摘要
第一部分肺肿瘤~(99)Tc~mN-NOET SPECT显像研究
第一节~(99)Tc~mN-NOET双时相SPECT鉴别诊断肺部单发结节良恶性
目的结合~(99)Tc~mN-NOET亲肿瘤的特点，系统研究原发性肺癌术前~(99)Tc~mN-NOET双时相SPECT鉴别诊断肺部单发结节良、恶性的价值，并与CT比较；分别分析早期和延迟病变部位与对侧对应正常组织早期和延迟放射性比值(T／N)，以及其影响因素；分析~(99)Tc~mN-NOET双时相SPECT测量肿瘤大小的价值，与CT比较；分析断层显像与平面显像对病灶检出率的差异。
方法62例经X线检查示肺部阴影疑肺癌的患者术前1周内和5例排除肺部恶性肿瘤疾患的门诊病人和部分健康志愿者(男3例，女2例，年龄30-64岁，平均42．53±7．52岁)进行~(99)Tc~mN-NOET SPECT 20-30min早期、2h延迟胸部前后位平面显像、断层显像和常规CT扫描，所有病例检查前均未经放、化疗和手术治疗，检查后均通过纤维支气管镜或穿刺活检或手术获得细胞学或组织学资料。62例中，1例为右中肺阻塞综合症，胸腔积液，下呼吸道感染，因为有较大的右肺中叶不张和右侧胸腔积液，影响病灶的肉眼分析和半定量分析，所以未列入统计。NOET冻干药盒均为北京师范大学应用化学研究所研制并提供，标记率>90％。~(99)Tc~mN-NOET SPECT显像采用美国ADAC公司生产的VERTEX双探头SPECT仪，配平行孔低能高分辨率准直器，能峰设为140KeV，窗宽设为±20％。局部静态平面显像采集1000k计数，矩阵256×256。断层像采360°，6°／帧，40s／帧，共60帧，矩阵128×128，放大倍数为1。数据用ADAC专用计算机软件处理后得到图像，横断面、矢状面及冠状面投影，采用Butterworth滤波函数(cutoff，0．36；order，15)。CT检查采用GE公司生产的64排螺旋CT仪。~(99)Tc~mN-NOET SPECT图像采取肉眼分析和半定量分析。由2位有经验的核医学科医师共同阅片。病理检查与显像结果进行双盲法对照。肉眼分析首先要确定病灶部位，确定病灶的根据：①目测(~(99)Tc~mN-NOET显像可见明显显像剂浓集)；②X线片或CT(~(99)Tc~mN-NOET显像未见明显显像剂浓集)，然后观察各个层面是否有显像剂异常浓聚灶。根据占位病变处显像剂浓聚程度将显像结果进行评分：0分：未见显像剂聚集(-)；1分：少量聚集(+)；2分：浓聚(++)，强度低于肝脏计数；3分：高度浓聚(+++)，强度等于或高于肝脏计数。在~(99)Tc~mN-NOET显像中，-、+为阴性，++、+++为阳性。半定量分析采用计算机感兴趣区(Region of interesting，ROI)技术在前位、后位的平面像及冠状位、矢状位和横断位的断层图像上的病灶部位(①对明显浓集~(99)Tc~mN-NOET：在图像上取1帧肿瘤显像剂浓聚最明显的图像，确定肿瘤ROI并将对侧镜面部位定为本底：②对肉眼未见浓集~(99)Tc~mN-NOET：参考X线片、CT或MRI图像确定肿瘤部位和ROI，并以对侧镜面部位定为本底)。勾画肿瘤部位感兴趣区(ROI_1)，并在对侧组织镜面部位取相同大小的感兴趣区(ROI_2)，分别测定每个pixel的平均计数，并计算肿瘤组织计数与正常组织比值(ROI_1／ROI_2)即摄取比值(T／N)进行半定量分析。T／N包括早期T／N(ER)和延迟T／N(DR)。计算滞留分数(RI%)=(DR-ER)／ER×100％。对于实性结节的T／N值，采用上述方法；对于病变中部有显像剂分布缺损的病灶，在病灶的周边选取几个部位进行测定，取其平均值作为该病灶的T／N值。采用计算机特有的测量方式，测量病灶和空洞的长径、横径及前后径。以长径×横径×前后径表示病灶和空洞的大小。结果判断根据1)肉眼分析：肺恶性肿瘤：在胸部平面和断层图像中，可见肺部异常放射性浓聚灶；肺良性病变：胸部平面和断层图像可见胸腔内放射性分布均匀，两侧基本对称或呈局限性放射性稀疏、缺损。2)半定量分析：根据统计学中单侧估计95％参考值范围的方法，取同一时间段、同一病种恶性组T／N值((?)-1．64s)和良性病变组T／N值((?)+1．64s)的平均值为阈值，用来判断肿块的良恶性。病理结果与显像结果进行双盲法对照。统计分析采用SPSS软件(11．5版)，定量资料以(?)±s表示，行t检验(Independent Samples T test);定性资料用率表示，行χ~2检验，计算~(99)Tc~mN-NOET SPECT诊断的灵敏度、特异性、准确性、阳性预测值和阴性预测值等指标，并与其它检查相应项目进行比较。采用重复测量方差分析(repeated measurement ANOVA)进行各组的ER、DR、RI差异的分析；CT和ECT测量病灶大小差异的分析。P<0．05有统计学意义。
结果①根据病理结果将61例肺部肿块患者分为恶性组(组1，G1)和良性组(组2，G2)。G1，51例(男36例，女15例，年龄38-80岁，平均年龄59．7±9．76岁，平均体重64．12±10．35kg，平均身高168．43±6．72cm)，其中28(28／51，54．9％)例鳞癌、13(13／51，25．5％)例腺癌、7(7／51，13．7％)例小细胞癌、2例大细胞癌、1例癌肉瘤。G2，10例(男2例，女8例，年龄44-61岁，平均年龄55．1±6．28岁，平均体重50．5±5．38kg，平均身高158．9±2．33cm)，其中7例炎性假瘤，2例硬化性血管瘤，1例错构瘤。经t检验两组间年龄、身高、体重均无统计学差异(P>0．05)。其中38例肺癌患者和7例良性病变的患者经手术治疗。②51例恶性病变，~(99)Tc~mN-NOET肺部早期显像结果显示94．1％(48／51)显像阳性，其中包括鳞癌92．86％(26／28)，腺癌92．31％(12／13)，小细胞癌100％(7／7)，大细胞癌100％(2／2)，癌肉瘤100％(1／1)；3例假阴性病例中2例鳞癌，1例腺癌；~(99)Tc~mN-NOET肺部延迟显像结果显示90．2％(46／51)显像阳性，其中包括鳞癌89．3％(25／28)，腺癌92．31％(12／13)，小细胞癌85．7％(6／7)，大细胞癌100％(2／2)，癌肉瘤100％(1／1)；5例假阴性病例中3例鳞癌，1例腺癌，1例小细胞癌。根据4分法进行评分，肺部恶性病变NOET评分早期为106分(2．078±0．935)，延迟为98分(2．032±1．021)。10例良性包块中，~(99)Tc~mN-NOET肺部早期显像70％(7／10)显示阴性，3例显示假阳性的是2例炎性假瘤，1例硬化性血管瘤；延迟显像有80％(8／10)的患者显示阴性，2例显示假阳性的是1例炎性假瘤，1例硬化性血管瘤。根据4分法进行评分，肺部良性病变NOET评分早期为8分(1．233±0．877)，延迟为4分(1．056±0．813)。而CT结果显示有90．2％(46／51)的肺癌患者结果阳性，其中包括鳞癌92．86％(26／28)，腺癌84．62％(11／13)，小细胞癌85．71％(6／7)，大细胞癌100％(2／2)，癌肉瘤100％(1／1)，良性包块中有80％(8／10)的患者显示阴性，2例显示假阳性的是1例炎性假瘤，1例硬化性血管瘤。~(99)Tc~mN-NOET早期显像鉴别诊断肺部肿物良、恶性的灵敏度、特异性、阳性预测值、阴性预测值和准确性分别为94．1％、70％、94．1％、70％、90．2％；~(99)Tc~mN-NOET延迟显像鉴别诊断肺部肿物良、恶性的灵敏度、特异性、阳性预测值、阴性预测值和准确性分别为90．2％、80％、95．8％、61．5％、88．5％；CT检查鉴别诊断肺部肿物良、恶性的灵敏度、特异性、阳性预测值、阴性预测值和准确性分别为90．2％、80％、95．8％、61．5％、88．5％。行χ~2检验后得出：~(99)Tc~mN-NOET早期显像和~(99)Tc~mN-NOET延迟显像及CT检查对肺部恶性病灶检出的灵敏度无差别(χ~2=0．543，P>0．1)，特异性无差别(χ~2=0．267，P>0．1)。因此，~(99)Tc~mN-NOET双时相SPECT同CT检查一样可以鉴别诊断肺部肿物良恶性。③~(99)Tc~mN-NOET显像早期靶非靶比值(ER)G1为1．25±0．15，G2为1．09±0．11，具有统计学差异(P<0．001)；延迟靶非靶比值(DR)G1为1．40±0．17，G2为1．18±0．21，具有统计学差异(P<0．001)；滞留指数(RI％)G1为12．22±6．38，G2为28．3±10．91，无统计学差异(P>0．05)。~(99)Tc~mN-NOET显像的半定量指标(ER、DR和RI％)与肺癌TNM分期、不同病理类型、肿瘤直径、肺部包快是否有空洞、是否有吸烟史、性别无关(P>0．05)。④~(99)Tc~mN-NOET SPECT显像中共有48例肺癌患者和2例炎性假瘤患者可见明确肿块，应用CT、~(99)Tc~mN-NOET早期显像、~(99)Tc~mN-NOET延迟显像分别其长径、横径和厚度。CT、~(99)Tc~mN-NOET早期显像、~(99)Tc~mN-NOET延迟显像测量48例肺癌患者病灶长径的平均值分别是4．34±2．9、5．28±3．04和5．44±3．01；测量2例炎性假瘤患者病灶长径的平均值分别是1．56±0．73、2．78±0．29和3．03±0．21。测量48例肺癌患者病灶横径的平均值分别是3．41±2．36、4．71±2．67和4．81±2．76；测量2例炎性假瘤患者病灶横径的平均值分别是1．28±0．61、2．50±0．12和2．61±0．11。测量48例肺癌患者病灶厚度的平均值分别是3．56±2．32、3．93±1．84和3．92±1．81；测量2例炎性假瘤患者病灶厚度的平均值分别是1．29±0．5、2．37±0．15和2．44±0．16。两组病例病变长径、横径、厚度的测量，可见NOET早期及延迟测量结果均大于CT测量结果，并且均具有统计学意义(P<0．001)；NOET早期与延迟测量结果稍有不同，但无统计学意义(P>0．05)。CT、NOET早期显像、延迟显像测量病灶的最小值分别为0．9cm、1．85cm和2．37cm。⑤共有9例肺癌患者同时进行了~(99)Tc~mN-NOETSPECT的平面和断层显像，早期平面显像示异常3例，延迟平面显像示异常4例。早期断层显像示异常7例，延迟断层显像示异常8例，病变显示清楚。~(99)Tc~mN-NOET早期断层显像对肺恶性病灶的检出率77．8％(7／9)明显高于平面显像33．3％(3／9)，P<0．05；~(99)Tc~mN-NOET延迟断层显像对肺恶性病灶的检出率88．9％(8／9)明显高于延迟平面显像44．4％(4／9)(P<0．05)。断层显像的ER(1．23±0．11)和DR(1．42±0．21)分别明显大于平面显像的ER(1．18±0．15)和DR(1.27±0．16)，且二者比较，ER和DR都有显著性差异(P<0．001)。
