99Tcm-MIBI显像评价非小细胞肺癌三维适形放疗疗效的临床研究

99Tcm-MIBI SPECT in estimation of the treatment response to three-dimensional conformal radiotherapy in patients with non-small cell lung cancer

目的 探讨99Tcm-甲氧基异丁基异腈（MIBI）显像评价非小细胞肺癌（NSCLC）三维适形放疗疗效的价值.方法 将102例NSCLC患者根据胸部CT检查结果分为放疗有效组（完全缓解＋部分缓解）和无效组（病情稳定＋病情进展）.患者于放疗前行99Tcm-MIBI早期（10～30 min）及延迟（2～3 h）显像,用感兴趣区（ROI）的方法分别获得早期相肿瘤/正常肺组织放射性摄取（T/N）比值（ER）和延迟相T/N比值（DR）,并计算出滞留指数[RI=（DR-ER）/ER×100%].采用SPSS 13.0软件进行统计学处理,检验方法为两独立样本t检验和秩和检验（Mann-Whitney U）.结果 99Tcm-MIBI显像结果中,放疗有效组的ER和DR分别为2.36±0.17和2.48±0.20,均高于放疗无效组的1.82±0.14和1.94±0.16,差异均有统计学意义（t=-13.1,-12.7,P均＜0.05）.放疗有效组的RI中位值为6.60%,高于放疗无效组的5.13%,差异有统计学意义（z=-6.83,P＜0.05）.结论 99Tcm-MIBI显像在评价NSCLC三维适形放疗疗效、为临床制订合适的放疗方案方面具有重要的临床价值.

Objective To explore whether the degree of 99Tcm-methoxyisobutylisonitrile （MIBI） uptake in non-small cell lung cancer （NSCLC） could be correlated with the treatment response to three-dimensional conformal radiotherapy.Methods A total of 102 patients with NSCLC were studied with 99Tcm-MIBI SPECT before radiotherapy.The patients were classified by a follow-up CT as responders （complete or partial remission） and non-responders （stable or progressive disease）.After intravenous administration of 740 MBq 99Tcm-MIBI, SPECT imaging at 10-30 min （early） and 2-3 h （delayed） were performed.Region of interest （ROI） was placed over the tumors and contralateral normal lung tissue.The uptake ratio of tumor to contralateral normal lung （T/N） was obtained from both early （ER） and delayed （DR） SPECT images.The retention index （RI） was measured as：RI = （DR - ER）/ER×100%.Statistical analysis was performed by two independent-sample t-test and Mann-Whitney U test using software SPSS 13.0.Results 99Tcm-MIBI uptake was significantly higher in responders than in non-responders：2.36 ±0.17 vs 1.82 ±0.14 （ER） and 2.48 ± 0.20 vs 1.94 ± 0.16 （DR）, respectively （t = - 13.1,- 12.7, both P〈 0.05）.The median RI in the responders group was also significantly higher than that in the non-responders group （6.60% vs 5.13%, z = - 6.83, P 〈 0.05）.Conclusion ER, DR and RI of 99Tcm-MIBI SPECT might be useful to estimate the treatment response to three-dimensional conformal radiotherapy in patients with NSCLC.