^(131)I-MIBG肾上腺髓质显像定量分析的临床应用  

Clinical evaluation of quantitative analysis in 131 I MIBG adrenal scintigraphy

作　　者：高再荣[1] 詹浩[1] 何勇[1] 张凯军[1] 张永学[1] 

机构地区：[1]同济医科大学附属协和医院核医学科

出　　处：《放射学实践》1999年第2期108-110,共3页Radiologic Practice

摘　　要：目的：建立肾上腺髓质显像的定量诊断指标。方法：本文对２５例对照者、１９例嗜铬细胞瘤患者及９例肾上腺髓质增生患者的肾上腺髓质及髓外嗜铬细胞瘤组织摄取１３１ＩＭＩＢＧ（间碘苄胍）进行了定量分析，以建立定量诊断指标。按常规方法于注射显像剂后２４ｈ、４８ｈ、７２ｈ分别行前位及后位全身显像。采用ＲＯＩ技术分别计算出肾上腺（包括髓外嗜铬细胞瘤组织）与心肌、肝脏、脾脏、肺和本底的比值。结果：除肾上腺／脾比值外，上述各比值在对照组与肾上腺髓质增生组或嗜铬细胞瘤组的鉴别诊断中均有不同程度的意义（Ｐ＜０．０５），以肾上腺／心肌比值与肾上腺／本底比值最稳定可靠（Ｐ＜０．０１）。同时对本底的选择亦进行了对比，本底的选择方法不同，其诊断价值亦有差别，以左肾外侧ＲＯＩ最为理想。肾上腺／心肌比值还能有效地鉴别嗜铬细胞瘤与肾上腺髓质增生，当比值大于１．５（２４ｈ）、１．６（４８ｈ）和１．８（７２ｈ）时，则嗜铬细胞瘤的可能性大，晚期显像（４８ｈ，７２ｈ）心肌显影可作为排除嗜铬细胞瘤的指标之一。嗜铬细胞瘤组织摄取ＭＩＢＧ程度与患者的年龄、性别、血压、病程、血／尿儿茶酚胺及香草基杏仁酸浓度之间无显著性相关（Ｐ＞０．０５）。结论：肾上腺髓质显像?Purpose:To define a quantitative diagnostic standard in 131 I MIBG(metaiodobenzylguanidine) adrenal scintigraphy. Methods: The adrenal uptakes in control group (group 1), patients with pheochromocytoma (group 2) and patients with adrenal medulla hyperplasia (group 3) were analyzed quantitatively. This study encompassed 25 patients in group 1, 19 patients in group2 and 9 patients in group 3. Whole body scintigraphies in anterior and posterior views were performed 24, 48 and 72 hrs after intravenous injection of 131 I MIBG in all patients. Regions of interest (RIs) were drawn over the adrenal, heart, lung, liver, spleen and background, and ratios of adrenal/heart, liver, spleen, lung, or background were calculated respectively in different time. Results: The ratios, except the adrenal/spleen ratio, can effectively make differentiation between group 1 and group 2 or group 3 (P<0.05). The ratios of adrenal/heart/background were more stable and sensitive than the ratios of adrenal/lung/liver (P<0.01). Furthermore, different background ROIs were of different identifying significances and the ROI beside left adrenal was the most satisfactory selection.The ratio of adrenal/heart was also an important identifying parameter between pheochromocytoma and adrenal medulla hyperplasia, and the cut off levels of the ratios were 1.5(24hr), 1.6(48hr) and 1.8(72hr), respectively. Visualization of heart activity on MIBG scintigraphy, especially in delayed images (48hr, 72hr), could be considered a useful clue to the exclusion of diagnosis of pheochromocytoma. There was no significant correlation between the ratios and age, sex, blood pressure, course of disease or catecholamine/vanillymandelic acid in blood/urine(P>0.05). Conclusion: Quantitative analysis of 131 I MIBG adrenal scintigraphy is an objective and sensitive method for diagnosing pheochromocytoma.

关 键 词：肾上腺髓质显像 定量分析 131I-MIBG 嗜铬细胞瘤 

分 类 号：R736.04[医药卫生—肿瘤] R730.44[医药卫生—临床医学]