结论~(99)Tc~mN-NOET双时相SPECT可以鉴别诊断肺部肿物良、恶性，且对肺部恶性病灶的珍断效能与常规CT检查没有差别。~(99)Tc~mN-NOET显像的半定量指标也可用于鉴别诊断肺部肿物良、恶性；~(99)Tc~mN-NOET显像对肿瘤大小的测量值大于CT；~(99)Tc~mN-NOET断层显像对肺恶性病变检出率高于平面显像；~(99)Tc~mN-NOET显像的半定量指标(ER、DR和RI％)不受肺癌TNM分期、不同病理类型、肿瘤直径、肺部包快是否有空洞、是否有吸烟史、性别的影响。
第二节~(99)Tc~mN-NOET SPECT探测肺癌纵隔淋巴结转移
目的探讨~(99)Tc~mN-NOET SPECT双时相断层显像探测肺癌纵隔淋巴结转移的价值，并且与CT比较。通过本课题的研究，以期为肺癌术前准确分期提供依据，协助临床选择合适的治疗方案。
方法51例肺癌患者共有29例行手术治疗，其中鳞癌17例，腺癌7例，小细胞癌4例，大细胞癌1例；男性21例，女性8例；平均年龄57．42±8．84。根据术后病理证实有无纵隔淋巴结转移进行分组，纵隔淋巴结转移组(组1，G1)11例，男／女比为7／4，平均年龄55．55±10．27岁，共发生34处纵隔淋巴结转移；无纵隔淋巴结转移组(组2，G2)18例，男／女比为12／6，平均年龄58．56±7．94岁。主要仪器或设备、~(99)Tc~mN-NOET SPECT显像、统计学分析同第一部分第一节。根据腋窝、纵隔内、颈部淋巴结区是否有异常显像剂浓聚，判断是否有淋巴结转移。
结果①G1中~(99)Tc~mN-NOET SPECT肺部早期显像术前检查结果显示72．7％(8／11)的患者纵隔淋巴结显像阳性，3例假阴性病例中2例小细胞癌，1例鳞癌；G2中77．8％(14／18)的患者显示阴性，4例假阳性者均为TNM分期为Ⅰb期的鳞癌。~(99)Tc~mN-NOET SPECT肺部延迟显像结果显示45．4％(5／11)的患者纵隔淋巴结显像阳性；G2中88．9％(16／18)的患者显示阴性。而CT结果显示有54．5％(6／11)的患者纵隔淋巴结转移，5例假阴性病例中2例小细胞癌，1例大细胞癌，1例腺癌，1例鳞癌。G2中83．3％(15／18)的患者显示阴性，3例假阳性的为2例Ⅱa期鳞癌，1例Ⅲa鳞癌。~(99)Tc~mN-NOET早期显像鉴别诊断纵隔淋巴结是否转移鉴别的灵敏度、特异性、阳性预测值、阴性预测值和准确性分别为72．7％、77．8％、66．7％、82．4％、75．9％；~(99)Tc~mN-NOET延迟显像鉴别诊断纵隔淋巴结是否转移鉴别的灵敏度、特异性、阳性预测值、阴性预测值和准确性分别为45．5％、88．9％、72．4％、71．4％、72．7％；CT检查鉴别诊断纵隔淋巴结是否转移鉴别的灵敏度、特异性、阳性预测值、阴性预测值和准确性分别为54．5％、83．3％、66．7％、75％、72．4％。行χ~2检验后得出：~(99)Tc~mN-NOET早期显像和CT检查探测肺癌纵隔淋巴结转移的灵敏度无差别(χ~2=0．786，P>0．1)，特异性无差别(χ~2=0．177，P>0．1)。~(99)Tc~mN-NOET延迟显像和CT检查探测肺癌纵隔淋巴结转移的灵敏度无差别(χ~2=0．182，P>0．1)，特异性无差别(χ~2=0．232，P>0．1)。~(99)Tc~mN-NOET早期显像和延迟显像灵敏度无差别(χ~2=1．692，P>0．1)，特异性无差别(χ~2=0．8，P>0．1)。因此，~(99)Tc~mN-NOET双时相SPECT同CT检查一样可以用于探测肺癌纵隔淋巴结是否转移。②G1的ER为1．26±0．11，DR为1．38±0．15；G2的ER为1．28±0．17，DR为1．43±0．22，两组DR均高于ER，说明随着时间的延长，不管有无纵隔淋巴结转移，肿瘤对于NOET的排泄均较对侧肺组织缓慢，并且均有统计学差异(P<0．001)。但是，虽然ER、DR和RI％两组比较G2的均高于G1，但均无统计学差异(P>0．05)，提示肺病变摄取NOET和有无纵隔淋巴结转移无关。
结论~(99)Tc~mN-NOET双时相SPECT可以用于探测肺癌纵隔淋巴结是否转移，其灵敏度及特异性与常规CT没有差别。肺癌患者进行~(99)Tc~mN-NOET显像时的半定量指标(ER、DR和RI％)和有无纵隔淋巴结转移无关，并且随着时间的延长，肺癌患者不管有无纵隔淋巴结转移，肿瘤对于NOET的排泄均较对侧肺组织缓慢。
第三节~(99)Tc~mN-NOET SPECT早期预测肺癌化疗疗效
目的初步探讨~(99)Tc~mN-NOET肺显像的半定量指标是否可以用来预测肺癌对化疗药物的耐药性，从而快速判断肺癌化疗疗效。
方法~(99)Tc~mN-NOET肺显像后，51例恶性病变患者中共有22例患者进行了化疗，化疗采用MVP或IVP方案，所有化疗药物均采用静脉注射，每位患者均接受2疗程化疗，疗效判断按WHO标准。根据化疗后CT复查结果、临床评价等进行分组，第一组(组1，G1)为缓解组，包括完全缓解(CR)、部分缓解(PR)。共9例，男／女比为6／3，平均年龄59．67±10．16岁。第二组(组2，G2)为非缓解组，包括无缓解(NR)及扩散。13例，男／女比为10／3，平均年龄58．00±5．55岁。比较两组化疗前T／N的差异。主要仪器或设备、~(99)Tc~mN-NOET SPECT显像、统计学分析同第一部分第一节。
结果化疗前G1的ER为1．42±0．13，DR为1．58±0．10；G2的ER为1．26±0．15，DR为1．40±0．22。缓解组的ER和DR均显著高于非缓解组(均为P<0．05)。提示化疗前T／N越高，则化疗效果越好。G1的RI％为11．56±7．55，G2的RI％为13．92±6．61，非缓解组高于缓解组，但未见有统计学差异(P>0．05)。
结论~(99)Tc~mN-NOET SPECT肺显像半定量指标可能是早期预测肺癌化疗效果的有效方法。
第二部分乳腺结节~(99)Tc~mN-NOET SPECT显像研究
第一节~(99)Tc~mN-NOET双时相SPECT鉴别诊断乳腺肿物良恶性
目的初步探讨~(99)Tc~mN-NOET双时相SPECT鉴别诊断乳腺肿块良、恶性的价值，并与钼靶片、超声比较；分析断层显像与平面显像对乳腺病灶的检出率。通过本课题的研究，以期为乳腺癌术前诊断、术中定向、病情的分析、临床的治疗方案及疗效的判断等提供一种无创的、实用的、新的检测手段。
方法临床触诊示乳腺结节高度可疑乳腺癌的25例女性患者术前1周内进行~(99)Tc~mN-NOET SPECT早期、延迟断层显像和X线钼靶检查，所有病例检查前均未行放、化疗和手术治疗，检查后均通过穿刺活检或手术获得细胞学或组织学资料。其中有1例术后病理证实为淋巴瘤，未列入统计。将其余24例病例根据病理结果分为恶性组(组1，G1)和良性组(组2，G2)。G1，19例(平均年龄51．32±4．97岁，平均体重59．95±8．30kg，平均身高157．89±5．39cm)均为浸润性导管癌，其中2例为Ⅰ期，17例为Ⅱ期；其中6例有腋下淋巴结转移。G2，5例(平均年龄48．80±4．55岁，平均体重50．5±5．38kg，平均身高157．6±4．39cm)均为纤维腺瘤，经t检验两组间年龄、身高、体重均无统计学差异(P>0．05)。主要仪器或设备、~(99)Tc~mN-NOET SPECT显像、统计学分析同第一部分第一节。
结果①G1中~(99)Tc~mN-NOET早期及延迟显像结果均显示有89．5％(17／19)的患者显像阳性，2例假阴性病例中1例为Ⅰ期，1例为Ⅱ期，肿瘤长径均<1cm。根据4分法进行评分，早期显像乳腺病变NOET总评分为35分(2．05±1．12)；延迟显像乳腺病变NOET总评分为34分(1．95±1．12)。G~2中~(99)Tc~mN-NOET早期显像有80％(4／5)的患者显示阴性，1例显示假阳性的为肿瘤长径>2cm。根据4分法进行评分，乳腺病变NOET总评分为3分(1．28±1．15)；~(99)Tc~mN-NOET延迟显像有100％(5／5)的患者显示阴性。根据4分法进行评分，乳腺病变NOET总评分为1分(0．58±0．49)。而钼靶片结果显示G1中有84．2％(16／19)的患者阳性，G2中有80％(4／5)的患者显示阴性，1例显示假阳性的是肿瘤长径>2cm。~(99)Tc~mN-NOET早期显像鉴别诊断乳腺肿物良、恶性的灵敏度、特异性、阳性预测值、阴性预测值和准确性分别为89．5％、80％、94．4％、66．7％、87．5％；~(99)Tc~mN-NOET延迟显像鉴别诊断乳腺肿物良、恶性的灵敏度、特异性、阳性预测值、阴性预测值和准确性分别为89．5％、100％、100％、71．4％、91．7％；钼靶片鉴别诊断乳腺肿物良、恶性的灵敏度、特异性、阳性预测值、阴性预测值和准确性分别为84．2％、80％、94．1％、57．1％、83．3％。行χ~2检验后得出：~(99)Tc~mN-NOET早期显像和钼靶片鉴别诊断乳腺肿物良、恶性的灵敏度无差别(χ~2=0．