肺部恶性肿瘤^(99m)Tc-HL91乏氧显像与^(18)F-FDG符合显像的对比研究

Clinical research of ^(99m)Tc-HL91 hypoxia lung i maging and ^(18)F-FDG SPECT on lung malignant tumor

目的 探讨比较99mTc -HL91肺显像和18F -FDG符合显像对肺部恶性肿瘤的诊断价值及肿瘤乏氧组织探测能力。方法 90例肺部恶性肿瘤 (81例原发性肺癌 ,9例肺转移性病变 )及 17例肺良性病变患者均完成18F -FDG符合显像及99mTc -HL91(92 5MBq)前位及后位静态显像。计算病灶和对侧肺组织摄取FDG及HL91的比值 (L/N)。结果 肺良性病变与原发性恶性病变摄取18F -FDG的L/N比值分别为 [(6 .4 1± 5 .6 8)和(12 .4 6± 10 .11) ,P <0 .0 5 ],其中腺癌组 (9.2 2± 6 .36 )与良性组比较 (P >0 .0 5 ) ,鳞癌组 (13.2 7± 9.96 )与良性组比较P <0 .0 5 ,转移性病变 (10 .97± 7.37)与良性组比较P >0 .0 5 ;肺良恶性病变摄取HL91的L/N值分别为[(1.15± 0 .2 5 )和 (1.4 5± 0 .2 2 ) ,P <0 .0 0 1],其中腺癌组为 (1.4 0± 0 .2 5 )与良性组比较P <0 .0 1,鳞癌组 (1.4 7± 0 .2 7)与良性组比较P <0 .0 0 1,转移性病变 (1.4 6± 0 .2 2 )与良性组比较P <0 .0 1。18F -FDG符合显像及99mTc-HL91肺显像诊断肺恶性病变的灵敏度为 10 0 % (90 / 90 )和 93.3% (84 / 90 ) ,特异性为 17.7% (3/ 17)和 6 4 .7%(11/ 17) ,准确性为 86 .9%和 88.8% ;肺部良恶性病变摄取FDG及HL91L/NT值的相关分析系数分别为r=0 .6 32 (P =0 .0 0

Objective: To study and compare the diagnostic value and the detected power of anoxic tissue in tumour of 99mTc-HL91 and 18F-FDG imaging in lung malignant tumor.Methods: 17 patients with lung benign disease and 90 patients with lung malignant tumors(81 cases with primary lung malignant tumors, 9 cases with metastatic lung tumors) were included. Ant and post planar scan were performed in every patient after intravenous injection 925 MBq 99mTc-HL91 , and 18F-FDG SPECT imaging were performed in eve ry patient. Lesion-to-normal(L/N) lung tissue background ratios were measure d for all 99mTc-HL91 scans and 18F-FDG SPECT imaging. Res ults: The L/N ratio was [( 6. 41± 5.68),(12.46± 10.11),P <0. 05] with lung benign and primary malignant disease in 18F-FDG SPEC T [ adenocarcinoma :(9.22 ±6.36), P> 0.05 ;spuamous cell carcinoma: (13.27±9.96), P<0.05], and (10.97± 7.37),(P>0.05) in metastatic lung tumor group. Th e L/N ratio was (1.15±0.25), (1.45±0.22),(P<0.001) with lung ben ign and primary malignant disease in 99mTc-HL91 imaging respectively( adenocarcinoma: 1.40～0.25, P<0.01;spuamous cell carcinoma: (1.47±0.27) , P<0. 001, and (1.46±0.22),P<0.01,) in metastatic lung tumor group. The sensitivity, specificity and accuracy of 18F-FDG SPECT and 99mTc-HL91 in diagnosing malignant and benign lesions were 100% ( 90/90 ) , 93.3% (84/90) ,17.7%(3/17), 64.7% (11/17), 86.9%, 88.8%,resp ectively. The correlation coefficient was r=0. 632(P=0. 006) and r=0. 203 (P=0. 055) in correlation analysis lung benign malignant disease uptaking FDG L/N ratio and HL91L/N ratio. Conclusions:Hypoxia inc reases tumor tissue uptake of FDG in lung malignant tumor. Increased FDG upta ke in lung malignant tumor tissue during 18F-FDG SPECT imaging may be p artly reflect the degree of tumor tissue hypoxia. 99mTc-HL91 has specif ic diagnostic value of lung pathological changes.