^(11)C-CHO PET/CT在脑胶质瘤治疗方案决定中的作用  

Value of ^(11)C-CHO PET/CT in the determination of treatment regimen for brain gliomas

作　　者：李方明[1] 朱奇[1] 聂青[1] 赵文锐[2] 康静波[1] 张丽萍[1] 杨平[1] 张军[1] 贾海威[1] 温居一[1] 郑伟[1] 吴苏东[1] 方恒虎[1] 王斌[1] 

机构地区：[1]海军总医院放射肿瘤中心,北京100048 [2]海军总医院核医学科,北京100048

出　　处：《海军总医院学报》2011年第2期72-75,共4页Journal of Naval General Hospital of PLA

摘　　要：目的探讨碳-11胆碱(11C-CHO)正电子体层发射摄影术/计算机体层摄影术(PET/CT)分子显像在脑胶质瘤治疗方案决定中的临床价值。方法对2008年1月-2009年6月经病理确诊的23例脑胶质瘤患者,在放疗前或放疗后进行PET/CT分子影像与同期MRI结构影像结果作对比分析,研究11C-CHOPET/CT在胶质瘤治疗方案的决定中所产生的影响。其中WHOⅡ级8例、Ⅲ级10例、Ⅳ级5例。根据PET/CT分子显像结果决定治疗方案。结果①11C-CHO PET/CT显示的病变靶区高代谢放射性浓聚区与正常脑组织的代谢分子显像对比度良好,肿瘤边界更清晰准确。②11C-CHO PET/CT分子显像改变了10例(43.48%)的诊断及靶区范围,并由此改变了治疗方案。其中,1例(Ⅲ级)肿瘤靶体积范围较同期MRI扩大;1例(Ⅱ级)由再程放疗(γ刀)或化疗改为高压氧治疗;1例(Ⅲ级)由预防量放疗改为根治量放疗加化疗;1例(Ⅱ级)由定期复查改为化疗;3例(Ⅱ级)由术后预防量放疗改为根治量放疗;3例(1例Ⅲ级、2例Ⅱ级)由化疗改为定期复查。③WHOⅡ、Ⅲ、Ⅳ级患者治疗方案的改变率分别为87.5%(7/8)、30.0%(3/10)、0(0/5)。表明11C-CHO PET/CT对Ⅱ、Ⅲ级患者的肿瘤靶区范围的确定以及对放疗后复发的鉴别诊断明显优于MRI,并由此显著地影响医生对患者治疗方案的决定。结论放疗前后行11C-CHO PET/CT分子显像有助于提高肿瘤靶区的准确性、鉴别肿瘤及其周围正常组织,可避免过度治疗和漏治,临床意义重大。Objective To Study the clinical value of the application of 11C-CHO PET/ CT imaging for brain gliomas. Methods Twenty-three patients with pathology proven brain gliomas were selected,including 8 cases in grade WHO Ⅲ ,10 cases in grade WHO Ⅲ ,and 5 cases in grade WHO Ⅳ. Co-registered 11C-CHO PET/CT image were selected properly for the determination treatment regimen in brain glioms. Results Integrated 11C-CHO PET/CT changed the clinical diagnosis in 10 patients （43.48γ. Treatment strategy was changed from prevetnive radiotherapy to follow-up in 3 cases,from chemotherapy to follow-up in 3 cases,from follow-up to curative radiotherapy and chemotherapy in 1 cases, from follow-up to chemotherapy in 1 eases, from chemotherapy to follow-up in 1 cases,detected target volume increased in 1 cases. Conclusion Integrated 11C-CHO PET/CT imagine before or after radiotherapy can improve the accuracy of clinical diagnostic and help to choose a proper treatment regimen. Moreover,it can clearly differentiate tumor from normal tisue and reduce the risk of geographic misdiagnosis.

关 键 词：脑胶质瘤 正电子发射断层扫描/计算机体层摄影术 碳-11胆碱 肿瘤靶区 放疗计划 

分 类 号：R730.44[医药卫生—肿瘤] R739.41[医药卫生—临床医学]