23，P>0．1)，特异性无差别(χ~2=0．111，P>0．1)。~(99)Tc~mN-NOET延迟显像和钼靶片鉴别诊断乳腺肿物良、恶性的灵敏度无差别(χ~2=0．23，P>0．1)，特异性无差别(χ~2=0．111，P>0．1)。因此，~(99)Tc~mN-NOET双时相SPECT同钼靶片一样可以用于鉴别诊断乳腺肿物良、恶性。②~(99)Tc~mN-NOET显像G1的ER为1．45±0．27，G2的ER为1．13±0．18，具有统计学差异(P<0．05)；DR则G1为1．67±0．32，G2为1．03±0．25，具有统计学差异(P<0．001)；滞留指数(RI％)G1为15．74%±11．55％，G2为-9．29%±18．40％，具有统计学差异(P<0．05)。结果显示，ER、DR和RI％G1均高于G2，两组间比较均具有统计学差异(P<0．05)，并且ER和DR组内比较也均具有统计学差异(P<0．001)。提示恶性病灶摄取NOET比良性病变多。③19例乳腺癌中，肿瘤直径≥2cm组16例，肿瘤直径<2cm组3例。结果显示，ER、DR和RI％组间比较均无统计学差异(P>0．05)，说明乳腺肿物摄取、滞留~(99)Tc~mN-NOET不受肿块大小的影响。ER和DR组内比较均有统计学差异(P<0．001)。④以病灶长径表示肿瘤大小。剔除所有病例中~(99)Tc~mN-NOET SPECT显像、超声、钼靶片未见肿块的病例。对14例乳腺癌患者和1例肿瘤长径>2cm的纤维腺瘤患者的病灶长径应用NOET早期显像、延迟显像、超声、钼靶片和专科检查分别测量，差异具有显著性(P<0．01)。NOET早期显像、延迟显像、超声、钼靶片和专科检查分别测量的最小长径为1．56cm、1．50cm、1．55cm、1．50cm和2．0cm。⑤共有6例乳腺癌患者同时进行了~(99)Tc~mN-NOET SPECT的平面和断层显像，早期平面显像示异常2例，延迟平面显像示异常3例。早期断层显像示异常5例，延迟断层显像示异常4例，病变显示清楚。~(99)Tc~mN-NOET早期断层显像对乳腺恶性病灶的检出率83．3％(5／6)明显高于平面显像33．3％(2／6)，P<0．05；~(99)Tc~mN-NOET延迟断层显像对乳腺恶性病灶的检出率66．7％(4／6)明显高于平面显像50．0％(3／6)(P<0．05)。断层显像的ER(1．71±0．30)和DR(1．91±0．37)分别明显大于平面显像的ER(1．46±0．26)和DR(1．48±0．30)，且二者比较，ER和DR都有显著性差异(P<0．05)。
结论~(99)Tc~mN-NOET双时相SPECT可以鉴别诊断乳腺肿物良、恶性，且其灵敏度、特异性与钼靶片无差别。~(99)Tc~mN-NOET SPECT显像半定量指标也是鉴别诊断乳腺肿物良、恶性的有效方法，且其不受乳腺癌肿瘤直径的影响。~(99)Tc~mN-NOET断层显像对病变的检出优于平面显像。
第二节~(99)Tc~mN-NOET双时相SPECT探测乳腺癌腋窝淋巴结转移
目的研究~(99)Tc~mN-NOET双时相SPECT探测乳腺癌腋窝淋巴结转移的临床价值，并与超声及钼靶片比较。通过本课题的研究，以期为乳腺癌术前准确分期提供依据，协助临床选择合适的治疗方案。
方法临床触诊示乳腺结节高度可疑乳腺癌的24例女性患者术前1周内进行~(99)Tc~mN-NOET SPECT 20-30min早期、2h延迟断层显像、超声检查和X线钼靶检查，所有病例均通过穿刺活检或手术获得细胞学或组织学资料。根据术后病理结果将19例乳腺癌患者进行分组。分为有腋下淋巴结转移组(组1，G1)和无腋下淋巴结转移组(组2，G2)。G1，6例(平均年龄49．67±5．43岁，平均体重59．83±5．530kg，平均身高155．67±1．97cm)均为Ⅱ期浸润性导管癌。G2，13例(平均年龄52．08±4．77岁，平均体重158．92±6．20kg，平均身高60．00±9．51cm)均为浸润性导管癌，2例Ⅰ期，11例Ⅱ期。经舱验出组间年龄、身高、体重均无统计学差异(P>0．05)。在早期相和延迟相中，观察双侧腋窝淋巴结区的显像剂分布情况；计算患侧病变区与相对应健侧的靶／非靶比值(T／N)，包括早期T／N(ER)和延迟T／N(DR)；计算滞留比(RI％)。主要仪器或设备、~(99)Tc~mN-NOET SPECT显像、统计学分析同第一部分第一节。
结果①G1中~(99)Tc~mN-NOET SPECT早期显像术前检查结果显示83．3％(5／6)的患者腋窝淋巴结显示阳性，~(99)Tc~mN-NOET SPECT延迟显像显示66．7％(4／6)的患者腋窝淋巴结显示阳性，超声和钼靶片结果分别为50％(3／6)和66．7％(4／6)的阳性。G2中~(99)Tc~mN-NOET SPECT早期显像76．9％(10／13)的患者显示阴性，延迟显像84．6％(11／13)的患者显示阴性，超声和钼靶片结果分别为53．8％(7／13)和61．5％(8／13)的阴性。~(99)Tc~mN-NOET SPECT早期显像对乳腺癌腋窝淋巴结转移的诊断灵敏度、特异性、准确性分别为：83．3％、76．9％、78．9％；~(99)Tc~mN-NOETSPECT延迟显像分别为：66．7％、84．6％、78．9％；超声对乳腺癌腋窝淋巴结转移的诊断灵敏度、特异性、准确性分别如下：50％、53．8％、52．6％；钼靶片对乳腺癌腋窝淋巴结转移的诊断灵敏度、特异性、准确性分别如下：66．7％、61．5％、63．2％。行χ~2检验后得出：~(99)Tc~mN-NOET早期显像和超声对乳腺癌腋窝淋巴结转移的探测灵敏度无差别(χ~2=1．5，P>0．1)，特异性一样(χ~2=1．529，P>0．1)；和钼靶片的灵敏度也无差别(χ~2=0．44，P>0．1)，特异性无差别(χ~2=0．722，P>0．1)。~(99)Tc~mN-NOET延迟显像和超声对乳腺癌腋窝淋巴结转移的探测灵敏度无差别(χ~2=0．343，P>0．1)，特异性无差别(χ~2=2．88，P>0．05)；和钼靶片的灵敏度也无差别(χ~2=0，P=1)，特异性无差别(χ~2=1．759，P>0．1)。因此，~(99)Tc~mN-NOET双时相SPECT可以用于探测乳腺癌腋窝淋巴结是否转移。②G1的ER为1．59±0．32，DR为1．77±0．36；G2的ER为1．39±0．23，DR为1．63±0．31，两组DR均高于ER，说明随着时间的延长，不管有无腋窝淋巴结转移，肿瘤对于NOET的排泄均较对侧乳腺组织缓慢，并且均有统计学差异(P<0．05)。虽然ER、和DR两组比较G1的均高于G2，RI％两组比较G2的均高于G1，但组间比较均无统计学差异(P>0．05)，提示乳腺病变摄取NOET和有无腋窝淋巴结转移无关。③共有6例乳腺癌患者同时进行了~(99)Tc~mN-NOET SPECT的平面和断层显像，其中3例术后病理证实有腋窝淋巴结的转移。早期和延迟平面显像均未见腋窝淋巴结显影。早期断层显像可见2例有腋窝淋巴结显影，延迟断层显像可见1例有腋窝淋巴结显影。
结论~(99)Tc~mN-NOET双时相SPECT可以用于探测乳腺癌腋窝淋巴结是否转移，且其诊断效能同超声、钼靶片无差别。乳腺病变摄取NOET的半定量指标和有无腋窝淋巴结转移无关；不管有无腋窝淋巴结转移，乳腺癌对NOET的排泄均较对侧乳腺组织缓慢。
第三部分~(99)Tc~mN-NOET肿瘤阳性显像鉴别诊断甲状腺结节良恶性
目的初步探讨~(99)Tc~mN-NOET在诊断甲状腺结节良、恶性的价值。
方法~(99)Tc~mO_4~-甲状腺结节扫描结果为单个“冷、凉”结节的33例患者隔日进行了~(99)Tc~mN-NOET显像，其中的2例(1例为甲状腺癌，1例为甲状腺腺瘤)患者进行了MIBI显像。所有患者在显像后2周内进行了手术。ROI技术划出病灶和对侧甲状腺组织对照区，测定计数求出靶本(T／N)比值。所有病例均有病理结果。主要仪器或设备、~(99)Tc~mN-NOET SPECT显像、统计学分析同第一部分第一节。
结果①根据术后病理结果分为恶性组(G1)和良性组(G2)。G1，16例(男1例，女15例，年龄24-78岁，平均年龄51．81±15．34岁)有乳头状癌5例，滤泡状癌9例，髓样癌2例。G2，17例(男2例，女15例，年龄23-78岁，平均年龄49．65±12．24岁)均为腺瘤。②16例甲状腺癌的患者，14例有NOET填充，2例为NOET部分填充，其中1例进行了MIBI显像，显示放射性填充。16例甲状腺癌NOET评分2分10例，3分6例，总得分为38分。17例良性病变中，15例为NOET阴性，2例假阳性病例为周边填充，中央未见填充，其中一例进行了MIBI显像，未见填充。③NOET的甲状腺癌T／N值为1．57±0．38，甲状腺腺瘤为1．05±0．36，NOET良恶性组间比较，F=16．095，P<0．001。ROI分析以甲状腺癌T／N值((?)-1．64s)和良性病变组T／N值((?)+1．64s)的平均值为阈值，用来判断肿块的良恶性。故NOET显像以1．3为判断良恶性阈值。
结论~(99)Tc~mN-NOET显像半定量指标可以鉴别诊断甲状腺肿物良、恶性。
Objective To investigated the value of ~(99)Tc~mN-NOET Dual-phase SPECT in diagnosis of solitary pulmonary nodule(SPN), and compared with CT. To analyzed the early and delay T/N (tumor ROI/normal tissue ROI) of diseased region, and further analyzed it's influencing factors. To analyzed the value of ~(99)Tc~mN-NOET Dual-phase SPECT in measuring SPN size, and compared with CT. To differentiated the detection rate of focal by planar imaging and tomography imaging.
