^(67)Ga显像对淋巴瘤治疗的监测

^(67)Ga scinitigraphy monitioring of therapy in Non-Hodgkin's lymphoma

目的 用67Ga显像预测和监测非霍奇金淋巴瘤 (NHL)治疗后的早期疗效。方法 86例治疗前67Ga显像和CT扫描阳性的淋巴瘤患者 ,经临床和病理检查证实为NHL。平面67Ga显像分别在治疗后 2和 4个疗程进行。有 5 1例患者治疗 4个疗程后进行CT扫描。患者经 4个疗程治疗后 ,平均随访时间为 1.5年 (3～ 30个月 )。治疗效果评价 :①完全有效 :病灶不显影 ;②部分有效 :病灶部分显影 ;③无效 :病灶显影无变化或进一步增大。结果 86例患者中 6 1例67Ga显像示治疗完全有效 ,14例部分有效 ,11例治疗无效。随访中 ,早期67Ga显像阴性预测值 90 % (4 3/ 48例 ) ,晚期67Ga显像阴性预测值 6 9% (9/ 13例 ) ,提示前者更有临床价值。病灶部分消失和无变化者 ,阴性预测值仅36 % (9/ 2 5例 ) ,提示这部分患者预后很差。CT结果 :治疗后 ,5 1例患者中 18例阴性 ,33例阳性 ,随访中 ,阴性预测值 6 7% (12 / 18例 ) ,而阳性预测值为 2 7% (9/ 33例 )。表明67Ga显像能有效预测疗效 (P<0 .0 0 1) ,而CT则不能 (P >0 .0 5 )。结论 治疗后早期67Ga显像对预测和检测NHL疗效优于晚期显像 ,对患者治疗疗效的评价明显优于CT。

Objective In early phase of therapy in Non Hodgkin's lymphoma (NHL), 67 Ga imaging was used to predict and monitor the therapeutic response. Methods In 86 patients with NHL proven by clinical syndrome and pathology and with positive 67 Ga imaging and CT scan before therapy, 67 Ga scintigraphy was performed after 2 and 4 cycles of therapy.CT scan was also performed after 4 cycles of therapy on 51 of the 86 patients.Average following time was 1.5 years (3～30 months).The therapeutic results were classified as:①complete remission (CR):the lesion uptake of 67 Ga was not detected;②partial remission (PR):the lesion uptake of 67 Ga was 50% less than that before therapy;③no remission (NR):the lesion uptake of 67 Ga was the same as or more than that before therapy. Results Based on 67 Ga imaging in 86 patients,61 patients were in CR after therapy,14 were in PR,and 11 were in NR.During the follow up,the negative predictive value (NPV) after 2 cycles of therapy was 90% (43/48),but negative predictive value after 4 cycles of therapy was 69% (9/13),suggesting that early NPV has more important significance.In PR and NR,NPV was only 36% (9/35).CT findings:in 51 patients undergone CT scan after therapy,18 were negative and 33 were positive.During the follow up,the NPV was 67% (12/18),the positive predictive value was only 27% (9/33).Statastical results showed that the 67 Ga imaging could effectively predict the therapeutic response ( P <0.001),but the CT could not ( P >0.05). Conclusions The early 67 Ga imaging after therapy may help confirm the presence of active NHL better than late 67 Ga imaging does;patients with PR or NR may have poor prognosis; 67 Ga imaging is better than CT in prediction and evaluation of therapeutic outcome in NHL.