^(99)Tc^m-MIBI脑显像对脑胶质瘤恶性程度的诊断及对预后的预测  

Evaluation for Degree of Malignancy and Prognosis of Patients with Br ain Glioma Using ^(99)Tc^m-MIBI Brain SPECT

作　　者：范义湘[1] 罗荣城[1] 李贵平[2] 郑航[1] 黄凯[2] 

机构地区：[1]第一军医大学南方医院肿瘤科,广东广州510515 [2]第一军医大学南方医院核医学科,广东广州510515

出　　处：《癌症》2004年第6期689-692,共4页Chinese Journal of Cancer

摘　　要：背景与目的:判断胶质细胞瘤恶性程度对制订治疗方案、评估预后具有重要意义。传统的影像学诊断方法如CT、MRI对胶质瘤的分级仅限于提供解剖信息,有时难以明确诊断。立体定向活检为有创性检查,仅能反映局部病理变化,而且标本采集误差会使肿瘤分级不准确。18F-FDGPET显像可直接反映肿瘤的葡萄糖代谢率,被认为是最有价值的方法,但因费用昂贵目前尚不能广泛应用。本研究通过99Tcm-MIBI脑肿瘤显像,测定不同病理类型胶质瘤对99Tcm-MIBI的摄取,以探讨其对胶质瘤恶性程度诊断及预测预后的价值。方法:回顾性分析进行99Tcm-MIBI脑显像的52例胶质瘤患者及15例对照者的临床资料。计算99Tcm-MIBI脑SPECT诊断脑胶质瘤的敏感性、特异性、准确率。采用t检验比较病灶T/N比值在不同病理类型组间的差异。随访患者生存率,将患者按T/N比值在不同区间分组,平均生存期(MST)在不同T/N比值组间的比较采用t检验。结果:99Tcm-MIBI显像发现44例阳性,2例假阳性。诊断敏感性为84.6%(44/52),特异性为86.7%(13/15),准确率为85.1%。早期显像及延迟显像中,Ⅰ级星形细胞瘤与Ⅱ级之间以及室管膜瘤与少突胶质细胞瘤之间,T/N比值未见显著性差异。其它任意两组进行比较,随胶质瘤恶性程度增高,T/N比值显著提高(P<0.001)。T/N比值越高。BACKGROUND &OBJECTIVE: It is important and useful to evaluate the degree of malignancy for therapeutic scheme and prognosis evaluation. Traditiona l imaging methods such as CT and MRI play the important role in distinguishing g lioma, but sometimes it was still difficult to diagnose accurately only having t he aid of these anatomic information. Stereotaxic needle biopsy is an invasive m ethod and indicates only local pathologic change, sometimes the error of sample collection will result in inaccurate grading. 18F-FDG PET can reflect the gluco se metabolic rate of tumor directly and is thought as the most useful method, bu t the cost is too high so that it cannot be used widely at present. This study m easured 99Tcm-MIBI uptake in the patients with different pathological types usi ng 99Tcm-MIBI brain scan and evaluated the malignant degree of astrocytoma and its prognosis. METHODS: Fifty-two patients with glioma and 15 collators were re trospectively analyzed. 99Tcm-MIBI was injected into each patient via elbow vei n. SPECT was performed 20 min(early phase) and 2 h (delayed phase) after injecti on. (1)Diagnostic indices such as sensitivity, specificity, and accuracy were ca lculated. (2) The tumor to non-tumor ratios (T/N) were calculated according to ROI and compared between groups of different malignancy grading by t-test. (3) The survival time (by means of mean survival time, MST) after 99Tcm-MIBI brain SPECT was follow-up surveyed. According to T/N ratios, the patients were divide d into four groups. The MST was compared between four groups by t-test. RESULTS : (1) Among 52 cases of glioma, 44 showed positive and 2 collators showed false-positive on 99Tcm-MIBI SPECT and the sensitivity, specificity, and accuracy w ere 84.6%, 86.7%, and 85.1%,respectively. (2) On early phase and delayed phas e,when T/N ratio was compared, there was no significant difference between grade-Ⅰastrocytoma and grade-Ⅱastrocytoma (P >0.05), nor was between patients wit h ependymocytomas and patients with oligodendrogliomas (P >0.

关 键 词：脑胶质瘤 ^99TC^M-MIBI 单光子发射型计算机断层成像 诊断 预后预测 

分 类 号：R739.4[医药卫生—肿瘤]