Methods ~(99)Tc~mN-NOET 20-30min early planer and SPECT imaging, 2h delay planer and SPECT imaging, and CT were performed on 62 pts suspected with lung lesion before operated in one week, meanwhile 5 normal controls exclude malignant disease of lung(male/female 3/2, age 30-64yo, mean age 42.53±7.52yo) undergone the same checks. All cases didn't accept the radiotherapeutic, chemotherapeutic and operation before checks. Moreover, all pts gained the cytology or histologic data by bronchofibroscope, puncture biopsy or operation. A case was obstruction syndrome of middle lobe of right lung, pleural effusion and lower respiratory infection. It didn't include in statistics for major atelectasis in middle lobe of right lung and right pleural effusion had an influence on naked eye and semiquantitative analysis to imaging. All NOET freeze drying kit manufactured and offered by Peking normal university, radioactivate-chemistry purity >90%. ~(99)Tc~mN-NOET SPECT by double detecting head VERTEX manufactured by ADAC company of American. Parallel hollow, hypo-energy and high resolution collimator were used in all ~(99)Tc~mN-NOET SPECT. energy peak was 140KeV.window width was±20%. Partly static planar imaging gathered by 1000k counted number, matrix 256×256. Tomography getted by 360°, 6°/frame, 40s/frame, matrix 128×128, enlargement factor was 1. Data was disposed by computer software of ADAC special purpose compute and butterworth filter function (cutoff, 0.36; order, 15), then obtained transverse plane, sagittal plane and coronal plane imaging. CT check applied by CT instrument manufactured by GE company. Images of ~(99)Tc~mN-NOET SPECT by naked eye analysis and semiquantitative analysis. Two salted doctor of nuclear medicine concomitanc examine imaging. Pathology and ~(99)Tc~mN-NOET imaging compared by double blind. Naked eye analysis roughly definited the location of focus of disease through eye-measurement, X-ray and CT in the first, then observed abnormality strong radioactivity gather focus of one-by-one deck whether or not. The scores undertaked according to the imaging agent gathered degree in occupy location: no gathered was (-) and 0 score; small amounts (+) and 1 score; gathered but lower than the counted number of liver (++) and 2 scores; obviously gathered and equal to or super to the counted number of liver (+++) and 3 scores. - and + were negative, ++ and +++ positive. Semiquantitative analysis applied by region of interesting(ROI) in the planer imaging and transverse plane, sagittal plane and coronal plane tomography imaging (the obviously gathered NOET occupation: to select apparente accumulate NOET frame, then definited tumor ROI and settled opposite side normal tissues as background; the little or no gathered NOET occupation: to reference the local of disease in X-ray, CT and MRI), then drawed the tumor ROI (ROI_1) and opposite side normal tissues ROI (ROI_2), surveyed and evaluated the mean count of every pixel. The uptake relative value (T/N) is tumor counts/normal tissue counts (ROI_1/ROI_2). T/N consist of early T/N (ER) and delay T/N (DR). fraction mark of stagnation (RI%)=(DR-ER)/ER×100%. The size of local disease and cavity was measured by characteristic of computer and expressed by diameter length×diameter transversa×anteroposterior diameter. The judgement standard on the basis of naked eye analysis and semiquantitative analysis. Pulmonary malignant tumor had abnormality radioactivity accumulation of chest plane and tomography imaging, wherase pulmonary benign lesion had no radioactivity acc umulation. Statistical analysis used SPSS software (11.5). x±s expressed quantitate data and used independent Samples T test. Ratio expressed qualitation data and usedχ~2 analysis. The sensitivity, specificity, accurate, positive predictive value and negative predictive value of ~(99)Tc~mN-NOET SPECT were calculated and compared with others check. The difference and relationship of ER, DR and RI% of every groups was analyzed by repeated measurement. The differential between CT and ECT in checking disease size was analyzed by repeated measurement also. P<0.05 is statistical significance.
