99Tcm-生长抑素受体显像对肺癌的诊断价值

目的探讨^99Tc^m-生长抑素受体(^99Tc^m-奥曲肽)显像对肺部肿瘤的诊断价值。方法56例胸部cT检查疑诊为肺癌的患者，行^99Tc^m-奥曲肽显像检查，其中23例行氟脱氧葡萄糖F18(^18F—FDG)双探头符合线路显像(DHC)，并将影像学结果与病理检查结果进行对比分析。结果病理检查证实，56例患者中，肺癌46例，肺良性病变10例。^99Tc^m-奥曲肽显像：53例结果与病理结果相同(44例肺癌、9例肺良性病变)；2例病理检查为肺腺癌，^99Tc^m-奥曲肽显像为肺良性病变，1例病理证实为肺结核球，^99Tc^m-奥曲肽显像为肺癌。^18F—FDG DHC：19例结果与病理结果相同(13例肺癌、6例肺良性病变)；4例病理证实为肺良性病变，^18F—FDG DHC检查为肺癌。以病理结果为诊断标准，^99Tc^m-奥曲肽显像诊断肺癌的敏感性、特异性和准确性分别为95．7％、90．0％和94．6％，阳性预测值(PPR)为97．8％，阴性预测值(NPR)为81．8％；^18F—FDG DHC诊断肺癌的敏感性、特异性、准确性分别为100％、60．0％、82．6％，PPR为76．5％，NPR为100％。^18F—FDG DHC诊断为肺癌的13例患者，6例有淋巴结转移，^18F—FDG DHC共检出10枚转移淋巴结，^99Tc^m-奥曲肽显像仅检出2枚。2例肺癌脑转移，两种显像方法均清晰显示脑部转移灶。结论^99Tc^m-奥曲肽显像是一种无创、安全、经济的检查方法，对肺癌原发病灶有较好的诊断价值，但对淋巴结转移诊断价值有限，它是^18F—FDG DHC的有效补充。

Application of technetium-99m labelled sandostatin Somatostatin receptor imaging in the detection of lung cancer

OBJECTIVE: To evaluate the clinical value of (99)Tc(m)-sandostatin receptors imaging ((99)Tc(m)-sandostatin) in detection of lung tumors in comparison with fludeoxyglucose F18 dual head coincidence imaging ((18)F-FDG DHC). METHODS: Fifty-six consecutive patients (40 men, 16 women; mean age: 62 years, range 35 - 80 years) with pulmonary neoplasm were referred for evaluation. All underwent sandostatin scintigraphy using hybrid SPECT/CT. (18)F-FDG DHC imaging was also performed in 23 patients using the same camera. The tumor uptake of (99)Tc(m)-sandostatin and (18)F-FDG DHC were measured respectively and expressed as the ratio of T/Nr and T/Nm. Final clinical diagnosis was confirmed by histopathological study. RESULTS: Out of 56 cases, 46 were confirmed to be malignant and 10 benign. The sensitivity, specificity and accuracy of (99)Tc(m)-sandostatin in diagnosis of lung cancer were 95.7%, 90.0%, 94.6%, respectively. The positive predictive value (PPR) was 97.8%, and the negative predictive value (NPR) was 81.8%. In the 23 patients underwent both methods, the sensitivity, specificity and accuracy of (18)F-FDG DHC were 100%, 60.0%, 82.6%, respectively; the PPR was 76.5%, and the NPR 100%. Out of 13 patients with malignant neoplasms, 6 patients had regional lymph node metastasis, and all of 10 abnormal lymph nodules showed high uptake of FDG, while (99)Tc(m)-sandostatin imaging only 2 regional metastatited lymph nodes in one patient. T/N(r) and T/N(m) were 3.15 +/- 1.30, and 10.61 +/- 4.35 respectively. There was no relationship between sandostatin uptake and glucose metabolism. CONCLUSION: (99)Tc(m)-sandostatin scintigraphy is a promising noninvasive imaging technique for detection of the primary tumor of lung cancer but of limited value in the detection of lymph node metastasis.