Wei Ming Chua, Charlene Yu Lin Tang, Kelvin S H Loke, Winnie Wing-Chuen Lam, Samantha Peiling Yang, Melissa Shuhui Lee, Wenlu Hou, May Yi Shan Lim, Kheng Choon Lim, Robert Chun Chen
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引用次数: 0
摘要
颈部 US 和其他成像模式的广泛应用导致分化型甲状腺癌(DTC)的检出率上升。这些癌症中的大多数仍然是隐匿性的,无需手术治疗。然而,一部分需要手术治疗的患者随后会出现疾病复发。这种情况最常见于颈部淋巴结和甲状腺床,其次是肺部和骨骼的远处转移。由于影像学检查是术后监测不可或缺的一部分,因此放射科医生在检测复发肿瘤和指导这些患者的治疗方面发挥着核心作用。US 是用于术后评估的主要成像模式。其他成像方式,如 CT、MRI、放射性碘成像和 PET/CT 有助于准确诊断和描述复发疾病。因此,放射科医生在解释这些多模态检查时,必须充分了解这些成像技术的用途以及复发性 DTC 的成像特征。对成像结果的解读还应该与患者的临床状态及其生化指标相关联,以尽量减少解读错误。作者对 DTC 的术后评估进行了全面概述,包括 DTC 的初始初治、分期和预后;复发疾病的临床风险分层;术后影像学监测和生化标志物评估;以及复发 DTC 的治疗。以 CC BY 4.0 许可发布。本文有补充材料。
Differentiated Thyroid Cancer after Thyroidectomy.
The widespread use of neck US and other imaging modalities has contributed to a phenomenon of increased detection of differentiated thyroid cancer (DTC). Most of these cancers remain indolent, without requiring surgical intervention. Nonetheless, a subset of patients who require surgical treatment experience subsequent disease recurrence. This most commonly occurs in the cervical lymph nodes and thyroid bed, followed by distant metastasis to the lungs and bones. Because imaging is an integral part of postoperative surveillance, radiologists play a central role in the detection of recurrent tumors and in guiding treatment in these patients. US is the primary imaging modality used for postoperative evaluation. Other modalities such as CT, MRI, radioactive iodine imaging, and PET/CT aid in the accurate diagnosis and characterization of recurrent disease. Therefore, radiologists must have a thorough understanding of the utility of these imaging techniques and the imaging characteristics of recurrent DTC when interpreting these multimodality studies. The interpretation of imaging findings should also be correlated with the clinical status of patients and their biochemical markers to minimize interpretative errors. The authors present a broad overview of the postoperative evaluation of DTC, including its initial primary management, staging, and prognostication; clinical risk stratification for recurrent disease; postoperative surveillance with imaging and evaluation of biochemical markers; and management of recurrent DTC. Published under a CC BY 4.0 license. Supplemental material is available for this article.
期刊介绍:
Launched by the Radiological Society of North America (RSNA) in 1981, RadioGraphics is one of the premier education journals in diagnostic radiology. Each bimonthly issue features 15–20 practice-focused articles spanning the full spectrum of radiologic subspecialties and addressing topics such as diagnostic imaging techniques, imaging features of a disease or group of diseases, radiologic-pathologic correlation, practice policy and quality initiatives, imaging physics, informatics, and lifelong learning.
A special issue, a monograph focused on a single subspecialty or on a crossover topic of interest to multiple subspecialties, is published each October.
Each issue offers more than a dozen opportunities to earn continuing medical education credits that qualify for AMA PRA Category 1 CreditTM and all online activities can be applied toward the ABR MOC Self-Assessment Requirement.