Results (1) Fifty-one pts were classified to primary malignancy of lung (group 1, G1), whereas 10 cases with benign diseases (group 2, G2) according to pat hology. G1 had 5leases (male/female, 36/15, age 38-80yo, mean age 59.7±9.7 6yo, mean weight 64.12±10.35kg, mean height 168.43±6.72cm). G1 included in 28(28/51, 54.9%) squamous carcinoma, 13 (13/51, 25.5%) adencarcinoma, 7 (7 /51, 13.7%) small cell cancer, 2 large cell carcinoma and 1 sarcocarcinoma. G 2 had 10 cases (male/female, 2/8, age 44-61yo, mean age 55.1±6.28yo, mean weight 50.5±5.38kg, mean height 158.9±2.33cm). G2 had 7 inflammatory pseud otumour, 2 sclerosing hemangioma and 1 hamartoma. Age, weight and height of two groups was no significant difference (P>0.05). (2) 51 cases of malignan t lesions (including 28 cases of squamous cell carcinoma, 13 cases of adenocar cinoma, seven cases of small cell carcinoma, two cases of large cell carcinom a, one case of sarcoma cancer). ~(99)Tc~mN-NOET early lung imaging showed that94.1% (48/51) of pts with lung cancer positive, including squamous cell card noma 92.86% (26/28), adenocarcinoma 92.31% (12/13), small cell carcinoma of100% (7/7), large cell carcinoma 100% (2/2), carcinosarcoma 100% (1/1); 3 f alse negative included 2 cases of squamous cell carcinoma and one case of ad enocarcinoma.~(99)Tc~mN-NOET delayed imaging showed that 90.2% (46/51) of pa tients with lung cancer positive, including squamous cell carcinoma 89.3% (25/ 28), adenocarcinoma 92.31% (12/13), 85.7% of small cell carcinoma (6/7), 1arg e cell carcinoma 100% (2/2), carcinosarcoma 100% (1/1); 5 false negative incl uded 3 cases of squamous cell carcinoma, one case of adencarcinoma and onecase of small cell carcinoma. According to 4 scores as score standard, NOETearly score of pulmonary malignant lesions was 106 points (2.078±0.935), del ayed was 98 scores (2.032±1.021). 10 cases of benign nodules (including sevencases of inflammatory pseudotumour, two cases of sclerosing hemangioma, on e case of hamartoma), ~(99)Tc~mN-NOET early lung scintigraphy showed 70% (7/1 0) of patients negative, 3 cases showed false positive was two cases of inflam matory pseudotumour , one case of sclerosing hemangioma; ~(99)Tc~mN-NOET dela yed imaging showed 80% (8/10) patients negative, two cases showed that falsepositive included one case of inflammatory pseudotumor, one case of sclerosin g hemangioma. According to 4 scores as score standard, lung benign lesions sc ores was five scores for early imaging, 4 scores for delayed. CT showed that 90.2% (46/51) of patients with lung cancer positive, including 92.86% (26/28) squamous cell carcinoma, 84.62% (11/13) adenocarcinoma, 85.71% (6/7) small cell carcinoma, and 100% (2/2) large cell carcinoma, 100% (1/1) carcinosarcom a. 80% (8/10) benign nodules of patients showed negative, two cases show tha t the false positive was one case of inflammatory pseudotumor and one case o f sclerosing hemangioma. ~(99)Tc~mN-NOET early imaging in the differential diagno sis of benign and malignant sensitivity, specificity, positive predictive value, ne gative predictive value, and accuracy were 94.1%, 70%, 94.1%, 70%, 90.2%. ~(99)Tc~mN-NOET delayed imaging in the differential diagnosis of pulmonary tumor s of benign and malignant sensitivity, specificity, positive predictive value, nega tive predictive value, and accuracy were 90.2%, 80%, 95.8%, 61.5%, 88.5%. C T differential diagnosis benign and malignant sensitivity, specificity, positive pre dictive value, negative predictive value, and accuracy were 90.2%, 80%, 95.8 %, 61.5%, 88.5%. We could drawn the conclusions afterχ~2 analysis that there was no difference between ~(99)Tc~mN-NOET early imaging with ~(99)Tc~mN-NOET del ay imaging and CT of sensitivity and specificity in diagnosing the lung malign ant disease respectively. Therefore, ~(99)Tc~mN-NOET dual-phase SPECT could be used to diagnosis the lung cancer.(3)~(99)Tc~mN-NOET imaging early tumor/normal tissues ratio (ER) 1.25±0.15 for G1, 1.09±0.11 for G2, there was significant d ifference (P<0.001); delay tumor/normal tissues ratio (DR) 1.40±0.17 for G1, 1. 18±0.21 for G2, there was significant difference (P<0.001); retention index (RI %) 12.22±6.38 for G1, 28.3±10.91 for G2, there was no significant difference (P>0.05). The semi-quantitative indicators (ER, DR and RI%) of ~(99)Tc~mN-NOE T imaging had nothing to do with TNM stages, different histological types, tu mor diameter, cavity, the history of smoking and sex (P>0.05). (4) Reject no 1 ump cases of ~(99)Tc~mN-NOET imaging. There was 48 cases of lung cancer patie nts and two cases of patients with inflammatory pseudotumor. The length, diam eter transversa and thickness of the lesions were measured by CT, ~(99)Tc~mN-NOE T early imaging and ~(99)Tc~mN-NOET delay imaging respectively. The length resu Its of malignant lesions by CT, ~(99)Tc~mN-NOET early imaging and ~(99)Tc~mN-NOETdelay imaging were as follows: 4.34±2.9, 5.28±3.04, 5.44±3.01; the length res ults of benign lesions by CT, ~(99)Tc~mN-NOET early imaging and ~(99)Tc~mN-NOET delay imaging were as follows: 1.56±0.73, 2.78±0.29, 3.03±0.21. The diameter transversa of malignant lesions were as follows: 3.41±2.36, 4.71±2.67, 4.81±2.7 6. The diameter transversa of benign lesions were as follows: 1.28±0.61, 2.50±0.12, 2.61±0.11. The thickness of malignant lesions were as follows: 3.56±2.32,3.93±1.84, 3.92±1.81. The thickness of benign lesions were as follows: 1.29±0.5, 2.37±0.15, 2.44±0.16. We coule see that the early and delayed NOET mea surement results exceed to CT about the length, diameter transversa and thickn ess, and there were statistically significant respectively (P<0.001). NOET early and delay measurement results had slightly different, but without statistical sign ificance (P>0.05). The minimum value measured by CT, NOET early imaging and delay imaging was 0.9cm, 1.85cm and 2.37cm. (5) There was 9 lung cane er cases undergone ~(99)Tc~mN-NOET SPECT and planar imaging, early planar ima ging showed abnormal of three cases, delayed planar imaging showed abnormalof four cases. Early tomography showed abnormal of seven cases, delayed im aging showed abnormal of eight cases, and the lesions showed distinctness. Th e detection rate of malignant lung lesions by ~(99)Tc~mN-NOET early imaging was77.8% (7/9), superior to planar imaging 33.3% (3/9) (P<0.05). The detection r ate of malignant lung lesions by ~(99)Tc~mN-NOET delay imaging was 88.9% (8/ 9), superior to planar imaging 44.4% (4/9) (P<0.05). ER (1.23±0.11) and DR (1.42±0.21) of ~(99)Tc~mN-NOET tomography were obviously exceed to ER (1.18±0.15) and DR (1.27±0.16) of ~(99)Tc~mN-NOET planar imaging. There were signifi cant difference between tomography with planar about ER and DR respectively(P<.001).
