^(99m)Tc-HL91在鼻咽癌乏氧显像检测中的初步研究

Clinical Application of ^(99m)Tc-HL91 Hypoxia Imaging in Nasopharyngeal Carcinoma

背景与目的:肿瘤组织乏氧是恶性肿瘤的一个重要生物学特征,直接影响临床放化疗效果。对于鼻咽癌乏氧检测目前还未有成熟可靠、简便易行的方法。本研究旨在探讨乏氧显像剂99mTc-HL91在鼻咽癌乏氧检测的临床应用价值。方法:对38例鼻咽癌患者静脉注射99mTc-HL91925MBq(25mCi)后3.5h进行头颈部SPE/CT断层显像,先对图像进行目测定性分析,以肉眼可辨别的鼻咽病灶区放射性浓聚高于正常鼻咽本底为乏氧显像阳性;再对阳性病例进行半定量分析,通过核医学感兴趣区(regionofinteresting,ROI)技术分别计算鼻咽病灶内乏氧显像部位(T+)及病灶内非乏氧显像部位(T-)与正常鼻咽组织(N)的放射性计数比(T+/N和T-/N);并将T+/N与肿瘤体积进行相关分析。结果:38例鼻咽癌中乏氧显像阳性32例(84.21%);阳性病例中T+/N为1.54±0.44,T-/N为1.08±0.19,两者存在显著性差异(P<0.001);肿瘤体积与T+/N呈正相关(r=0.788,P<0.001)。结论:99mTc-HL91在鼻咽癌乏氧显像检测中对鼻咽癌的放疗影响及确定生物靶区有一定的临床应用价值。

BACKGROUND ＆ OBJECTIVE： Tumor hypoxia is an important biologic feature of malignancies, which affects their response to radiotherapy and chemotherapy. There is still no reliable and convenient way in clinic to detect the hypoxia of nasopharyngeal carcinoma （NPC）. This study was to explore the clinical application value of ^99mTc-HL91 hypoxia imaging in NPC. METHODS： A total of 38 NPC patients were included. Single photon emission computed tomography （SPECT） scan of the head and neck was performed 3.5 h after intravenous injection of 925 MBq ^99mTc-HL91. The images were qualified visually and processed with semi-quantitative analysis. The nasopharynx （NP） lesions with radioactivity higher than that of normal NP tissue background （N） were identified as hypoxia positive. Region of interesting （ROI） technique was used to determine the positive imaging interested region （T^＋） and the negative imaging interested region （T^-） in the same NP lesion for all positive cases. T^＋ -to-normal NP tissue background （T^＋ /N） ratio and T^--to-normal NP tissue background （T^-/N） ratio were measured. The correlation of T^＋/N ratio to tumor volume was analyzed. RESULTS： Of the 38 NPC patients, 32 （84.21%） were hypoxia-positive, with the T＋/N ratio significantly higher than the T-/N ratio （1.54±0.44 vs. 1.08±0.19, P 〈0.001）. The T^＋/N ratio was positively correlated to tumor volumes （r=0.788, P 〈0.001）. CONCLUSION：^99mTc-HL91 is a convenient hypoxia imaging agent, and has potential clinical value in NPC hypoxia imaging and confirming target area for radiotherapy.