鼻咽癌^(99)mTc-MDP SPECT/CT颅底显像阳性的探讨  

Clinical role of the skull base with increased uptake of ^(99)mTc-MDP on SPECT/CT fused imaging with patients of nasopharyngeal carcinoma

作　　者：姚红霞[1] 刘生[2] 张金山[1] 

机构地区：[1]广州医学院第三附属医院核医学科,510150 [2]中山大学第二附属医院核医学科

出　　处：《影像诊断与介入放射学》2009年第5期225-227,共3页Diagnostic Imaging & Interventional Radiology

摘　　要：目的探讨鼻咽癌(NPC)患者头颅SPECT/CT颅底显像阳性的临床意义。方法经病理证实为NPC患者44例(初诊患者30例,复诊14例,低分化鳞癌38例,未分化癌6例,其中患头痛14例),同期行头颅^(99)mTc-MDP(锝标亚甲基二膦酸盐)SPECT/CT与鼻咽MR显像对比,正常对照组10例行头颅SPECT/CT。于SPECT/CT图像矢状面颅底异常浓集最高计数区域(L)与高位颈椎体(S)处各画相同大小的感兴热区(ROI),计算L/S值。L/S>1考虑颅底骨侵犯。结果①SPECT/CT示颅底骨侵犯组(SBBI)24例与未侵犯组(none-SBBI)20例,L/S值分别为1.83±0.69和0.68±0.13,差异显著(P<0.01);MRI示24例SBBI和20例none-SBBI,但病例与SPECT/CT不全一致,且SPECT/CT与MRI有一定的相关性②伴头痛患者,SPECT/CT颅底阳性检出率较高(P<0.01);低分化鳞癌和未分化癌的阳性检出率无显著差异(P>0.05),颅底骨受累部位的多少未见明显影响阳性检出率(P>0.05)。③对照组L/S<1。结论NPC患者头颅^(99)mTc-MDP SPECT/CT颅底显像阳性为颅底骨侵犯可能性大,与MRI有较好的相关性。伴头痛患者应高度怀疑颅底骨受肿瘤侵犯,其它影响因素还有待进一步临床研究。Objective To investigate the clinical role of the fused skull single photon emission computed tomographic and computed tomographic images （SPECT/CT） when there was ＂hot＂ in the skull base of patients with NPC. Methods 99mTc-MDP SPECT/ CT and MRI were performed in a week in 44 patients （30 with first-visited cases and 14 with return-visited, 38 cases of poorly differentiated squarnous cell carcinoma and 6 cases of undifferentiated cancer, 14 with headache）. Region of interests （ROI） were drawn on the area of the suspected skull base and the upper cervical vertebral body on the same slice. A lesion-to-spine （L/S） ratio was interpreted on SPECT/CT as normal, benign, or malignant. L/S〉I indicated malignant skull base bone involvement （SBBI）. Ten patients were studied as contro/s. Results ①Of the 44 study patients, 24 had SBBI （55%） based on SPECT/CT detecting skull base bone lesions with L/S =1.83 ±0.69. Twenty patients had normal or benign bone lesions on SPECT/CT with L/S=0.68±0.13. There was statistic significance compared SBBI with no SBBI subgroups （P 〈0.01）. In 24 or 20 of the 44 study patients （55%）, the definition of SBBI or no SBBI by SPECT/CT and MRI did not draw a parallel. And both them were relative. ②Patients with headache had higher positive rate （13/ 14） by SPECT/CT comparing with those patients without headache （P 〈0.01）. There was no significance in positive rate of SPECT/CT compared poorly differentiated squamous cell carcinoma with undifferentiated cancer （P 〉0.05）. The numbers of SBBI had no relationship with positive rate of SPECT/CT （P 〉0.05）. ③There was no obviously increased uptake in the skull base in the 10 control patients （L/S〈1）. Conclusion The skull SPECT/CT was recommended as one of clinical diagnosis tool for SBBI from NPC. Patients with headache should be highly suspected whether tumor cells involved the skull base bone or not. Further accumulation of other clinical factors would clarify the values of SPECT/C

关 键 词：鼻咽癌 99MTC-MDP SPECT/CT 颅底骨侵犯 

分 类 号：R739.63[医药卫生—肿瘤] R730.44[医药卫生—临床医学]