^(18)氟脱氧葡萄糖代谢功能图像在头颈部肿瘤诊断中的价值及机理研究

Value of ^(18)F-FDG metabolic imaging in diagnosis and treatment of head and neck tumors and its mechanism study

目的研究^(18)氟脱氧葡萄糖(^(18)F-FDG)双探头符合线路显像和同机 CT 融合技术在头颈部肿瘤诊治中的价值及机理。方法用^(18)F-FDG 双探头符合线路显像(DHTC)和同机 CT 融合技术检查25例头颈部肿瘤,并与 CT/MRI 结果相比较。另收集38例[20例术前行单光子发射型计算机断层(SPECT)/CT 检查]耳鼻咽喉科、口腔外科住院的头颈部癌的新鲜组织标本,行逆转录聚合酶链反应(RT-PCR)和免疫组织化学方法检测。结果 SPECT/CT 诊断灵敏度、特异性和准确性分别为100.0%、87.5%、96.0%;CT/MRI 诊断灵敏度、特异性和准确性分别为64.7%、50.0%、60.0%。在同部位 SPECT/CT 与 CT/MRI 解剖显像比较中,对4例颈部转移淋巴结癌的原发灶及4例头颈部肿块的良恶性的判断,解剖显像不能作出正确诊断,而符合线路显像及图像融合均能作出正确判断。RT-PCR 及免疫组织化学结果:葡萄糖转运蛋白-1(Glut-1)、Glut-3基因在头颈部癌中表达明显高于正常组织、癌旁组织(均 P<0.05);Glut-1蛋白在头颈部癌的表达为78.9%,Glut-3蛋白在正常组织、癌旁组织、头颈部癌中均无表达。结论符合线路显像及图像融合可作为对头颈部肿瘤良恶性鉴别及肿瘤临床分期和分级、鉴别肿瘤经手术或放射治疗后复发、不明原发灶肿瘤检出方面的一种前瞻性检查工具;Glut-1、Glut-3异常表达与头颈部癌的葡萄糖吸收增高有关。

Objective To study the value of ^18F-FDG dual-head tomography with coincidence （DHTC） and single photon emission computerized tomography （SPECT）coincidence imaging in diagnosis and treatment of head and neck tumors and mechanism thereof and analyze the value of glucose transporter proteins in the mechanism of increased uptake glucose of head and neck malignant tumor. Methods Twentyfive patients with head and neck tumors were examined by CT or MRI and underwent ^18F-FDG DHTC and coincidence imaging. The results of these 2 different methods were compared. Fresh tissues of 38 patients with malignant tumors of the head-and-neck underwent RT-PCR and immunohistochenmical examinafion. Results The sensitivity, specificity, and accuracy of ^18F-FDG coincidence imaging and registration with integrated CT （SPECT/CT） in diagnosis of the head and neck tumors was 100. 0%, 87.5%, and 96.0% respectively, all significantly higher than those of the anatomical imaging（64.7%, 50. 0%, and 60. 0% respectively, all P 〈 0. 05 ）. For the lesions on the same site, SPECT/CT could diagnose exactly the primary tumor site of neck metastasis in four cases and diagnose the malignancy or benignancy of other four cases that anatomical imaging（CT/MRI） could not diagnose exactly. ^18F-FDG coincidence imaging and registration with integrated CT could find extra lesions of tumors. The results of RT- PCR and immunohistochemistry showed that the mRNA expression and protein expression of Glut-1 and Glut- 3 were higher in the head and neck cancer than that in the normal tissue of head and neck or in the adjacent tissue （ all P 〈 0. 05）. Conclusion ^18 F-FDG coincidence imaging and registration with integrated CT can be as a prospective tool that can judge the malignancy or benignancy of head and neck tumor, and stage and classify the tumor, and distinguish recurrence or necrosis of tumor after treatment by surgery or radiotherapy, and detect unknown primary tumor. The abnormal expressions of Glut-1 and Glut-3 may be correhtted with the increased uptake of glucose of head and head cancer.