^(201)Tl和^(99)mTc-MIBI显像定量分析在骨肉瘤新辅助化疗中的价值

^(201)Tl and ^(99)mTc-MIBI scintigraphy in evaluation of neoadjuvant chemotherapy for osteosarcoma

目的:探讨201Tl和99mTc-MIBI显像在术前新辅助化疗治疗骨肉瘤中的临床价值。方法:22例在新辅助化疗前和3周期化疗后均进行201Tl显像和99mTc-MIBI显像的患者,根据肿瘤坏死率的分级[1]将其分为3组:无反应组4例(Ⅰ级<50%),部分反应组12例(Ⅱ级50%～89%),反应良好组6例(Ⅲ级>90%)。对所采集的图像数据进行定性和半定量分析,通过测量肿瘤病灶与正常组织的放射性计数,计算摄取比率(uptake ratio,UR)和变化率(alteration ratio,AR)。并采用SPSS 13.0软件进行数据分析。结果:201Tl显像时,无反应组URpre和URpost分别为2.14±0.67和2.07±0.71,两者无统计学意义(P>0.05);部分反应组URpre为3.45±1.57,URpost为2.02±0.97,两者有显著统计学意义(P<0.01);反应良好组URpre为3.57±0.67,URpost为1.36±0.20,两者有显著统计学意义(P<0.01);99mTc-MIBI显像时,无反应组URpre为1.66±0.42,URpost为1.85±0.70,两者无统计学意义(P>0.05);部分反应组URpre为2.39±1.41,URpost为1.68±0.72,两者有统计学意义(P<0.05);反应良好组URpre为2.56±0.60,URpost为1.19±0.14,两者有显著统计学意义(P<0.01);201Tl显像时AR值范围为-0.03～0.72,AR值和TNR之间存在良好的相关性,相关系数r=0.95;99mTc-MIBI显像时AR值范围为-1.21～0.64,AR值和TNR之间存在良好的相关性,相关系数r=0.71;201Tl显像的AR值与99mTc-MIBI显像的AR值之间存在良好的相关性,相关系数r=0.70。结论:201Tl显像与99mTc-MIBI显像显示新辅助化疗后AR值与TNR均存在良好的相关性,对骨肉瘤化疗疗效的评估有重要意义。201Tl显像对骨肉瘤化疗疗效的评估优于99mTc-MIBI显像,但两者无显著差别。

Objective： To evaluate the application of 201Tl and 99mTc-MIBI scintigraphy in assessment of neoadjuvant chemotherapy for osteosarcoma.Methods： Twenty-two patients with osteosarcoma underwent both 201Tl and 99mTc-MIBI scintigraphy.According to tumor necrosis rate（TNR）,22 patients were classified into three groups：Group 1（necrosis less than 50%）,Group 2（50%~89% necrosis） and Group 3（necrosis greater than 90%）.The uptake ratio（UR） was obtained in images before and after chemotherapy.The alteration ratio（AR） and tumor necrosis ratio（TNR） were calculated.Results： In 201Tl images,URpre and URpost（mean±s.d.） of Group 1 were 2.14±0.67,2.07±0.71（P0.05）;URpre and URpost of Group 2 were 3.45±1.57 and 2.02±0.97（P0.01）;URpre and URpost of Group 3 were 3.57±0.67 and 1.36±0.20（P0.01）.In 99mTc-MIBI images,URpre and URpost of Group 1 were 1.66±0.42 and 1.85±0.70（P0.05）;URpre and URpost of Group 2 were 2.39±1.41 and 1.68±0.72（P0.05）;URpre and URpost of Group 3 were 2.56±0.60 and 1.19±0.14（P0.01）.The AR value in 201Tl scintigraphy was-0.03-0.72,the liner regression analysis of AR versus TNR showed a highly significant positive correlation（r=0.95）.The AR value in 99mTc-MIBI scintigraphy was-1.21-0.64,the liner regression analysis of AR versus TNR showed a highly significant positive correlation（r=0.71）.The liner regression analysis of AR in 201Tl scintigraphy versus AR in 99mTc-MIBI scintigraphy showed a highly significant positive correlation（r=0.70）.Conclusion： The AR changes significantly after neoadjuvant chemotherapy and is positively correlated with TNR,which indicates that 201TI-and 99mTc-MIBI scintigraphy can be used for evaluation of neoadjuvant chemotherapy.