Assessment Of Ultrasound Combined With SPECT/CT About Cervical Lymph Node After Thyroid Cancer Surgery And Application Of Ultrasound In Laser Ablation Of Metastatic Lymph Node

Objective: 1. To investigate the diagnostic value of ultrasound combined with SPECT/CT fusion imaging and Tg on the abnormal foci of papillary thyroid carcinoma after 131 I treatment. 2. Research the therapeutic value of the cervical lymph node metastasis treated by percutaneous laser ablation guided under ultrasound after thyroidectomy. Methods: 1. A retrospective analysis about 131I-SPECT/CT fusion imaging and ultrasound results were caught out, including 266 patients who had at least two times 131 I treatment after thyroidectomy. Analyze the ultrasound characteristics of cervical metastatic lymph node of 66 cases with pathological results. We compared and evaluated the diagnostic efficacy of alone and combined of two approaches about PTC recurrent lesions with the combination of stimulated serum Tg. Some abnormal iodine uptake lesions were accepted second-look ultrasound, and were diagnosed by results of FNAB and Tg. 2. We gave 20 metastatic lymph nodes laser ablation, with the whole procedure monitored by ultrasound. We evaluated PLA by examining common ultrasound and CEUS, testing serum Tg before and after treatment, and calculating shrink rate of post-ablative lymph node before deadline. Results: 1. Ultrasound findings of liquefaction, high echo area and micro calcification have significant with lymph node metastasis.The incidence of liquefaction, high echo area and microcalcification in lateral neck metastatic lymph node was significantly higher than central neck. 2. When metastatic standard is pathology and stimulated Tg, the diagnostic effects has no difference between ultrasound and SPECT/CT, but parallel test can increase the sensitivity. When metastatic standard is only pathology, the diagnostic effects between them has obvious difference, and series test can increase specificity. 3. Second-look ultrasound can increase diagnostic efficiency of conventional ultrasound and SPECT/CT. 4. The complications of laser ablation are associated with total energy release in one treatment. 5. CEUS after one hour of post-ablation can be used to judge if treatment is enough. CEUS after 3-7 days of post-ablation can be used to make sure if the ablative range enlarged. Common ultrasound before and after PLA can be used to ensure the change of lymph node size. Conclusion: 1. Liquefaction, hyperechoic and microcalcification, which are the most significant feature with metastatic lymph node, have higher incidence rate in lateral neck than central neck. Ultrasound combined with SPECT/CT fusion imaging can raise the accuracy rate in diagnosis of metastatic lymph node or recurrence lesion after 131 I treatment of papillary thyroid carcinoma. 2. Laser ablation guided by ultrasound can be used as a safe and effective minimal invasive method in the treatment for cervical lymph node metastasis; Conventional ultrasound and contrast-enhanced ultrasound can effectively monitor the laser ablation treatment and follow-up results.