^(11)C-胆碱PET/CT显像在肺癌中的应用价值及其机理的研究  

The research of ^(11)C-choline PET/CT imaging and choline metabolism on lung cancer

作　　者：李昕[1] 王晴文[2] 姚树展[1] 黄召勤[1] 芮军[1] 刘庆伟[1] 

机构地区：[1]山东大学附属省立医院医学影像科,山东济南250021 [2]山东省医学影像学研究所,山东济南250021

出　　处：《医学影像学杂志》2012年第4期546-551,共6页Journal of Medical Imaging

基　　金：国家自然科学基金资助项目(30670581);山东省医药卫生科技发展计划(2009-QW014)

摘　　要：目的探讨11 C-胆碱PET/CT显像在肺癌中的应用价值及胆碱代谢机理。方法目测法和半定量法分析38例可疑肺癌患者PET/CT显像结果;RT-PCR和Western blot方法进行分子生物学检测。结果手术病理证实29例为肺癌,3例为良性病变。6例因发生远处转移未行手术。肺癌原发病灶、纵隔及肺门淋巴结转移及远处转移灶均显示放射性摄取明显增高。目测法及半定量分析法均显示良、恶性病变无显著性差异。鳞癌、腺癌、不典型类癌的11 C-胆碱摄取值相比也不具有显著性差异。12例肺癌组织细胞中,9例Chok mRNA及蛋白质的表达比正常肺组织升高,5例ChATmRNA及蛋白质表达升高,其中5例Chok及ChAT表达均升高。结论 11 C-胆碱PET/CT显像能够发现肺癌原发病灶、纵隔及肺门淋巴结转移及远处转移灶,有助于准确临床分期;但不能有效鉴别肺部病灶的良恶性。肺癌组织细胞中不仅有磷酸化途径的增强,而且存在乙酰化途径。Objective To investigate the potential of 11^ C-choline PET/CT imaging for diagnosis and staging of lung canc- er and investigate the real metabolic mechanismof 11^ C-choline in vivo. Methods 38 patients with suspicious lung cancer were examined with 11^ C-choline PET/CT imaging. Lung cancers were analysed visually and semiquantitatively using the ratio of tumour-to-normal radioactivity （T/N ratio） and standardized uptake value （SUV）. RT-PCR and Western blot were used to investigate the expression of choline acetyhransferase （CHAT） and choline kinase （ChoK） genes in lung canc- er specimens and the normal lung tissues. Results① All lung lesions could be visualized as avid accumulation of 11^C-cho- line; ② The mean values of SUVmax of lung cancer and benign lesions were 4.82±1.79 and 4.51±4. 74, respectively. There was no significant difference between these two groups. （ t =3. 18, P〉0.05）. The mean T/NT of malignant and benign lesions were 5.59± 2. 19 and 8.07±1. 75, respectively. The statistical differences of T/NT between them were still not significant （ t =3.18, P〉0.05） ; ③ The SUVmax and T/NT of the all 14 squamous cell carcinoma patients were 4.98±1.96 and 6.06±2.01 respectively, while the SUVmax and the T/NT of the 10 adenocarcinoma patients were 4.09 ＋_l. 62 and 4.68±2.05. The difference was not statistically significant; ④ 6 patients with distant metestases were detec- ted by 11^ C-choline PET/CT which demonstate it was useful in staging of lung cancer. In the assessment of mediastinal lymph node involvement, 11^ C-choline PET/CT detected 10. patients in all 13 patients proven by pathology. The overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 11^ C-Choline PET/CT in the de- tection of lymph node metastasis were 67, 6%, 84.2%, 80.6%, 72.7%, 72.7% ; ⑤ The expression of ChAT mRNA and protein were enhanced in 5 of 12 lung tumor specimens~ and the expression of ChoK mRNA and protein were increased in 9 of 12 lu

关 键 词：肺肿瘤 胆碱激酶 正电子 体层摄影术 胆碱 

分 类 号：R734.2[医药卫生—肿瘤]