Ergün Eser L, Kara Pelin O, Gedik Gonca K, Kars Ayşe, Türker Alev, Caner Biray
Department of Nuclear Medicine, School of Medicine, Hacettepe University, 06100 Sihhiye, Ankara, Turkey.
Ann Nucl Med. 2007 Jul;21(5):275-83. doi: 10.1007/s12149-007-0017-z. Epub 2007 Jul 25.
To define the role of Tc-99m (V) dimercaptosuccinic acid (DMSA) scanning in the detection of lung cancer (LC) and its metastases, and monitoring the response of LC lesions (LCL) to chemo/radiotherapy (TH).
Tc-99m (V) DMSA whole-body scans, planar thorax views, and thorax Single-photon emission computed tomography (SPECT) images were obtained both 30 min (early) and 5 h (late) after Tc-99m (V) DMSA administration in 12 small/nonsmall cell LC patients (11 men, 1 woman; mean age 59 years). Five patients also had bone scans. The same scintigraphic protocol was performed in 7 of 12 patients, 3 weeks after first-line TH. TH response was evaluated visually in all LCL and semiquantitatively in primary tumors (PT) of six patients, by comparing the tumor uptake ratios (TUR) of pre-TH and post-TH Tc-99m (V) DMSA SPECT [TUR = mean counts of region of interests (ROI) in PT/mean counts in contralateral ROI]. In seven patients, a 6-month survival was determined.
Tc-99m (V) DMSA accumulated in 34 LCL (11 PT, 19 bone metastases, 1 suprarenal mass, 1 axillary node, 2 supraclavicular nodes). A total of 11 patients displayed Tc-99m (V) DMSA uptake in LCL and one patient did not show uptake. In six patients, SPECT imaging showed deeply located PT in the lung parenchyma better than planar views. In five patients, both planar and SPECT views revealed peripherally located PT in the lungs. Early scans showed 18 LCL and late scans displayed all the LCL. Nine bone metastases on pre-TH Tc-99m (V) DMSA scans revealed matched areas of increased Tc-99m methylene diphosphonate (MDP) uptake on bone scans; six bone metastases were additionally detected on Tc-99m (V) DMSA scans when compared with bone scans, and four bone metastases on Tc-99m (V) DMSA scans could not be compared with bone scans because bone scan was not performed. In one patient, Tc-99m (V) DMSA scans became positive for bone metastases on post-TH later than the bone scans for some of the bone metastases. Neither planar nor SPECT imaging showed mediastinal lesions defined on thorax CT in nine patients. On TH monitoring, 17 LCL showed diminished Tc-99m (V) DMSA uptake, one disappeared, four were unchanged, three displayed increased uptake, and five new lesions were established. Of the six patients, TUR in PT increased in two (one survived), decreased in one (exitus), was unchanged in two (two exitus) on post-TH scans, and PT totally disappeared in one (survived) patient.
Tc-99m (V) DMSA scans are useful in detecting LCL, except for those around the blood pool regions, making it a promising modality to monitor TH response. Obtaining a single fifth hour late Tc-99m (V) DMSA scan is appropriate. SPECT should be applied to all patients for the detection of deeply located lesions.
明确锝-99m（V）二巯基丁二酸（DMSA）扫描在肺癌（LC）及其转移灶检测中的作用，以及监测LC病灶（LCL）对化疗/放疗（TH）的反应。
对12例小细胞/非小细胞LC患者（11例男性，1例女性；平均年龄59岁）在给予锝-99m（V）DMSA后30分钟（早期）和5小时（晚期）进行锝-99m（V）DMSA全身扫描、胸部平面显像及胸部单光子发射计算机断层扫描（SPECT）图像检查。5例患者还进行了骨扫描。12例患者中的7例在一线TH治疗3周后采用相同的闪烁显像方案。通过比较TH治疗前和治疗后锝-99m（V）DMSA SPECT的肿瘤摄取率（TUR）[TUR = 原发肿瘤（PT）感兴趣区（ROI）的平均计数/对侧ROI的平均计数]，对所有LCL进行视觉评估，并对6例患者的PT进行半定量评估TH反应。7例患者确定了6个月的生存率。
锝-99m（V）DMSA在34个LCL中积聚（11个PT、19个骨转移灶、1个肾上腺肿块、1个腋窝淋巴结、2个锁骨上淋巴结）。共有11例患者的LCL显示有锝-99m（V）DMSA摄取，1例患者未显示摄取。6例患者中，SPECT成像显示肺实质内深部的PT比平面显像更好。5例患者中，平面显像和SPECT显像均显示肺部外周的PT。早期扫描显示18个LCL，晚期扫描显示所有LCL。TH治疗前锝-99m（V）DMSA扫描上的9个骨转移灶在骨扫描上显示锝-99m亚甲基二膦酸盐（MDP）摄取增加的匹配区域；与骨扫描相比，锝-99m（V）DMSA扫描上另外检测到6个骨转移灶，4个锝-99m（V）DMSA扫描上的骨转移灶因未进行骨扫描而无法与骨扫描比较。1例患者中，TH治疗后锝-99m（V）DMSA扫描上骨转移灶出现阳性的时间比骨扫描上某些骨转移灶出现阳性的时间晚。9例患者中，平面显像和SPECT显像均未显示胸部CT上定义的纵隔病变。在TH监测中，17个LCL显示锝-99m（V）DMSA摄取减少，1个消失，4个不变，3个摄取增加，5个新病灶形成。6例患者中，TH治疗后扫描PT的TUR在2例中增加（1例存活），1例中减少（死亡），2例中不变（均死亡），1例患者的PT完全消失（存活）。
锝-99m（V）DMSA扫描在检测LCL方面有用，除血池区域周围的病灶外，使其成为监测TH反应的一种有前景的方法。进行单次5小时后的晚期锝-99m（V）DMSA扫描是合适的。所有患者均应采用SPECT检测深部病灶。
