^(99m)Tc-HYNIC-TOC显像和^(131)I-MIBG显像在嗜铬细胞瘤和副神经节瘤中的诊断价值  

Evaluation of ^(99m)Tc-HYNIC-TOC and ^(131)I-MIBG imaging in diagnosis of pheochromocytoma and paraganglioma

作　　者：王宇 童安莉 周玥 张文倩 崔云英 景红丽 李玉秀 WANG Yu;TONG Anli;ZHOU Yue;ZHANG Wenqian;CUI Yunying;JING Hongli;LI Yuxiu(Department of Endocrinology,Key Laboratory of Endocrinology of National Health Commission,Peking Union Medical College Hospital,CAMS&PUMC,Beijing 100730;Graduate School,Hebei North University,Zhangjiakou 075000,China;Department of Nuclear Medicine,Peking Union Medical College Hospital,CAMS&PUMC,Beijing 100730)

机构地区：[1]中国医学科学院、北京协和医学院、北京协和医院内分泌科、国家卫生健康委员会内分泌重点实验室 [2]河北北方学院研究生学院,河北张家口075000 [3]中国医学科学院、北京协和医学院、北京协和医院核医学科、国家卫生健康委员会内分泌重点实验室,北京100730

出　　处：《基础医学与临床》2024年第3期374-378,共5页Basic and Clinical Medicine

基　　金：国家重点研发计划(2021YFC2501600,2021YFC2501603);中央高水平医院临床科研业务费(2022-PUMCH-C-028);中国医学科学院医学与健康科技创新工程(2021-I2M-C&T-B-002)。

摘　　要：目的探讨^(99m)Tc标记肼基烟酰胺奥曲肽类似物(^(99m)Tc-HYNIC-TOC)显像与^(131)I-间碘苄胍(^(131)I-MIBG)肾上腺髓质显像对嗜铬细胞瘤和副神经节瘤(PPGL)的临床诊断价值。方法回顾性研究359例经手术病理确诊、临床资料完整的PPGL患者的临床资料,分析^(99m)Tc-HYNIC-TOC生长抑素受体显像与^(131)I-MIBG肾上腺髓质显像的诊断敏感性及影响因素。结果319例行^(99m)Tc-HYNIC-TOC生长抑素受体显像,病灶检出阳性184例,诊断敏感性为57.7%;279例行^(131)I-MIBG肾上腺髓质显像,病灶检出阳性232例,诊断敏感性为83.2%,原发灶位于肾上腺、腹膜后、头颈部、心脏及纵膈、盆腔及膀胱部位的^(99m)Tc-HYNIC-TOC生长抑素受体显像敏感性分别为53.3%、62.5%、95.0%、66.7%、50.0%和11.0%,^(131)I-MIBG肾上腺髓质显像敏感性分别86.7%、88.5%、45.4%、50.0%、75.0%和33.3%。不同遗传背景[包括琥珀酸脱氢酶(SDH)、希佩尔-林道(VHL)及RET原癌基因(RET)基因突变]的PPGL患者中,两种方法诊断PPGL的敏感性差异无统计学意义(P>0.05)。肿瘤最大径的中位数为4.4(3.0,6.1)cm。^(99m)Tc-HYNIC-TOC生长抑素受体显像和^(131)I-MIBG肾上腺髓质显像对较大肿瘤组(≥4.4 cm)的诊断敏感性均显著高于较小肿瘤组(<4.4 cm)(64.0%vs.51.3%;92.3%vs.74.1%)(P<0.01);19例患者(占5.3%)的肿瘤对这两种显像方法均不摄取。结论本研究为迄今中国最大PPGL队列的^(99m)Tc-HYNIC-TOC生长抑素受体显像及^(131)I-MIBG肾上腺髓质显像的研究。总体而言,^(131)I-MIBG肾上腺髓质显像敏感性较^(99m)Tc-HYNIC-TOC生长抑素受体显像高,但对部分部位的肿瘤,如头颈副神经节瘤,后者有明显优势,两者有互补性,临床中需要结合患者的特点进行选用。Objective To evaluate^(99m)Tc-HYNIC-TOC somatostatin receptor and^(131)I-MIBG imaging in clinical diag-nostic of pheochromocytoma and paraganglioma(PPGL).Methods This was a retrospective study.359 PPGL patients diagnosed by pathology microscopy were included.The diagnostic sensitivity and influencing factors on^(99m)Tc-HYNIC-TOC somatostatin receptor and^(131)I-MIBG imaging were analyzed.Results The positive rate of^(99m)Tc-HYNIC-TOC somatostatin receptor scintigraphy was 57.7%(184/319)and^(131)I-MIBG imaging was 83.2%(232/279).The positive rates of^(99m)Tc-HYNIC-TOC somatostatin receptor imaging in the adrenal glands,retroperitoneum,head and neck,heart and mediastinum,pelvis and bladder were 53.3%,62.5%,95.0%,66.7%,50.0%and 11.0%respectively and the positive rates of^(131)I-MIBG imaging were 86.7%,88.5%,45.4%,50.0%,75.0%and 33.3%respectively.The positive rate of the two imaging did not showed difference among patients with different genetic backgrounds(SDH,VHL,RET mutations).The median maximum diameter of tumors was 4.4(3.0,6.1)cm.and the diagnostic sensitivity of somatostatin receptor imaging and^(131)I-MIBG imaging for larger tumors(≥4.4 cm)was significantly higher than those for the smaller tumor group(<4.4 cm)(64.0%vs.51.3%;92.3%vs.74.1%)(P<0.01).Tumors in 19 patients(5.3%)failed to uptake neither imaging method.Conclusions This is the largest PPGL cohort in China concerning^(99m)Tc-HYNIC-TOC somatostatin receptor imaging and^(131)I-MIBG imaging.The sensitivity of^(131)I-MIBG imaging is higher than that of^(99m)Tc-HYNIC-TOC somatostatin receptor imaging,but for some tumors,such as head and neck paraganglioma,the latter has obvious advantages.These two imagings technologies are complementary and the choice of them should depend the individual situation of patients.

关 键 词：嗜铬细胞瘤 副神经节瘤 ^(99m)Tc-HYNIC-TOC生长抑素受体显像 ^(131)I-MIBG显像 诊断敏感性 

分 类 号：R586.9[医药卫生—内分泌]