Conclusion ~(99)Tc~mN-NOET dual-phase SPECT could be used to diagnosis the lung cancer and there was no significant difference between ~(99)Tc~mN-NOET dual-phase SPECT with CT. The measurement results by ~(99)Tc~mN-NOET exceed to CT. The detection rate of malignant lung lesions by ~(99)Tc~mN-NOET early imaging superior to planar imaging. The semi-quantitative indicators (ER, DR and RI%) of ~(99)Tc~mN-NOET imaging had nothing to do with TNM stages, different histological types, tumor diameter, cavity, the history of smoking and sex (P>0.05).
Objective To investigate the value of ~(99)Tc~mN-NOET dual-phase SPECT in detection mediatinal lymphnode metastasis of pts with lung cancer. The results were compared with that of computed tomography (CT). Through this research in order to provide a new view to accurate preoperative staging of lung cancer and help to choose appropriate clinical treatment.
Methods 29 pts with proved lung cancer underwent surgeries, including 17 cases of squamous cell carcinoma, 7 cases of adenocarcinoma, 4 cases of small cell carcinoma, 1 case of large cell carcinoma. Males/females, 21/8. Mean age was 57.42±8.84yo. According to pathologically results, 29 pts divided into two groups: 11 cases with mediastinal lymphnode metastasis as one group (group 1, G1), male/female, 7/4, the average age of 55.55±10.27yo, the total of 34 mediastinal lymphnode metastasis; 18 cases without mediastinal lymphnode metastasis as another group (group 2, G2), male/female, 12/6, the average age 58.56±7.94yo. Major equipments, ~(99)Tc~mN-NOET SPECT imaging and the statistical analysis methods the same as the first part of the first quarter. To determine whether there is any lymphnode metastasis according to the abnormal imaging agent concentration of nodus lymphaticus of axillary space, mediastinum and cervical part.
Results (1)~(99)Tc~mN-NOET early lung imaging showed that 72.7% (8/11) pts in G1 with mediastinal lymphnode metastasis, 3 false negative cases included two cases of small cell carcinoma and one case of squamous cell carcinoma. ~(99)Tc~mN-NOET early lung imaging showed that 77.8% (14/18) pts in G2 without mediastinal lymphnode metastasis, 4 false-positive cases were I b period of squamous cell carcinoma. ~(99)Tc~mN-NOET delay imaging showed that 45.4% (5/11) of patients with mediastinal lymphnode metastasis. ~(99)Tc~mN-NOET delay lung imaging showed that 88.9% (16/18) pts in G2 without mediastinal lymphnode metastasis. The CT showed that 54.5% (6/11) of patients with mediastinal lymphnode metastasis, 5 false-negative cases included two cases of small cell carcinoma, one case of large cell carcinoma, one case of adenocarcinoma and one case of squamous cell carcinoma, three false-positive cases included the two cases ofⅡa period of squamous cell carcinoma and one case ofⅢa squamous cell carcinoma. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ~(99)Tc~mN-NOET early imaging differential diagnosis of mediastinal lymphnode metastasis were 72.7%, 77.8%, 66.7%, 82.4%, 75.9% respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ~(99)Tc~mN-NOET delay imaging differential diagnosis of mediastinal lymphnode metastasis were 45.5%, 88.9%, 72.4%, 71.4%, 72.7%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT scan differential diagnosis of mediastinal lymphnode metastasis were 54.5%, 83.3%, 66.7%, 75%, 72.4%. We could drawn the conclusions afterχ~2 analysis that there was no difference between ~(99)Tc~mN-NOET early imaging with CT of sensitivity and specificity in diagnosing the mediastinal lymphnode metastasis of lung cancer respectively. ~(99)Tc~mN-NOET delay imaging with CT of sensitivity and specificity in diagnosing the mediastinal lymphnode metastasis of lung cancer respectively.~(99)Tc~mN-NOET early imaging with ~(99)Tc~mN-NOET delay imaging of sensitivity and specificity in diagnosing the mediastinal lymphnode metastasis of lung cancer respectively. Therefore, ~(99)Tc~mN-NOET dual-phase SPECT could be used to detecting mediastinal lymphnode metastasis of lung cancer. (2) ER of G1 was 1.26±0.11, DR of G1 was 1.38±0.15; ER of G2 was 1.28±0.17, DR of G2 was 1.43±0.22. Not only ER but also DR, G2 higher than G1, that indicated that tumor excretion NOET slower than contralateral lung tissue with the time prolong, regardless of whether mediastinal lymphnode metastasis. There was statistically different (P<0.001). However, while ER, DR and RI% of G2 higher than G1, and no significant difference respectively (P>0.05). This was a cue to illustrate the lung lesion uptake NOET had nothing to do with mediatinal lymphnode metastasis.
Conclusions ~(99)Tc~mN-NOET dual-phase SPECT could be used to detecting mediastinal lymphnode metastasis of lung cancer and there was no difference with CT. The semiquantitative indexes (ER, DR and RI%) had nothing to do with mediatinal lymphnode metastasis. Moreover, we found that the lung lesion washed out NOET slower than opposite side normal lung in spite of mediatinal lymphnode metastasis with the time prolong after injection.
Objective To investigate the value of ~(99)Tc~mN-NOET SPECT semi-quantitative indexes in early predicting the chemotherapy reaction in lung cancer.
Methods A total of 22 cases of 51 pts with lung malignant lesions underwent chemotherapy after early and delay ~(99)Tc~mN-NOET SPECT. They were used MVP or IVP chemotherapy programme and each patients received 2 courses of chemotherapy, chemotherapy drugs were used intravenous. The curative effect judgement on the base of WHO standards. 22 cases were divided into relieve groups and non-relieve groups according to the recheck results of CT and clinical evaluation after two course of chemotherapy. Relieve group (group 1, G1) including complete relieve (CR) and partial remission (PR) had 9 cases, male/female 6/3, mean age 59.67±10.16yo. Non-relieve groups (group 2, G2) including non-response (NR) and proliferation had 13 cases, male/female 10/3, mean age 58.00±5.55yo. Then compared the difference of T/N before chemotherapy in two groups. Major equipments, ~(99)Tc~mN-NOET SPECT imaging and statistical analysis of part the same as the first part of the first chapter.
Results The value of early T/N ratio (ER) and delayed T/N ratio (DR) in G1 was 1.42±0.13 and 1.58±0.10; in G2 was 1.26±0.15 and 1.40±0.22. ER and DR of relieve group significant higher non-relieve group (P<0.05, respectively). This was a cue to illustrate the higher of T/N before chemotherapy, the better of curative effect. The value of RI% was 11.56%±7.55% in Gl, 13.92%±6.61% in G2. The value of RI% in G2 higher than G1, but there had no significant difference (P>0.05). This was possibily due to lung lesion in relieve groups washed out NOET faster than non-relieve groups (P>0.05).
Conclusions The semiquantitative indexes (ER and DR) of ~(99)Tc~mN-NOET SPECT may be effective method for early predicting the chemotherapy reaction in lung cancer.
Objective To initial investigate the value of ~(99)Tc~mN-NOET Dual-phase SPECT in diagnosis of breast lesions. The results were compared with that of mammography and ultrasound. To analyzed the detection rate about breast cancer of planar imaging and tomography respectively. Through this research topics, we hoped to provide a non-invasive, practical and new detection methods for preoperative diagnosis of breast cancer, orientate during operation, condition analysis and clinical efficacy of treatment program.
