单光子发射型计算机断层成像与CT融合图像评价125I粒子在靶器官中的分布

目的 结合全身扫描,探讨单光子发射型计算机断层成像(SPECT)与CT融合图像对植入的放射性125I粒子在体内分布的评价.方法 2008年5月至2009年6月复旦大学附属中山医院核医学科接受治疗的47例125I粒子植入患者中,6例前列腺癌患者实施了超声诱导下125I粒子植入,另41例有明确肿瘤病史并伴有门静脉或上腔静脉癌栓患者,在数字减影血管成像(DSA)诱导下行支架和125I粒子链条植入到血管腔内.所有患者在125I粒子植入24 h后行全身扫描,再根据125I粒子所在部位行SPECT与CT显像检查.结合全身扫描图像和SPECT与CT图像对植入125I粒子的分布情况进行评价.结果 全身扫描图像为SPECT与CT检查提供准确定位,但无法显示粒子的准确解剖部位.6例前列腺癌患者中,SPECT与CT融合图像显示5例患者植入粒子在前列腺内分布较好,而1例患者粒子植入到右侧精囊腺内;41例有明确肿瘤病史并伴有门静脉或上腔静脉癌栓患者中,SPECT与CT融合图像显示40例血管腔内的粒子链条位于合理的位置,1例植入到上腔静脉内的粒子链条脱离到右心腔内.结论 结合全身扫描,SPECT与CT融合图像可以评价125I粒子在靶器官的分布情况,能及时发现位置偏离的粒子.

SPECT/CT image fusion for evaluation of iodine-125 seeds distribution in target organ

Objective To explore the role of SPECT/CT image fusion, combined with whole body scan, in evaluation of implanted iodine- 125 seeds distribution in the target organ. Methods From May 2008 to June 2009, 47 patients underwent iodine- 125 seed implantation in the Department of Nuclear Medicine, Zhongshan Hospital, Fudan University. Among 47 patients, 6 patients with prostate cancer received iodine-125 seed chain implantation under ultrasound guidance, and the remaining 41 patients with confirmed tumor history and concurrent cancer emboli at the portal vein or superior vena cava received stenting and iodine-125 seeds implantation into lumen of blood vessel under DSA guidance. All the patients underwent whole body scan and SPECT/CT imaging of the target organ after iodine-125 seeds implantation 24 h later. Seed distribution in target organ was evaluated by whole body scan combined with SPECT/CT imaging. Results The whole body scans provided accurate positioning for SPECT/CT scan but not any information for precise anatomical distribution of the seeds. SPECT/CT image fusion showed satisfactory seeds distribution in 5 of the 6 prostate cancer patients except for 1 patients in whom the seeds were implanted into right seminal vesicle. Of 41 patients with confirmed tumor history and portal vein or superior vena cava tumor thrombus, SPECT/CT fused imaging showed intraluminal seed chain at desired location in 40 cases except for 1 case where the seed chain was implanted in the superior vena cava and migrated to the right ventricle.Conclusion SPECT/CT fusion images may be used for evaluating 125I seed distribution in target organs and may identify any aberration in positioning of seeds, when combined with whole body scan.