^(18)F-FDG、^(99)Tc^m-MIBI和^(111)In-奥曲肽对肺癌诊断和治疗评价的比较

Comparison of ^(18) F-FDG, ^(99)Tc^m-MIBI and ^(111) In-octreotide in the evaluation of patients with lung lesions

目的 比较18F 脱氧葡萄糖 (FDG)、99Tcm 甲氧基异丁基异腈 (MIBI)和111In 奥曲肽在肺癌诊断和治疗评价时的优缺点。方法 研究对象包括99Tcm MIBISPECT显像 90例 ,111In 奥曲肽SPECT显像 2 1例以及18F FDGPET显像 118例。其中 15例进行了MIBI和奥曲肽 ,7例做了FDG与MIBI 2种显像。 2 6例用MIBI,12例用FDG进行了治疗前后的比较。结果 MIBI显像对大于 1cm的肺内占位病变的诊断、鉴别诊断和治疗后评价有较好效果 ,其核素血管显像可以帮助了解肺内大血管受累情况 ,但受血流灌注和多药耐药的影响。病灶对奥曲肽的摄取显著高于MIBI(P <0 0 1) ,但两者相关性不高 (r=0 47)。PET可以发现更小的病灶 ,具有更好的图像质量。结论 MIBI显像具有较好的效价比 ,而奥曲肽显像可以更好地显示所有“存活”的肿瘤细胞。

Objective Compare the advantages and pitfalls of 18 F FDG, 99 Tc m MIBI and 111 In octreotide in the diagnostic and therapeutic evaluation of lung cancer. Methods The patients were divided into 3 groups:①Group Ⅰ: MIBI lung imaging was used in 90 patients (76 with malignant lesions, 14 with benign lesions) , octreotide in 21 patients (15 with malignant lesions, 6 with benign lesions) and FDG PET lung imaging in 118 patients (73 with malignant tumors, 45 with benign lesions) ②GroupⅡ: Both MIBI and octreotide imaging were performed in 15 patients Both MIBI and FDG imaging were performed in 7 patients ③GroupⅢ: 26 patients were followed up with MIBI imaging and 12 patients with FDG PET. Results For MIBI, the sensitivity, specificity and accuracy in differentiating malignant from benign lesions were 96%, 77%, and 94% respectively MIBI images were not affected by post therapeutic anatomic change, and showed residue tumor definitely and detected relapse at early stage For octreotide, the sensitivity, specificity, and accuracy were 100%, 50% and 86%, respectively Octreotide uptake was observed not only in small cell lung cancer but also in non small cell lung cancer For the 15 patients in whom both MIBI and octreotide scintigraphy were performed, the T/B ratios of octreotide were significantly higher than those of MIBI in both tumors and benign lesions with high uptake (P<0 01) However, the correlation was not good (r=0 47) FDG PET had the sensitivity, specificity, and accuracy of 97%, 89% and 94% respectively 3 patients with negative results in MIBI scintigraphy were positive in FDG PET Conclusions This preliminary clinical study showed that each of MIBI, octreotide and FDG had its own advantage and disadvantage in demonstrating lung lesions With relatively low costs, MIBI scan is good enough for identification, differentiation and post therapeutic follow up of lung cancer In case of highly suspicious patient with negative or low uptake of MIBI, octreotide or FDG scan should be recommended Although octreotide is not more specific than MIBI, it seems to be better in showing “viable' cells Despite its high cost, FDG PET has many advantages over MIBI and octreotide SPECT FDG PET can detect much smaller lesions, so it is suitable for further evaluation and accurate staging of lung cancer