^(99)Tc^(m)-HYNIC-TOC SPECT/CT在胃肠胰神经内分泌肿瘤诊疗中的增益价值  

Added value of ^(99)Tc^(m)-HYNIC-TOC SPECT/CT in the diagnosis and treatment of gastroenteropancreatic neuroendocrine tumors

作　　者：柳舒心 武新宇 李博 汤敏敏 刘斯淼 薛宇航 狄子臣 何菲菲 徐俊玲 高永举 Liu Shuxin;Wu Xinyu;Li Bo;Tang Minmin;Liu Simiao;Xue Yuhang;Di Zichen;He Feifei;Xu Junling;Gao Yongju(Department of Nuclear Medicine,People′s Hospital of Zhengzhou University,Henan Provincial People′s Hospital,Henan Key Laboratory of New Molecular Probes for Nuclear Medicine and Clinical Translational Medicine,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院、河南省人民医院核医学科,河南省核医学新型分子探针与临床转化医学重点实验室,郑州450003

出　　处：《中华核医学与分子影像杂志》2025年第1期13-18,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨^(99)Tc^(m)-联肼尼克酰胺(HYNIC)-酪氨酸3-奥曲肽(TOC)SPECT/CT显像在胃肠胰神经内分泌肿瘤(GEP-NETs)诊疗中的增益价值。方法回顾性分析2017年12月至2023年6月间在郑州大学人民医院先后行增强CT(MR)及^(99)Tc^(m)-HYNIC-TOC SPECT/CT检查的54例患者[男28例、女26例,年龄(52.6±11.7)岁]。以手术或活组织检查的病理结果作为患者诊断标准,以病理、影像及随访结果的综合评估为病灶判定标准,采用McNemarχ^(2)检验比较不同影像学方法对GEP-NETs患者及转移灶的诊断效能。结果病理示54例患者中43例为GEP-NETs,11例非神经内分泌肿瘤(NETs)。增强CT、增强MR诊断GEP-NETs患者的灵敏度分别为65.1%(28/43)、60.0%(15/25),^(99)Tc^(m)-HYNIC-TOC显像后灵敏度提高至93.0%(40/43)、92.0%(23/25),差异均有统计学意义(χ^(2)值:8.64、4.90,P值:0.002、0.021)。增强CT、增强MR示非典型强化者分别有22、15例,这2种方法对非典型强化者的GEP-NETs诊断灵敏度分别为54.5%(12/22)、8/15,^(99)Tc^(m)-HYNIC-TOC显像后灵敏度提高[95.5%(21/22)、14/15;χ^(2)值:5.82、4.17,P值:0.012、0.031]。相较于增强CT,^(99)Tc^(m)-HYNIC-TOC显像后肝转移、骨转移灶的检出率分别由90.8%(158/174)、55.2%(32/58)提高至96.6%(168/174)、87.9%(51/58),差异均有统计学意义(χ^(2)值:5.79、9.82,P值:0.013、0.001);^(99)Tc^(m)-HYNIC-TOC显像也较增强MR对骨转移灶的检出率高[88.0%(22/25)与56.0%(14/25);χ^(2)=4.08,P=0.039]。^(99)Tc^(m)-HYNIC-TOC显像后,7.0%(3/43)患者分期改变,11.6%(5/43)患者被检出更多数量或更大范围的转移灶。在治疗后随访中,相较于增强CT,^(99)Tc^(m)-HYNIC-TOC显像在40.0%(8/20)的患者中额外检出复发或转移性病灶。结论^(99)Tc^(m)-HYNIC-TOC显像在诊断增强CT(MR)非典型强化GEP-NETs、探测肝转移及早期骨转移病灶、协助优化临床治疗策略中具有增益价值。Objective To investigate the additional value of ^(99)Tc^(m)-hydrazinonicotinamide(HYNIC)-Tyr3-octreotide(TOC)SPECT/CT imaging in the diagnosis and treatment of gastroenteropancreatic neuroendocrine tumors(GEP-NETs).MethodsA total of 54 patients(28 males and 26 females,age:(52.6±11.7)years)who underwent enhanced CT(MR)and ^(99)Tc^(m)-HYNIC-TOC SPECT/CT in People′s Hospital of Zhengzhou University between December 2017 and June 2023 were analyzed retrospectively.Surgical pathology or biopsy was the gold standard of patients′diagnosis(primary tumors),and comprehensive evaluation based on pathology,imaging and follow-up results was used as the diagnostic criteria of lesions.McNemarχ^(2) test was used to compare the diagnostic efficacy of different imaging methods.ResultsPathological results showed that 43 of the 54 patients were with GEP-NETs and 11 were with non-neuroendocrine tumors(NETs).The sensitivities of enhanced CT and enhanced MR in the diagnosis of patients with GEP-NETs were 65.1%(28/43)and 60.0%(15/25)respectively,which increased to 93.0%(40/43)and 92.0%(23/25)with the addition of ^(99)Tc^(m)-HYNIC-TOC imaging(χ^(2) values:8.64,4.90,P values:0.002,0.021).There were 22 and 15 patients showing atypical enhancement on enhanced CT and enhanced MR respectively.The sensitivities of these two methods for GEP-NETs in patients with atypical enhancement were 54.5%(12/22)and 8/15 respectively,which increased to 95.5%(21/22)and 14/15 with the addition of ^(99)Tc^(m)-HYNIC-TOC imaging(χ^(2) values:5.82,4.17,P values:0.012,0.031).Compared with enhanced CT,the detection rates of liver and bone metastatic lesions were improved significantly from 90.8%(158/174)and 55.2%(32/58)to 96.6%(168/174)and 87.9%(51/58)with the addition of ^(99)Tc^(m)-HYNIC-TOC imaging(χ^(2) values:5.79,9.82,P values:0.013,0.001).Compared with enhanced MR,the detection rate of bone metastases was improved significantly from 56.0%(14/25)to 88.0%(22/25)with the addition of ^(99)Tc^(m)-HYNIC-TOC imaging(χ^(2)=4.08,P=0.039).After ^(99)Tc^(m)-

关 键 词：神经内分泌瘤 体层摄影术 发射型计算机 单光子 体层摄影术 X线计算机 锝 奥曲肽 

分 类 号：R735[医药卫生—肿瘤] R730.44[医药卫生—临床医学]