^(99)Tc^m-奥曲肽显像在淋巴瘤诊断中的应用

The role of ^(99)Tc^m-octreotide scintigraphy in lymphoma

目的评价^(99)Tc^m-奥曲肽显像在淋巴瘤中的临床应用价值。方法 11名健康志愿者和30例淋巴瘤患者进行^(99)Tc^m-奥曲肽显像。所有患者均进行了体格检查,胸部和腹、盆部 CT,颈部和腹股沟 B 超检查,部分完成了腹、盆腔 B 超检查(11例),^(67)Ga-枸橼酸盐全身显像(5例)和骨髓检查(8例)。结果在志愿者中,^(99)Tc^m-奥曲肽可使脑垂体、鼻咽部、甲状腺、肝、脾、双肾、膀胱、胆囊、消化道等组织器官显影,骨骼和骨髓区内放射性分布明显低下或缺损。在30例患者中,^(99)Tc^m-奥曲肽显像发现22例阳性,其中2例为淋巴结炎性反应性增生疾病。其诊断患者的灵敏度和特异性分别为83.3%(20/24)和4/6,假阴性率为16.7%(4/24);诊断病灶的灵敏度为49.3%(72/146);对膈肌上区和膈肌下区淋巴瘤病灶的诊断灵敏度分别为51.6%(48/93)和45.3%(24/53)。显像发现4个假阳性病灶,对病灶的诊断特异性为99.6%(990/994)。结论 ^(99)Tc^m-奥曲肽显像探测淋巴瘤病灶的灵敏度较低;其无法对恶性淋巴瘤和淋巴结炎性反应性增生进行鉴别。

Objective The aim of the study was to evaluate the role of ^99Tc^m-octreotide scintigraphy in malignant lymphoma. Methods The subjects of the study consisted of 11 healthy adults, 6 Hodgkin lymphomas （ HL）, 16 non-Hodgkin lymphomas （NHL）, 2 recurrent NHL,4 post-treatment NHL and 2 inflammatory reactive proliferations. After fasting over 12 h, the subjects received 555 - 740 MBq ^99Tc^m-ocreotide intravenously, followed by a whole-body scan at 3 - 4 h post-injection. Additional planar or tomographic imaging over neck/thorax and abdomen/pelvis were undertaken if necessary. Results In healthy subjects, the radioactivity was noted in pituitary gland, nasopharynx, thyroid glands, liver, spleen, kidneys, urinary bladder, gallbladder and gastrointestinal tract. Positive uptake of ^99Tc^m-octreotide was found in 20/24 newly diagnosed lymphoma and 2 cases of inflammatory reactive proliferations. The diagnostic sensitivity of detecting lymphoma patients was 83.3% （20/24）. The false negative rate was 16.7% （4/24）. The sensitivity for overall focal lesions, supradiaphragmatic lesions and infradiaphragmatic lesions were 49.3% （ 72/146）, 51.6% （48/93） and 45.3 % （ 24/53 ）, respectively. The specificity for detect patients was 4/6 and for detecting lesions was 99.6% （990/994）. Four lesions on scintigraphic scan were proved to be false positive. Conclusion With a limited sensitivity, ^99Tc^m-octreotide imaging may not help in distinguishing the lymph node lesions with inflammatory process from malignant lymphoma.