用术后放疗治疗的恶性胶质瘤预后评估中的铊-201单光子发射计算机断层扫描

Thallium-201 SPECT in prognostic assessment of malignant gliomas treated with postoperative radiotherapy.

作者信息

Semba Takatoshi, Sugawara Yoshifumi, Ochi Takashi, Fujii Takashi, Mochizuki Teruhito, Ohnishi Takanori

机构信息

Department of Radiology, Ehime University School of Medicine.

出版信息

Ann Nucl Med. 2006 May;20(4):287-94. doi: 10.1007/BF02984645.

DOI:10.1007/BF02984645

PMID:16856572

Abstract

OBJECTIVE

This study was designed to investigate the value of preoperative thallium-201 (201Tl) SPECT as a predictor of outcome in malignant glioma.

METHODS

From January 1990 to September 2003, 109 patients with glioma were treated with postoperative radiotherapy. Of these, 36 patients with malignant gliomas who underwent preoperative 201Tl-SPECT were included in this study (grade 3: n=14, grade 4: n=22). On early (10 minutes) and delayed (2 hours) images after 111 MBq 201TlCl injection, we calculated radioactivity ratios of tumors to contralateral normal brain (T/N ratios) and retention indices (RIs). For early and delayed images, we compared outcome between a high T/N ratio group (T/N ratio equal or greater than the average) and a low T/N ratio group (T/N ratio less than the average). We also divided the patients into two groups on the basis of RI; a high RI group (RI equal or greater than the average) and a low RI group (RI less than the average), and similarly compared outcome between the two groups.

RESULTS

Median survival time was 12 months for both grade 3 and grade 4 tumors; however, two-year survival was 53% for grade 3 and 15% for grade 4. In both early and delayed images, outcome was significantly better for patients with low T/N ratios (early < 4.71, delayed < 3.96) than those with high T/N ratios (early: p = 0.030, delayed: p = 0.049). However, no significant survival difference was apparent between the low- (< -12.25) and high RI groups. In grade 3 glioma, patients with high T/N ratios demonstrated a tendency toward poorer outcome, although this trend was not significant (early: p = 0.079, delayed: p = 0.099). Overall outcome was poor for grade 4 glioma, and the difference in survival between low and high T/N ratio groups was not significant (early: p = 0.51, delayed: p = 0.53). However, long survival was seen only in patients with lower T/N ratios.

CONCLUSIONS

Differences of 201Tl uptake in malignant gliomas could predict outcome. 201Tl-SPECT is potentially useful in the management of patients with malignant gliomas.

摘要

目的

本研究旨在探讨术前铊-201（201Tl）单光子发射计算机断层扫描（SPECT）作为恶性胶质瘤预后预测指标的价值。

方法

1990年1月至2003年9月，109例胶质瘤患者接受了术后放疗。其中，36例接受术前201Tl-SPECT检查的恶性胶质瘤患者纳入本研究（3级：n = 14，4级：n = 22）。静脉注射111 MBq氯化铊后，在早期（10分钟）和延迟（2小时）图像上，计算肿瘤与对侧正常脑组织的放射性比值（T/N比值）和滞留指数（RI）。对于早期和延迟图像，比较高T/N比值组（T/N比值等于或大于平均值）和低T/N比值组（T/N比值小于平均值）的预后。我们还根据RI将患者分为两组；高RI组（RI等于或大于平均值）和低RI组（RI小于平均值），并同样比较两组之间的预后。

结果

3级和4级肿瘤的中位生存时间均为12个月；然而，3级肿瘤的两年生存率为53%，4级肿瘤为15%。在早期和延迟图像中，低T/N比值患者（早期<4.71，延迟<3.96）的预后明显优于高T/N比值患者（早期：p = 0.030，延迟：p = 0.049）。然而，低RI组（< -12.25）和高RI组之间没有明显的生存差异。在3级胶质瘤中，高T/N比值患者的预后有较差的趋势，尽管这一趋势不显著（早期：p = 0.079，延迟：p = 0.099）。4级胶质瘤的总体预后较差，低T/N比值组和高T/N比值组之间的生存差异不显著（早期：p = 0.51，延迟：p = 0.53）。然而，只有T/N比值较低的患者生存期较长。