Källén K, Geijer B, Malmström P, Andersson A M, Holtås S, Ryding E, Rosén I
Department of Neurology, University Hospital, Lund, Sweden.
Nucl Med Commun. 2000 Mar;21(3):259-67. doi: 10.1097/00006231-200003000-00010.
The aim of this study was to establish if repeated quantitative 201Tl SPET scanning during follow-up of astrocytoma therapy can provide information that is relevant for clinical management. Sixteen consecutive patients, with histopathologically verified highly malignant astrocytoma, were followed during PCV chemotherapy. Imaging with 201Tl SPET and CT was performed repeatedly over 8-16 weeks until treatment discontinuation, with a maximum follow-up of 74 weeks. Tumour uptake volume (TUV), a measure of metabolically active tumour tissue, was calculated from the SPET images. The reliability of early identification of treatment failure, defined as > 25% tumour volume increase, following one course (week 8) and three courses (week 24) of chemotherapy, was calculated for the two imaging methods. 201Tl SPET positive patients (> 25% tumour volume increase) were compared with 201Tl SPET negative patients in terms of time to treatment discontinuation (TTD) and survival time (ST). The patients were followed with a total of 59 SPET examinations, and treatment was continued for a median 27 weeks (range 16-78 weeks). The comparative reliability of SPET and CT showed the highest sensitivity and accuracy for SPET in the early identification of astrocytoma treatment failure at the week 24 assessment. Patients with positive 201Tl SPET after three courses of chemotherapy had a significantly reduced TTD (P = 0.040) but not significantly reduced ST. Of the ten patients who received concomitant radiation and chemotherapy, five had a small (0-10 ml) TUV at the week 24 assessment. Patients with a TUV > 10 ml at this assessment had a shorter TTD (P = 0.016) and a reduced ST (P = 0.024) compared to patients with a TUV < 10 ml. In conclusion, the assessment of progressive disease by quantitative 201Tl SPET appears to provide information on treatment response, earlier and with a higher reliability than CT. Repeated 201Tl SPET scanning during follow-up of astrocytoma treatment is an alternative tool for the early identification of treatment failure.
本研究的目的是确定在星形细胞瘤治疗随访期间重复进行定量201Tl单光子发射计算机断层扫描（SPET）是否能提供与临床管理相关的信息。16例经组织病理学证实为高度恶性星形细胞瘤的连续患者在接受PCV化疗期间接受随访。在8 - 16周内反复进行201Tl SPET和CT成像，直至治疗中断，最长随访74周。从SPET图像计算肿瘤摄取体积（TUV），这是一种衡量代谢活跃肿瘤组织的指标。计算两种成像方法在化疗一个疗程（第8周）和三个疗程（第24周）后早期识别治疗失败（定义为肿瘤体积增加>25%）的可靠性。将201Tl SPET阳性患者（肿瘤体积增加>25%）与201Tl SPET阴性患者在治疗中断时间（TTD）和生存时间（ST）方面进行比较。患者共接受了59次SPET检查，治疗持续的中位时间为27周（范围16 - 78周）。SPET和CT的比较可靠性显示，在第24周评估时，SPET在早期识别星形细胞瘤治疗失败方面具有最高的敏感性和准确性。三个疗程化疗后201Tl SPET阳性的患者TTD显著缩短（P = 0.040），但ST无显著缩短。在接受同步放疗和化疗的10例患者中，5例在第24周评估时TUV较小（0 - 10 ml）。与TUV < 10 ml的患者相比，在此评估时TUV > 10 ml的患者TTD更短（P = 0.016），ST更低（P = 0.024）。总之，通过定量2Tl SPET评估疾病进展似乎能提供有关治疗反应的信息，比CT更早且可靠性更高。在星形细胞瘤治疗随访期间重复进行201Tl SPET扫描是早期识别治疗失败的一种替代工具。
