99Tc-甲氧异腈显像在鼻部原发NK/T细胞淋巴瘤中的诊断价值

目的探讨⁹⁹Tc-甲氧异腈(MIBI)显像在鼻部原发NK/T细胞淋巴瘤疗效预测中的诊断价值及显像特点。 方法对诊断明确的58例鼻部原发NK/T细胞淋巴瘤患者，按治疗效果进行分组，完全缓解(CR)、部分缓解(PR)为疗效较佳组，稳定状态(SD)、病情进展(PD)为疗效欠佳组。疗效较佳组31例，疗效欠佳组27例。单光子发射计算机断层扫描(SPECT/CT)扫描显示原发灶部位，鼻面部多处侵犯10例、鼻腔部28例、鼻咽部20例。所有患者于放化疗前后分别行⁹⁹Tc-MIBI SPECT/CT显像，计算每例患者断层扫描时病灶部位/头皮组织放射性(T/N)比值。本研究为回顾性研究。 结果58例患者中，⁹⁹Tc-MIBI SPECT/CT显像明确诊断49例，与病理诊断符合率达84.5%；58例患者治疗前原发灶T/N值为(3.9±1.9)，治疗后为(1.6±0.7)，差异有统计学意义(t＝5.14，P＝0.017)；治疗前疗效较佳组T/N值(4.0±2.8)高于疗效欠佳组(2.8±1.2)，差异有统计学意义(t＝4.07，P＝0.025)；疗效较佳组患者治疗前T/N值(4.0±2.8)高于治疗后(1.5±0.8)，差异有统计学意义(t＝8.29，P＝0.003)。治疗后鼻面部多处侵犯组患者T/N值(2.7±1.1)高于鼻腔组、鼻咽组(1.4±0.6、1.6±0.7)，差异有统计学意义(t＝5.15，4.39；P＝0.035，0.032)；T/N值变化率(0.13±0.21)低于鼻腔组、鼻咽组(0.51±0.25、0.49±0.30)，差异有统计学意义(t＝6.27，4.96；P＝0.048，0.033)；鼻腔组治疗后与治疗前T/N值比较，治疗后(1.4±0.6)低于治疗前(3.7±1.4)，差异有统计学意义(t＝2.97，P＝0.017)；鼻咽组治疗后与治疗前T/N值比较，治疗后(1.6±0.7)低于治疗前(3.4±1.6)，差异有统计学意义(t＝3.08，P＝0.028)；鼻面部多处侵犯组治疗后与治疗前T/N值比较，治疗后(2.7±1.1)低于治疗前(4.1±2.0)，差异无统计学意义(t＝6.78，P＝0.078)。 结论本研究结果提示，⁹⁹Tc-MIBI作为一种功能性显像，可以提高病情诊断能力，及时进行疗效预测，指导临床确定治疗方案。

Clinical value of 99Tc-MIBI scintigraphy in primary nasal type NK/T-cell lymphoma

ObjectiveTo investigate the usefulness of ⁹⁹Tc-MIBI scintigraphy in diagnosing and predicting therapeutic response of nasal type NK/T-cell lymphoma. MethodsFifty-eight patients with histologically proved primary nasal type NK/T-cell lymphoma were enrolled, and were divided into four groups, as complete remission group, partial remission group, stable disease group(SD), progressive disease group(PD). All patients underwent ⁹⁹Tc-MIBI SPECT/CT scintigraphy before and after chemoradiothetapy.Tumor-to-background (T/N) ratios were calculated. ResultsThe accuracy of ⁹⁹Tc-MIBI SPECT-CT was 84.5%.The T/N value of before therapy (3.9±1.9) was higher than that after therapy(1.6±0.7). Before therapy, the T/N value of good responders was significantly higher than that in poor responders (t=4.07, P=0.025). In good responders, the T/N value of before therapy also was higher than that after therapy(t=8.29, P=0.003). The T/N value of patients with several lesions were higher than patients in the other two groups(t=5.15, 4.39; P=0.035, 0.032). The T/N value rate was lower than those in the other two groups (t=6.27, 4.96; P=0.048, 0.033). The before therapy T/N value of the patients with Nasal lymphoma or Nasopharyngeal lymphoma were also higher than those in after therapy (t=2.97, 3.08; P=0.017, 0.028). Conclusion⁹⁹Tc-MIBI scintigraphy plays a very important role in diagnosing and predicting therapeutic response of primary nasal type NK/T-cell lymphom.