Wengenmair H, Kopp J, Vogt H, Wawroschek F, Gröber S, Dorn R, Heidenreich P
Klinik für Nuklearmedizin, Klinikum Augsburg, Deutschland.
Nuklearmedizin. 2002 Apr;41(2):102-7.
To visualise the sentinel lymph nodes (SLNs) of the prostate we injected the radiotracer into the parenchyma of the prostate. The activity was deposited in liver, spleen, bone marrow, urinary bladder and regional lymphatic system. The aim of this work is to determine biokinetical data and to estimate radiation doses to the patient.
The patients with prostate cancer received a sonographically controlled, transrectal administration of 99mTc-Nanocoll, injected directly into both prostate lobes. In 10 randomly selected patients radionuclide distribution and its time course was determined via regions of interest (ROIs) over prostate, urinary bladder, liver, spleen and the lymph nodes. The uptake in the SLNs was estimated from gamma probe measurements at the surgically removed nodes. To compare tumour positive with tumour free lymph nodes according to SLN-uptake and SLN-localisation we evaluated 108 lymph nodes out of 24 patients with tumour positive SLN. For calculating the effective dose according to ICRP 60 of the patients we used the MIRD-method and the Mirdose 3.1 software.
The average uptake of separate organs was: bladder content 24%, liver 25.5%, spleen 2%, sum of SLN 0.5%. An average of 9% of the applied activity remained in the prostate. The residual activity was mainly accumulated in bone marrow and blood. Occasionally a weak activity enrichment in intestinal tract and kidneys could be recognized. The effective dose to the patient was estimated to 7.6 microSv/MBq. The radioactivity uptake of the SLN varied in several orders of magnitude between 0.006% and 0.6%. The probability of SLN-metastasis was found to be independent from tracer uptake in the lymph node. The radioactivity uptake of the SLNs in distinct lymph node regions showed no significant differences.
The radiotracer is transferred out of the prostate via blood flow, by direct transfer via the urethra into the bladder and by lymphatic transport. Injecting a total activity of 200 MBq leads to a mean effective dose of 1.5 mSv. It is not recommended to use the tracer uptake in lymph nodes as the only criterion to characterize SLNs.
为了可视化前列腺前哨淋巴结（SLN），我们将放射性示踪剂注入前列腺实质。活性沉积于肝脏、脾脏、骨髓、膀胱及区域淋巴系统。本研究的目的是确定生物动力学数据并估算患者所受辐射剂量。
前列腺癌患者在超声引导下经直肠给予99mTc - Nanocoll，直接注入双侧前列腺叶。在10例随机选取的患者中，通过在前列腺、膀胱、肝脏、脾脏及淋巴结上设置感兴趣区（ROI）来确定放射性核素分布及其时间进程。通过对手术切除淋巴结的γ探针测量估算前哨淋巴结的摄取情况。为了根据前哨淋巴结摄取情况和定位比较肿瘤阳性与无肿瘤淋巴结，我们评估了24例前哨淋巴结肿瘤阳性患者中的108个淋巴结。为根据ICRP 60计算患者的有效剂量，我们使用了MIRD方法和Mirdose 3.1软件。
各器官的平均摄取量为：膀胱内容物24%，肝脏25.5%，脾脏2%，前哨淋巴结总和0.5%。平均9%的注入活性留存于前列腺。残余活性主要积聚于骨髓和血液中。偶尔可在肠道和肾脏中识别出微弱的活性富集。患者的有效剂量估计为7.6微希沃特/兆贝可。前哨淋巴结的放射性摄取在0.006%至0.6%之间变化达几个数量级。发现前哨淋巴结转移的概率与淋巴结中示踪剂摄取无关。不同淋巴结区域前哨淋巴结的放射性摄取无显著差异。
放射性示踪剂通过血流、经尿道直接进入膀胱以及淋巴转运从前列腺排出。注入200兆贝可的总活度导致平均有效剂量为1.5毫希沃特。不建议将淋巴结中示踪剂摄取作为表征前哨淋巴结的唯一标准。