Methods X-ray mammography examination, early and delay ~(99)Tc~mN-NOET SPECT imaging were performed on 25 female pts by clinical breast palpation method suspected with breast lesion within one week before operated. All pts didn't recept radiotherapy, chemotherapy and surgery before checks. All pts had surgery, biopsy histology or cytology information. Among them, one case of postoperative pathology confirmed lymphoma didn't included in the statistics. The remaining 24 cases were divided into malignant group (group 1, G1) and benign group (group 2, G2) according to pathology. G1 had 19 cases (mean age 51.32±4.97yo, average weight 59.95±8.30kg, average height 157.89±5.39cm) who were invasive ductal carcinoma, including 2 cases in stage 1,17 cases in stageⅡ; 6 cases with axillary lymphnode metastasis. G2 had 5 cases (mean age 48.80±4.55yo, average weight 50.5±5.38kg, average height 157.6±4.39cm) who were fibroadenoma. There was no significant difference between two groups about age, height and weight respectively (P>0.05). Major equipments, ~(99)Tc~mN-NOET SPECT imaging and statistical analysis of part the same as the first part of the first chapter.
Results(1)~(99)Tc~mN-NOET early and delayed imaging showed that 89.5% (17/19) patients in G1 with positive imaging. The two cases with false-negative was one case in stageⅠ, one case in stageⅡ, the diameter of lesions were little than lcm. According to the judgement of 4 scores, ~(99)Tc~mN-NOET early imaging showed 35 (2.05±1.12) scores; ~(99)Tc~mN-NOET delayed imaging 34 (1.95±1.12) scores. ~(99)Tc~mN-NOET early showed that 80% (4/5) patients in Gl with negative imaging. 1 case with false-positive showed tumor diameter exceed 2cm. According to the judgement of 4 scores, ~(99)Tc~mN-NOET early imaging showed 3 scores. ~(99)Tc~mN-NOET delayed imaging showed 100% (5/5) patients negative. According to the judgement of 4 scores, ~(99)Tc~mN-NOET delayed imaging showed 1 score. The results of mammography showed that 84.2% (16/19) of patients in G1 with positive results, 80% (4/5) patients in G2 showed negative, 1 false-positive patients showed tumor diameter exceed 2cm. ~(99)Tc~mN-NOET early imaging in the differential diagnosis of benign and malignant sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 89.5%, 80%, 94.4%, 66.7%, 87.5%. ~(99)Tc~mN-NOET delayed imaging in the differential diagnosis of pulmonary tumors of benign and malignant sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 89.5%, 100%, 100%, 71.4%, 91.7%. X-ray mammography differential diagnosis benign and malignant sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.2%, 80%, 94.1%, 57.1%, 83.3%. We could drawn the conclusions afterχ~analysis that there was no difference between ~(99)Tc~mN-NOET early imaging with X-ray mammography of sensitivity and specificity in diagnosing the breast cancer respectively. There was no difference between ~(99)Tc~mN-NOET delay imaging with X-ray mammography of sensitivity and specificity in diagnosing the breast cancer respectively. Therefore. ~(99)Tc~mN-NOET dual-phase SPECT could be used to diagnosed the breast cancer. (2) The value of ER in G1 and G2 was 1.45±0.27 and 1.13±0.18; the value of DR in G1 and G2 was 1.67±0.32 and 1.03±0.25; the retention index (RI%) of G1 and G2 was 15.74±11.55 and -9.29±18.40, the difference was significant respectively (P<0.05). The results showed that ER, DR and RI% in G1 higher than G2, there was significant difference between two groups of every semi-quantitative index respectively (P<0.05). Meanwhile, ER and DR had significant difference respectively in every group (P<0.05). That indicated that malignant lesions uptaked NOET more than benign lesions. (3) 19 cases of breast cancer including 16 cases with tumor diameter exceed 2cm and 3 cases with tumor diameter little than 2cm. The value of ER, DR and RI% had no statistically different between G1 and G2 respectively (P>0.05). That indicated that breast tumor uptaked NOET had nothing with the size of lumps. (4) The length of the lesion signify the size of tumor. Reject no lump cases of ~(99)Tc~mN-NOET imaging, ultrasound and mammography. There was 14 cases of breast cancer patients and 1 case of fibroadenoma who's lesion diameter exceed 2cm. The length of the lesions were measured by ~(99)Tc~mN-NOET early imaging, ~(99)Tc~mN-NOET delay imaging, ultrasound, mammography and specialist examination respectively. There was significant difference (P<0.01). The minimum lengths measured by ~(99)Tc~mN-NOET early imaging, ~(99)Tc~mN-NOET delay imaging, ultrasound, mammography and specialist examination were 1.56cm, 1.50cm, 1.55cm, 1.50cm and 2.0cm respectively. (5) There was 6 breast cancer cases undergone ~(99)Tc~mN-NOET SPECT and planar imaging, early planar imaging showed abnormal of 2 cases, delayed planar imaging showed abnormal of 3 cases. Early tomography showed abnormal of 5 cases, delayed imaging showed abnormal of 4 cases, and the lesions showed distinctness. The detection rate of malignant breast lesions by ~(99)Tc~mN-NOET early imaging was 83.3% (5/6), superior to planar imaging 33.3% (2/6) (P<0.05). The detection rate of malignant breast lesions by ~(99)Tc~mN-NOET delay imaging was 66.7% (4/6), superior to planar imaging 50.0% (3/6) (P<0.05). ER ((1.71±0.30) and DR (1.91±0.37) of ~(99)Tc~mN-NOET tomography were obviously exceed to ER (1.46±0.26) and DR (1.48±0.30) of ~(99)Tc~mN-NOET planar imaging. There were significant difference between tomography with planar about ER and DR respectively (P<0.05).
Conclusions ~(99)Tc~mN-NOET dual-phase SPECT could be used to diagnosed the breast cancer and there was no difference with X-ray mammography. The semi-quantitative index was a effective method to differentiating benign and malignant breast lesions, moreover, it couldn't be influenced by tumor size. ~(99)Tc~mN-NOET tomographic imaging manifest super to planar imaging in detection malignant disease.
Objective To investigate the value of ~(99)Tc~mN-NOET dual-phase SPECT in detectioning axillary nodes metastasis of pts with breast cancer and compare with ultrasound and mammography. We plan to provide a new view to accurate preoperative staging of breast cancer and help choose appropriate clinical treatment.
Methods 19 female pts with proved breast cancer underwent surgeries. According to pathologically results, 19 pts was divided into two groups: 6 cases of invasive ductal carcinoma at the stage ofⅡwith axillary lymphnode metastasis as one group (group 1, G1), mean age 49.67±5.43yo, average weight 59.83±5.530kg, average height 155.67±1.97cm; 13 cases of invasive ductal carcinoma without axillary lymphnode metastasis as other group (group 2, G2), mean age 52.08±4.77yo, average weight 158.92±6.20kg, average height 60.00±9.51cm. G2 had 2 cases at the stage of 1,11 cases at the phaseⅡ. There was no significant difference between two groups of age, height and weight respectively (P>0.05). To observed the bilateral axillary lymphnode imaging agent distribution in the ~(99)Tc~mN-NOET early and delay imaging and calculated the target/non-target ration (T/N), including early T/N (ER) and delayed T/N (DR). Then to calculate the retention index (RI%). Major equipments, ~(99)Tc~mN-NOET SPECT imaging and the statistical analysis methods the same as the first part of the first quarter.
Results (1) ~(99)Tc~mN-NOET early imaging showed that 83.3% (5/6) patients of G1 with axillary lymphnodes metastasis. ~(99)Tc~mN-NOET delay imaging showed 66.7% (4/6) patients of Gl with axillary lymphnode. Ultrasound and mammography showed 50% (3/6) and 66.7% (4/6) patients of G1 with axillary lymphnode. ~(99)Tc~mN-NOET early imaging showed that 76.9% (10/13) of patients in G2 without axillary lymphnode. ~(99)Tc~mN-NOET delay imaging showed 84.6% (11/13) of patients in G2 negative. Ultrasound and mammography showed 53.8% (7/13) and 61.5% (8/13) of patients in G2 without axillary lymphnode. The sensitivity, specificity and accuracy of ~(99)Tc~mN-NOET early imaging differential diagnosis of axillary lymphnode metastasis were 83.3%, 76.9%, 78.9% respectively. The sensitivity, specificity and accuracy of ~(99)Tc~mN-NOET delay imaging differential diagnosis of axillary lymphnode metastasis were 66.7%, 84.6%, 78.9%. The sensitivity, specificity and accuracy of ultrasound differential diagnosis of axillary lymphnode metastasis were 50%, 53.8%, 52.6%. The sensitivity, specificity and accuracy of mammography differential diagnosis of axillary lymphnode metastasis were 66.7%, 61.5%, 63.2%. We could drawn the conclusions afterχ~2 analysis that there was no difference between ~(99)Tc~mN-NOET early imaging with ultrasound and X-ray mammography of sensitivity and specificity in differential diagnosis of axillary lymphnode metastasis respectively. There was no difference between ~(99)Tc~mN-NOET delay imaging with ultrasound and X-ray mammography of sensitivity and specificity in differential diagnosis of axillary lymphnode metastasis respectively. Therefore, ~(99)Tc~mN-NOET dual-phase SPECT could be used to detecting the axillary lymphnode metastasis of pts with breast cancer. (2) The value of early T/N ratio (ER) in G1 and G2 was 1.59±0.32 and 1.39±0.23; delay T/N ratio (DR) was 1.77±0.36 and 1.63±0.31. DR was higher than ER of two groups respectively. This means the breast cancer washed out NOET slower than opposite side normal breast in spite of with or without axillary nodes metastasis with the time prolong after injection (P<0.05). However, the value of ER, DR and RI% in two groups were no significiant difference respectively (P>0.05), this was a cue to illustrate the breast lesion uptake NOET had nothing to do with axillary nodes metastasis. (3) There was 6 cases of patients with breast cancer underwent ~(99)Tc~mN-NOET SPECT and planar imaging, including 3 cases of postoperative pathology confirmed with axillary lymphnode metastasis. ~(99)Tc~mN-NOET early and delayed planar imaging had no axillary lymphnode metastasis. ~(99)Tc~mN-NOET early tomography showed that 2 cases with axillary lymphnode metastasis. ~(99)Tc~mN-NOET delay imaging showed that 1 cases with axillary lymphnode metastasis.t
Conclusions ~(99)Tc~mN-NOET dual-phase SPECT could be used to detecting the axillary lymphnode metastasis of pts with breast cancer, and there was no difference with ultrasound and mammography. The breast lesion uptake NOET had nothing to do with axillary nodes metastasis. The breast cancer washed out NOET slower than opposite side normal breast in spite of axillary nodes metastasis with the time prolong after injection.
