Сцинтиграфия при узловой патологии щитовидной железы

Сцинтиграфия щитовидной железы (ЩЖ) – метод, сформировавшийся более 60 лет назад и сохраняющий свое значение для диагностики и оценки риска злокачественности узловой патологии. В обзоре рассматривается использование сцинтиграфического метода при функциональной и метаболической оценке узлового зоба. Изложены предпосылки для функционального скрининга узлов ЩЖ с короткоживущим 99mТс-пертехнетатом. Приведены сведения о принципах его получения и фармакокинетике, а также о вариантах функциональной активности узлов ЩЖ, их возможном злокачественном потенциале и показаниях к метаболическому скринингу. Характеристика метаболической активности позволяет оценить риск малигнизации функционально «холодных» узлов ЩЖ. Представлены основные этапы использования неспецифических туморотропных радиофармпрепаратов, механизм их накопления и метаболизма в опухолях ЩЖ, возможности дифференциальной диагностики различных типов узловых образований. Современные взгляды на диагностические возможности двухфазной сцинтиграфии с 99mТс-метилизобутил изонитрилом отражены с учетом взаимосвязи поглощения радиофармпрепаратов с факторами пролиферативной активности и ультраструктурными типами клеток, вариантом онкоцитарной патологии и экспрессией белка множественной лекарственной устойчивости.

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