用^(99)Tc^m-HL91显像预测脑肿瘤放疗敏感性

The study of ^(99)Tc^m-HL91 imaging in predicting the radiosensitivity of brain tumor

目的应用99Tcm-4,9-二氮-3,3,10,10-四甲基十二烷-2,11-二酮肟(HL91)乏氧显像预测脑肿瘤放疗疗效。方法经临床确诊的30例未治疗的脑肿瘤患者,肘静脉注射99Tcm-HL91 740 MBq 后进行早期(10 min)、中期(2 h)和晚期(4 h)显像。应用感兴趣区(ROI)技术勾画并分别测定早、中、晚期肿瘤部位放射性计数(T),以及对侧相应部位放射性计数(N),求出相应T/N比值。检查后患者接受放射治疗,4周后按WHO标准,在放疗科医师协助下进行放疗疗效评价,分为完全缓解(CR),部分缓解(PR),无变化(NC)和进展加重(PD),并与99Tcm-HL91显像结果比较。结果①30 例脑肿瘤患者99Tcm-HL91显像早、中、晚各时相的T/N比值分别为1.453±0.292,1.532±0.299和1.607±0.305,各时相间差异均有显著性(P=0.000,双侧)。②30例脑肿瘤患者中CR 0例,PR 15 例,NC 6例,PD 1例,死亡或失访共8例;放疗有效组(CR+PR)与放疗无效组(NC+PD)99Tem-HL91 显像早、中和晚期相T/N比值分别为1.333±0.277与1.779±0.183,1.409±0.274与1.856±0.185 和1.484±0.278与1.937±0.191,差异均有显著性(P=0.001,双侧)。③受检者均未发现主观性不适和毒副作用。④99Tcm-HL91在鼻、口咽部有明显放射性摄取。结论99Tcm-HL91脑肿瘤显像可预测脑肿瘤的放疗敏感性,对鼻、口咽部肿瘤应用价值较低。

Objective To explore the value of ^99Tc^m-4,9-diaza-3,3,10,10-tetramethyldodecan-2, 11-dione dioxime （ HL91 ） imaging in predicting the radiosensitivity of brain tumor. Methods 30 untreated brain tumor cases underwent ^99Tc^m-HL91 plannar imaging at 10 rain, 2 and 4 h postinjection of ^99Tc^m-HL91. The tumor-to-normal ratio（T/N） was calculated by drawing region of interest （ROI）. Radiotherapy was accepted after examination. Four weeks later the radiotherapeutic evaluation underwent by the radiotherapist based on the criteria of World Health Organization （WHO）, and also the value of ^99Tc^m-HL91 imaging in predicting the radiosensitivity of therapy was evaluated. Results ①Among 30 ^99Tc^m-HL91 images, the early, middle and late T/N ratio averaged were 1.453 ± 0. 292, 1. 532 ± 0. 299 and 1. 607 ± 0. 305, respectively. There were significant differences between each phase. ②Among 30 malignant brain tumor patients, none of the cases complete remission（CR） ; 15 partial remission（PR） ; 6 no changing（NC） ; one progressive depravation（PD） and 8 cases of death and lost follow-up. The averaged T/N ratio of early, middle and late phase in effective（CR ± PR） and ineffective group（ NC ± PD） were 1. 333 ± 0. 277, 1. 409 ± 0. 274, 1. 484 ± 0. 278 and 1. 779±0. 183, 1. 856±0. 185, 1.937 ±0. 191, respectively, there were significant differences between the two groups（ P = 0. 001,2 tails）.③No adverse reaction were noticed in all subjects after injection of ^99Tc^m-HL91. ④Significant radioactivity was shown in nose and oropharynx region in all of the patients. Conclusion ^99Tc^m-HL91 brain tumor imaging can predict the radiosensitivity of brain tumors but less valuable in nasal and oral tumor.