采用不同方法对格雷夫斯眼眶病疾病活动度进行成像：（99m）锝-二乙三胺五乙酸和（99m）锝-去铁草胺单光子发射断层扫描、磁共振成像及临床活动度评分的比较

Imaging of disease activity in Graves' orbitopathy with different methods: comparison of (99m)Tc-DTPA and (99m)Tc-depreotide single photon emission tomography, magnetic resonance imaging and clinical activity scores.

作者信息

Galuska Laszlo, Leovey Andras, Szucs-Farkas Zsolt, Szabados Lajos, Garai Ildiko, Berta Andras, Balazs Erzsebet, Varga Jozsef, Nagy Endre V

机构信息

Department of Nuclear Medicine, University of Debrecen Medical and Health Science Centre, Debrecen, Hungary.

出版信息

Nucl Med Commun. 2005 May;26(5):407-14. doi: 10.1097/00006231-200505000-00003.

DOI:10.1097/00006231-200505000-00003

PMID:15838422

Abstract

BACKGROUND

The immunosuppressive treatment of Graves' orbitopathy (GO) influences the course of the disease in the early, active, retrobulbar inflammatory phase (active GO), which cannot be detected by direct clinical examination.

AIM

To evaluate the clinical effectiveness of a newly developed method for the detection of intraorbital inflammatory activity in patients suffering from Graves' orbitopathy, utilizing a four-headed single photon emission tomograph (SPET) camera and (99m)Tc-diethylenetriamine pentaacetic acid (Tc-DTPA).

METHODS

The magnetic resonance imaging (MRI) T2 relaxation time score, as a measure of ongoing orbital inflammation (reference method), was compared with the uptake activities (UA) of (99m)Tc-DTPA orbital SPET and the more specific (99m)Tc-Neospect ((99m)Tc-depreotide) SPET, as well as the clinical activity scores (CAS), in 21 patients (42 orbits).

RESULTS

By visual inspection, the 'eye SPET' frames of patients suffering from active GO could be easily distinguished from those with inactive GO. Although the distributions of the two radiopharmaceuticals were mildly different, the information obtained was essentially the same. The MRI activity scores correlated well with both (99m)Tc-DTPA and Tc-depreotide UA. The mean (99m)Tc-DTPA UA value of 25 inactive GO orbits was (6.55 +/- 1.4) x 10(-6) ID x cm3 (where ID is the injected dose); the values of the active GO orbits (12 orbits with an MRI score of 1 and five orbits with an MRI score of 2) were significantly higher: (8.87 +/- 1.63) x 10(-6) and (10.36 +/- 1.60) x 10(-6) ID x cm3, respectively. Similar differences were observed for the (99m)Tc-depreotide UA values: the averages in the inactive and active groups with MRI scores of 1 and 2 were (5.23 +/- 1.23) x 10(-6), (7.69+/-2.24) x 10 and (10.92 +/- 3.85) x 10(-6) ID x cm3, respectively. The (99m)Tc-DTPA accumulation pattern in the orbital region of active GO patients was similar to that of the more specific (99m)Tc-depreotide. There was a good correlation (r = 0.71, P<0.001) between the UA values of the two radiopharmaceuticals, but CAS did not correlate with either of the UA values.

CONCLUSIONS

(99m)Tc-DTPA eye SPET is a potentially useful method, allowing rapid imaging at an acceptable cost. It provides essential supplementary information to traditional CAS in assessing disease activity in Graves' orbitopathy.

摘要

背景

格雷夫斯眼眶病（GO）的免疫抑制治疗会影响疾病在早期、活动期、球后炎症阶段（活动期GO）的病程，而这一阶段无法通过直接临床检查检测到。

目的

利用四头单光子发射断层扫描仪（SPET）和（99m）锝 - 二乙三胺五乙酸（Tc - DTPA），评估一种新开发的检测格雷夫斯眼眶病患者眶内炎症活动方法的临床有效性。

方法

将作为持续性眼眶炎症测量指标的磁共振成像（MRI）T2弛豫时间评分（参考方法）与（99m）Tc - DTPA眼眶SPET以及更具特异性的（99m）Tc - Neospect（（99m）锝 - 去抑肽）SPET的摄取活性（UA），以及21例患者（42只眼眶）的临床活动评分（CAS）进行比较。

结果

通过视觉检查，活动期GO患者的“眼部SPET”图像可轻易与非活动期GO患者的图像区分开来。尽管两种放射性药物的分布略有不同，但获得的信息基本相同。MRI活动评分与（99m）Tc - DTPA和去抑肽UA均具有良好的相关性。25只非活动期GO眼眶的平均（99m）Tc - DTPA UA值为（6.55±1.4）×10⁻⁶ ID×cm³（其中ID为注射剂量）；活动期GO眼眶（MRI评分为1的12只眼眶和MRI评分为2的5只眼眶）的值显著更高：分别为（8.87±1.63）×10⁻⁶和（10.36±1.60）×10⁻⁶ ID×cm³。（99m）Tc - 去抑肽UA值也观察到类似差异：MRI评分为1和2的非活动组和活动组的平均值分别为（5.23±1.23）×10⁻⁶、（7.69±2.24）×10和（10.92±3.85）×10⁻⁶ ID×cm³。活动期GO患者眼眶区域的（99m）Tc - DTPA积聚模式与更具特异性的（99m）Tc - 去抑肽相似。两种放射性药物的UA值之间存在良好的相关性（r = 0.71，P<0.001），但CAS与任何一个UA值均无相关性。