Objective To initial investigate the value of ~(99)Tc~mN-NOET SPECT in diagnosis of benign and malignant of thyroid "cool or cold" nodules.
Methods ~(99)Tc~mN-NOET SPECT was performed on 33 pts who had "cool or cold nodule" within two weeks before operated. ~(99)Tc~mO_4~-and ~(99)Tc~mN-NOET SPECT had been done every other day. Two cases (1 case of papillary carcinoma, 1 case of follicle carcinoma) done the ~(99)Tc~m-MIBI SPECT also. All pts had pathology results after operated. The characters of the nodules were defined by images and the semiquantitative measurements of T/N. Major equipments, ~(99)Tc~mN-NOET SPECT imaging and the statistical analysis methods the same as the first part of the first quarter.
Results (1) All pts was divided into two groups on the base of pathology. 16 patients were found with malignant (group 1, G1), male/female, 1/15, age from 24 to 78 yo, mean age 51.81±15.34yo), including 5 cases of papillary carcinoma, 9 cases of follicular carcinoma and 2 cases of medullary. Whereas 17 cases with benign diseases (group 2, G2), male/female, 2/15, age from 23 to 78 yo, mean age 49.65±12.24 yo, including 17 cases of adenomas. The value of T/N in G1 and G2 was 1.57±0.38 and 1.05±0.36 (P<0.001). The threshold value of ~(99)Tc~mN-NOET SPECT was 1.3 to diagnosis thyroid cancer. (2) There was 14 cases of thyroid cancer filled NOET, 2 cases part filled NOET. Which one case of ~(99)Tc~m-MIBI imaging showed that radioactive filled. There were 10 cases with 2 scores, 6 cases with 3 scores of ~(99)Tc~mN-NOET imaging. The total of scores was 38 scores. There was 15 cases of benign lesions unfilled NOET, 2 cases of benign lesions neighboring filled NOET and the central unfilled. Which one case of ~(99)Tc~m-MIBI imaging showed that radioactive unfilled. (3) The value of T/N of thyroid cancer was 1.57±0.38, thyroid adenoma was 1.05±0.36. There was significant between benign and malignant group (F= 16.095, P<0.001). The mean value of thyroid cancer T/N ((?)-1.64 s) and benign lesions T/N ((?)+1.64 s) could be as the threshold values to determine the mass of benign and malignant. Therefore, the threshold value of ~(99)Tc~mN-NOET imaging for judging thyroid mass of benign and malignant was 1.3.
Conclusions The semiquantitative index of ~(99)Tc~mN-NOET SPECT may be to diagnosis thyroid cancer.
引文
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[1] Sandier MP, Coleman RE, Patton JA, et al. Diagnostic Nuclear Medicine[M]. Fourth edition. USA: Lippincott Williams & Wilkins, A Wolters Kluwer Company. 2003, 911-1034.
[2] Kent MS, Port JL, Altorki NK. Current state of imaging for lung cancer staging. Thorac Surg Clin, 2004, 14(1): 1213.
[3] Aquino SL, Fischman AJ. Does whole-body-2[~(18)F]-fluoro-2-deoxy-D-glucose positron emission tomography have an advantage over thoracic positron emission tomography for staging patients with lung cancer? Chest, 2004, 126(3):755-760.
[4] Huang G, Zhu CM. A study of dual-head tomography with coincidence. Chin J Nucl Med, 2000, 20(5):238-239.
[5] Eschmann SM, Bitzer M, Paulsen F, et al. The benefit of functional-anatomical imaging with [~(18)F] fluorodeoxyglucose utilizing a dual-head coincidence gamma camera with an integrated X-ray transmission system in non-small cell lung cancer. Nucl Med Commun, 2004, 25(9):909-915.
[6] Schillaci O. Hybrid SPECT/CT: a new era for SPECT imaging? Eur J Nucl Med Mol Imaging, 2005, 2(5):521-524.
[7] Vilela Filho O, Carneiro Filho O, Arquivosde Neuro-Psiquiatria. Gamma probe-assisted brain tumor microsurgical resection: a new technique[J]. Cancer, 2002, 60(4): 1042-1047.
[8] Venuta F, Rendina EA, De Giacomo, et al. Thymectomy for myasthenia gravis: prognostic factors and long term follow-up. British Journal of Surgery-Supplement, 1998, 85(2):99(Supple).
[9] Ando A, Shaolin L, Ando I, et al. Tumor affinity of ~(203)Pb-chloride: comparison with ~(67)Ga-citrate and ~(201)Tl-chloride, Nuclear Medicine Communications, 1994, 15(1):39-46.
[10] Kaplan WD, Takvorian T, Morris JH, et al. ~(201)Tl brain tumor imaging: a comparative study with pathologic correlation[J]. J Nucl Med, 1987, 28:47-52.
[11] Schwartz BB, Carvalho PA, Alexander ED, et al. Radiation necrosis vs high-grade recurrent glioma: Differentiation by using dual-isotope SPECT with ~(201)T1 and ~(99m)Tc-HMPAO[J]. AJNR, 1991, 12:1187-92.
[12] Waxman AD. The role of ~(99m)Tc-methoxyisobutylisonitrile in imaging breast cancer. Seminars in Nucl Med, 1997, 27(1):40-54.
[13] Shibata Y, Matsumura A, Nose T. Effect of expression of P-glycoprotein on technetium-99m methoxyisobutylisonitrile single photon emission computed tomography of brain tumors[J]. Neurologia Medico-Chirurgica, 2002, 42(8):325-30.
[14] Hassan IM, Sahweil A, Constantinider C, et al. ~(99)Tc~m-MIBI uptake in malignant tumor. J Nucl Med, 1988, 29(Suppl): 985.
[15] Muller J, Kieffer P, Scepi M, et al. Krukenberg's tumor. Apropos of a case. Case Reports. Journal de Chirurgie, 1987, 124(10):527-32.
[16] Delmon-Mongeon LI, Piwnica-Worms D, et al. Uptake of the cation hexakis (2-methoxyisonutylisonitrile) technetium-99m by human carcinoma cell lines in vitro. Cancer Res, 1995; 55: 2198.
[17] Maffioli L, Steens J, Pauwels E, et al. Application of ~(99m)Tc-sestamibi in oncology[J]. Tumori, 1996, 82(1): 12.
[18] Chia Hung Kao, Shih Chuan, Tsai Liu TC, et al. Pglycoprotein and multidrug resistence-related protein expressions in relation to technetium-99m methoxyisobutylisonitrile scintimammography findings[J]. Cancer Res, 2001, 15(61):1412-1414.
[19] Ak Ilknur, Gulbas Zafer, Altinel Faruk, et al. Tc-99m MIBI Uptake and Its Relation to the Proliferative Potential of Brain Tumors[J]. Clinical Nuclear Medicine, 2003, 28(1):29-33.
[20] Hassan IM, Mohammad MM, Constantinides C, et al. Problems of duodenogastric reflux in Tc-99m Hexa MIBI planar, tomographic and bull's eye display. Clinical Nuclear Medicine, 1989, 14(4):286-9.
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