肺灌注显像检查预测肺癌放射性肺损伤的价值  

SPECT lung perfusion scans in predicting radiation pneumonitis in lung cancer patients

作　　者：赵路军[1] 张雯杰[2] 王绿化[1] 郑容[2] 冯勤富[1] 王颖杰[1] 梁军[1] 欧广飞[1] 殷蔚伯[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤研究所肿瘤医院放射治疗科,北京100021 [2]中国医学科学院中国协和医科大学肿瘤研究所肿瘤医院核医学科,北京100021

出　　处：《中华肿瘤杂志》2006年第2期127-129,共3页Chinese Journal of Oncology

基　　金：首都医学发展科研基金资助项目(2002-1016)

摘　　要：目的探讨肺癌患者肺灌注显像的特点及其放射治疗过程中的变化，观察其与放射性肺损伤发生的关系。方法31例接受根治性放疗的肺癌患者接受了肺灌注显像检查，其中8例仅在放疗前接受了此项检查。以照射前后计算区域的肺灌注平均计数值占相应全肺平均计数值的百分比，比较照射前后肺灌注的变化。放射性肺损伤的评价按美国肿瘤放射治疗组（RTOG）急性放射性肺炎标准评定。结果31例患者中，中央型22例，周围型9例。病理类型：鳞癌12例，腺癌1例，小细胞肺癌15例，未分型3例。Ⅰ、Ⅱ期8例，Ⅲa期9例，Ⅲb期14例。行适形放疗26例，常规放疗5例；照射剂量32—72Gy，中位剂量58Gy。6例发生2级或3级放射性肺炎，无放射性肺炎死亡病例。全部患者治疗前均有不同程度的灌注受损，中央型肺癌患者灌注受损范围≥2级者占68．2％（15／99），而周围型仅占22．2％（2／9，P=0．04）。受损范围为1级和2级以上者，分别有40．0％（6／15）和37．5％（6／16）的患者发生2级以上放射性肺损伤。在两次行肺灌注检查的23例中，肺灌注受损有所改善者占70．0％（16／23），其中2级以上放射性肺炎发生率为31．3％（5／16）；在肺灌注受损加重者中，2级以上放射性肺炎发生率为42．9％（3／7）。结论灌注受损是肺癌患者的常见表现，中央型肺癌灌注受损较重，放射治疗后多数病例肺灌注受损有所改善；放疗前和放疗中，肺灌注受损范围的变化和放射性肺损伤的发生无明显相关性。Objective To evaluate single photon emission computed tomography （SPECT） lung perfusion in predicting radiation pneumonitis in lung cancer patients. Methods From April 2003 to March 2004, 31 lung cancer patients treated with radical radiotherapy received SPECT lung perfusion scans, among whom, 23 had had perfusion scans both before and at the time of 40 Gy irradiation. The perfusion changes in the region of interest （ ROI ） after irradiation were obtained through comparing post-radiotherapy with preradiotherapy average proportion of SPECT counts within the ROI relative to average counts of the whole lung. Endpoint was defined as grade 2 and above radiation pneumonitis according to RTOG criteria . Results Lung perfusion defect was observed in all the patients at baseline.≥grade 2 lung perfusion defect was found in 68.2% （15/22） of patients with central lesion and in 22.2% （2/9） of patients with peripheral lesions （ P = 0. 04 ）. Seventy percent of the patients （ 16/23 ） experienced improved perfusion at 40-50 Gy. ≥grade 2 radiation pneumonitis was observed in 12 patients （38. 7% ） in the whole group, with 6 in those with grade 1 perfusion defects and another 6 in ≥grade 2 group, respectively; Of the 23 patients who had had both preand post-radiotherapy SPECT perfusion scan, 5 ≥ grade 2 radiation pneumonitis occurred in the 16 perfusion-improved patients and 3 in the 7 unimproved patients. Conclusion There is no significant correlation between radiation pneumonitis and the extent of perfusion defect either before or after 40-50 Gy irradiation based on our limited data analysis in this series.

关 键 词：灌注显像检查 肺癌 放射性肺损伤 

分 类 号：R734.2[医药卫生—肿瘤]