核医学在胃癌隐匿转移诊断中的应用

The Application of Nuclear Medicine in the Diagnosis of Gastric Cancer with Occult Metastases

目的 探讨核医学在提高胃癌隐匿转移的诊断和指导手术方案中的应用。方法 3 0例胃癌术前13 1I -McAb3H11(鼠抗人胃癌单克隆抗体 3H11)肿瘤局部注射 ,在 2h、2 4h、48h、72h显像 ,同时行99mTcO4-胃粘膜显像 ;术中GDP手持式γ深测器。探测相关各部位 ,并与病理比较。结果 各时间段13 1I显像病灶清晰 ,2例于 48h ,72h见脾门部异常浓聚区 ,99mTcO4-显像病灶区显示放射性稀疏、缺损 ,余部轮廓完整、清晰 ;术中GDP探测对所有原发灶获得正确定位 ,对转移淋巴结判断的敏感性、特异性、准确率分别为 90 .7%、98.0 %、94.6%。结论 核医学检查有助于提高胃癌隐匿转移的诊断 ,弥补传统手术的不足 ;99mTcO4-胃粘膜显像在胃部疾病诊断中有一定的意义。

Objective To discuss the application of nuclear medicine in enhancing the diagnosis of gastric cancer with occult metastases and directing surgical procedure.Methods Before surgery, thirty patients with gastric cancer were injected into 131 I-McAb3H 11 at the verge of tumour. They were imaged at 2h、24h、48h、72h and 99m TcO 4 - gastric mucosa image was performed at meantime; At the time of operation, detecting related part by GDP, and comparing with pathology.Results At each time,lesions were visualized clearly with [3] I,and 2 Patients were found adnormal densenes in hilum of spleen at 48h,72h.Abnormal rarefaction or defect of radioactivity of 99m TcO - 4 were found in lesions at the same time.All tumors were localized imtraoperatively.For the detection of lymphatic metastasis,the sensitivity of RIGS was 90.7%,the specificity 98.0%, and the accuracy 94.6%.Conclusion The application of nuclear medicine is helpful to improve the diagnosis of gastric cancer with occult metastases and more reliable than traditional exploration in identifying occult metastases; 99m TcO 4 - gastric mucosa image has particular significance in the diagnosis of stomach disease.