7]俞秀华,黄炜坤,林玉梅.131I治疗Graves病合并肝损害的临床观察[J].国际放射医学核医学杂志,2014,38(2):90.[doi:10.3760/cma.j.issn.1673-4114.2014.02.005]
　Yu Xiuhua,Huang Weikun,Lin Yumei.Clinical observation of 131I therapy in Graves disease patients with hepatic dysfunction[J].International Journal of Radiation Medicine and Nuclear Medicine,2014,38(6):90.[doi:10.3760/cma.j.issn.1673-4114.2014.02.005]
[8]郑艳,赵德善,付松海,等.儿童和青少年Graves甲亢患者131Ⅰ治疗剂量的分析研究[J].国际放射医学核医学杂志,2013,37(2):69.[doi:10.3760/cma.j.issn.1673-4114.2013.02.002]
　ZHENG Yan,ZHAO De-shan,FU Song-hai,et al.The dose analysis of 131Ⅰ treatment in pediatric patients with Graves hyperthyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2013,37(6):69.[doi:10.3760/cma.j.issn.1673-4114.2013.02.002]
[9]王朝点,史育红,颜兵.TRAb水平测定在Graves眼病中的临床意义探讨[J].国际放射医学核医学杂志,2013,37(2):77.[doi:10.3760/cma.j.issn.1673-4114.2013.02.004]
　WANG Chao-dian,SHI Yu-hong,YAN Bing.The clinical value of serum thyrotrophin receptor antibody level in patients with Graves ophthalmopathy[J].International Journal of Radiation Medicine and Nuclear Medicine,2013,37(6):77.[doi:10.3760/cma.j.issn.1673-4114.2013.02.004]
[10]张瑞国,秦岚,张又萍,等.初诊Graves甲亢合并肝损害及其影响因素的临床分析[J].国际放射医学核医学杂志,2013,37(5):283.[doi:10.3760/cma.j.issn.1673-4114.2013.05.008]
　ZHANG Rui-guo,QIN Lan,ZHANG You-ping,et al.Clinical study of hepatic dysfunction and its correlative factors in newly diagnosed patients with Graves hyperthyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2013,37(6):283.[doi:10.3760/cma.j.issn.1673-4114.2013.05.008]
[11]胡晓琳,张海燕.Graves’病患者促甲状腺素受体抗体和甲状腺刺激免疫球蛋白水平的变化及临床意义[J].国际放射医学核医学杂志,2006,30(6):350.
　HU Xiao-lin,ZHANG Hal-yan.Clinical significance and changes of TRAb and TSI assay in patients with Graves’ disease[J].International Journal of Radiation Medicine and Nuclear Medicine,2006,30(6):350.

备注/Memo

备注/Memo:
收稿日期:2014-10-06。
基金项目:国家临床重点专科建设项目
通讯作者:谭建(Email:tanpost@163.com)
更新日期/Last Update: 1900-01-01