中国实用外科杂志

中国实用外科杂志

• 专题笔谈 • 上一篇    下一篇

甲状腺癌远处转移常见部位及影像学检查的应用

王志宏，张    浩   

  1. 中国医科大学附属第一医院甲状腺外科，辽宁沈阳110001
  • 出版日期:2024-06-01

  • Online:2024-06-01

摘要： 甲状腺癌远处转移可发生在全身各个组织或器官中，其中肺转移和骨转移最常见，其次是肝转移和脑转移。由于不同部位远处转移的影像学表现不同，容易发生误诊或漏诊。因此，对甲状腺癌远处转移常见部位及其影像学特征的认识尤其重要。超声是评估甲状腺结节和颈部淋巴结的常用方法，但在远处转移检测中敏感度有限。CT、MRI、全身碘扫描（WBS）和正电子发射计算机断层扫描（PET-CT）在诊断远处转移中显示出更高的敏感度和特异度。在肺转移方面，CT因其高空间分辨率而被广泛应用。WBS对评估转移灶对放射性碘的亲和力至关重要，而PET-CT能提供肿瘤代谢活性信息，有助于生物学行为的评估。骨转移方面，MRI因其高分辨率和三维解剖信息在检测骨转移方面具有优势。MRI灌注技术有助于早期发现脊柱转移。PET-CT与特定骨放射性示踪剂在成骨细胞病变检测中敏感度更高。肝转移在甲状腺髓样癌病人中发生率相对较高。超声造影技术可提高诊断准确性，MRI对甲状腺癌肝转移病灶的检测价值较高。脑转移在甲状腺癌中极为罕见，主要见于甲状腺未分化癌的病人。MRI是评估脑转移的首选检查方式，具有高敏感度和特异度。此外，甲状腺癌远处转移还包括肾、心脏、皮肤等罕见部位，通过影像学方法可辅助诊断。

关键词: 甲状腺癌, 远处转移, 转移部位, 影像学检查

Abstract: The common sites of distant metastases in thyroid cancer and application of imaging examinations        WANG Zhi-hong, ZHANG Hao. Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang 110001, China 
Corresponding author: ZHANG Hao, E-mail:haozhang@cmu. edu. cn
Abstract    Metastatic Thyroid cancer can occur in various tissues or organs throughout the body, with lung and bone metastases being the most common, followed by liver and brain metastases. Due to the different imaging manifestations of distant metastases in different sites, misdiagnosis or missed diagnosis can quickly  occur. Therefore, understanding the common sites of metastatic thyroid cancer and their imaging characteristics is particularly important. Ultrasound is a commonly used method for assessing thyroid nodules and cervical lymph nodes, but its sensitivity in detecting distant metastases is limited. In contrast, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Whole Body Radioiodine Scan(WBS), and positron emission tomography/computed tomography (PET-CT) show higher sensitivity and specificity in diagnosing distant metastases. For lung metastases, CT is widely used due to its high spatial resolution.WBS is crucial for assessing the affinity of metastatic lesions to radioactive iodine, while PET-CT can provide information on tumor metabolic activity, which helps assess biological behavior. In terms of bone metastases, MRI has advantages in detecting bone metastases due to its high resolution and three-dimensional anatomical information.PET-CT combined with specific bone radiotracers has higher sensitivity in detecting osteoblastic lesions.MRI perfusion techniques help in the early detection of spinal metastases. Liver metastases are relatively rare in thyroid cancer but have a higher incidence in medullary thyroid cancer patients. Contrast-enhanced ultrasound can improve diagnostic accuracy, and MRI is valuable for detecting liver metastases in thyroid cancer. Brain metastases are extremely rare in thyroid cancer and are mainly seen in anaplastic thyroid cancer patients.MRI, with high sensitivity and specificity, is the preferred imaging method for assessing brain metastases. Additionally, metastatic thyroid cancer includes rare sites such as the kidney, heart, and skin, and imaging methods can assist in diagnosis.

Key words: thyroid cancer, distant metastases, metastatic site, imaging examinations