^(99)Tc^m-HTOC和^(131)Ⅰ-MIBG显像诊断嗜铬细胞瘤的比较

A comparative study of ^(99)Tc^m-HTOC and ^(131)Ⅰ-MIBG in diagnosing pheochromocytoma

目的比较和评价^(99)Tc^m-奥曲肽(HTOC)和^(131)Ⅱ-间碘苄胍(MIBG)显像诊断嗜铬细胞瘤的临床价值。方法 28例临床疑嗜铬细胞瘤患者先后进行^(99)Tc^m-HTOC 和^(131)Ⅰ-MIBG 全身显像,如全身显像发现异位病灶则加做同机 CT 融合检查。结果 28例中最终证实为嗜铬细胞瘤者19例,18例经手术或活组织病理检查证实,1例经生化和其他影像学检查证实。28例患者中9例^(99)Tc^m-HTOC 和^(131)Ⅰ-MIBG 显像均阳性,病灶位于心脏1例、腹主动脉旁3例、肾上腺3例,恶性多发病灶2例;恶性多发患者^(99)Tc^m-HTOC 显像发现的病灶多于^(131)Ⅰ-MIBG。^(99)Tc^m-HTOC 显像阳性而^(131)I-MIBG 显像阴性患者共5例,病灶位于心脏3例,恶性多发病灶2例。^(99)Tc^m-HTOC 显像阴性而^(131)Ⅰ-MIBG 显像阳性4例,病灶均位于肾上腺。两种显像均阴性10例,1例为嗜铬细胞瘤伴囊性变,其他9例均除外嗜铬细胞瘤。^(99)Tc^m-HTOC 和^(131)Ⅰ-MIBG 显像的灵敏度、特异性、准确性分别为73.7%、100%、82.1%和68.4%、100%、78.5%。^(99)Tc^m-HTOC 显像对异位于心脏的嗜铬细胞瘤和恶性多发病灶的诊断明显优于^(131)I-MIBG,但对肾上腺来源的嗜铬细胞瘤的检出不如^(131)Ⅰ-MIBG。结论 ^(131)Ⅰ-MIBG 显像仍是诊断嗜铬细胞瘤的首选检查,但结果阴性时需进行^(99)Tc^m-HTOC 显像.

Objective To evaluate and compare the chnical value of ^99Tc^m-hydrazinonicotinamide-3trysinoctreotide （HTOC） and ^131 I-meta-iodobenzyl guanidine （MIBG） in diagnosing pheochromocytoma. Methods Whole body imaging was performed in 28 patients suspected pheochromocytoma with both ^99Tc^m-HTOC and ^131 I-MIBG. SPECT and CT fusion imaging was performed in patients with ectopic lesions. All patients also underwent CT study. There were 19 of 28 cases confirmed by operation or biopsy, and 1 by other imaging modality techniques. Results In 9 cases both ^99Tc^m-HTOC and ^131 I-MIBG imaging indicated positive finding. The lesions were 3 in adrenal gland, 1 in heart, 3 in para-abdominal aorta, and multi-position in 2. ^99Tc^m-HTOC detected more lesions than ^131 I-MIBG. Among the 5 cases who were positive in ^99Tc^m-HTOC imaging but negative in ^131 I-MIBG, 2 cases were multiple malignant lesions, and 3 originated from the heart. There were 4 cases with negative ^99Tc^m-HTOC but positive in ^131 I-MIBG, all were in adrenal gland. In 10 cases while both ^99Tc^m-HTOC and ^131 I-MIBG findings were negative, one was a pheochromocytoma of adrenal gland with cystic change and the other 9 were ruled out of pheochromocytoma. The sensitivity, specificity and accuracy of ^99Tc^m-HTOC were 73.2%, 100% and 82.1% respectively, while those of ^131 I-MIBG were 68.4%, 100% , 78.5% respectively. ^99Tc^m-HTOC was superior to ^131 I-MIBG in diagnosing malignant pheochromocytoma with multiple lesions and those located in heart. Conclusions ^131 I-MIBG remains to be the first choice in detecting pheochromocytoma. However, a negative finding of ^131 I-MIBG cannot rule out the diagnosis of pheochromocytoma, and ^99Tc^m-HTOC imaging must be performed.