^99Tc^m-HL91乏氧显像在恶性肿瘤治疗后随访中的应用

目的评价^99Tc^m-4，9-二氮-3，3，10，10-四甲基十二烷-2，11-二酮肟（HL91）乏氧显像在恶性肿瘤治疗后随访中的价值。方法37例胸部和头颈部恶性肿瘤患者在治疗结束后3—12个月的临床随访中，CT检查怀疑肿瘤残余、复发或转移，再行^99Tc^m-HL91乏氧显像。目测定性分析，判定乏氧显像阳性病例，再用感兴趣区（ROI）技术对阳性病例进行半定量分析，计算肿瘤部位（T）与对侧相应部位或头皮（NT）的放射性比值（T／NT），并采用成组设计两样本均数t检验进行比较。以鼻咽内镜检查、病理活组织检查结果和12个月的临床随访资料作为判断肿瘤残余、复发或转移的依据，计算^99Tc^m-HL91显像和cT的诊断效能。结果37例患者中，无肿瘤局部残余或复发病灶者19例，存在肿瘤局部残余或复发病灶者11例，有远处转移病灶者7例。（1）无肿瘤局部残余或复发组与肿瘤局部残余或复发组的T／NT比值分别为1．18±0．14和1．58±0．16，两者差异有统计学意义（t=4．87，P〈0．001）。（2）^99Tc^m-HL91显像监测肿瘤局部残余或复发的灵敏度72．73％（8／11），特异性89．47％（17／19），准确性83．33％（25／30）；CT监测肿瘤局部残余或复发的灵敏度63．64％（7／11），特异性84．21％（16／19），准确性76．67％（23／30）。^99Tc^m-HL91显像与CT结果一致的有21例患者，^99Tc^m-HL91显像与CT联合监测此21例肿瘤残余或复发的灵敏度4／4，特异性94．12％（16／17），准确性95．24％（20／21）。（3）7例转移患者，^99Tc^m-HL91显像阳性4例，CT均阳性。结论^99Tc^m-HL91乏氧显像对恶性肿瘤治疗后局部残余、复发或转移灶的鉴别有一定价值，与CT联合可有效提高对恶性肿瘤治疗后局部残余、复发或转移灶的早期诊断效能。

Evaluation of 99Tcm-HL91 hypoxic imaging in post-therapeutic patients with cancers

Objective 99Tcm-4, 9-diaza-3, 3, 10, 10-tetramethyldodecan-2, 11-dione dioxime (HL91) is a new hypoxia imaging agent that demonstrates increased uptake and retention in tumor hypoxic tissues in vivo. The objective of this study was to evaluate the clinical value of 99Tcm-HL91 hypoxia imaging in post-therapeutic patients with cancers. Methods Thirty-seven patients with primary cancers at head and neck and upper aerodigestive region who were suspected to have residual, recurrent, or metastatic disease at either clinical follow-up or by regular CT follow-up, were included. All underwent 99Tcm-HL91 imaging. The radioactivity ratios of tumor to normal tissues (T/NT) were calculated using the region of interest (ROI) technique. A t-test was used for data analysis. The " gold standard" of diagnostic accuracy was based on histopathology or clinical follow-up. Results were compared between 99Tcm-HL91 and CT. Results Of the 37 patients, 11 had either residual or recurrent lesions and 7 had distant disease. (1) A significantly higher 99Tcm-HL91 uptake were noted in residual or recurrent lesions than benign lesions (1.58 ± 0. 16 vs 1.18 ±0.14, t =4. 87, P <0.001). (2) The sensitivity, specificity, and accuracy for residual or recur-rent lesions were 72. 73% (8/11), 63.64% (7/11), 4/4; 89.47% (17/19), 84. 21% (16/19), 94. 12% (16/17), and 83.33% (25/30), 76.67% (23/30), 95.24% (20/21) in 99Tcm-HL91, CT, and combined 99Tcm-HL91 and CT, respectively. (3) For distant sites detection (n = 7), CT detected all but 99Tcm-HL91 missed three. Conclusions A combination of 99Tcm-HL91 and CT in detection either residu-al, recurrent, or metastatic disease would have the highest benefit in patients with cancers at head and neck and upper aerodigestive region.