Bleichner-Perez Sarah, Le Jeune Florence, Dubois Francois, Steinling Marc
Service de Médecine Nucléaire et d'imagerie fonctionnelle, Unité fonctionnelle de neurologie, Hôpital Roger Salengro, CHRU Lille.
Nucl Med Commun. 2007 Dec;28(12):888-94. doi: 10.1097/MNM.0b013e3282f1646c.
Malignant brain tumors carry a pejorative prognosis and necessitate aggressive therapy. Chemotherapy can be used in cases of tumor recurrence. With limited response rate and potential toxicity to chemotherapeutic treatment in patients with recurrent glioma, reliable response assessment is essential.
To define the place of 99mTc hexakis 2-methoxyisobutylisonitrile (99mTc-MIBI) Single Positron Emission Computed Tomography (SPECT) in monitoring chemotherapy response in recurrent primary brain tumors.
In a retrospective analysis, thirty patients were investigated with MIBI SPECT. Imaging was performed 1h after the intravenous injection of 555 MBq of 99mTc-MIBI using a dedicated SPECT system. A MIBI uptake index (UI) was computed as the ratio of counts in the lesion to those in contralateral region. For all patients, we compared changes over time in UI with MRI and clinical data.
The changes in UI agreed well with the clinical and MRI-based assessments in 97% of cases. In 44% of these cases, the scintigraphic response appeared before the MRI response. In instances of treatment failure or rebound, the concordance between scintigraphy and MRI was 52%, and the scintigraphic response appeared before the MRI response in 48% of cases.
This study confirms our previous results obtained on a short series of patients with recurrent glioma, concerning the usefulness of MIBI SPECT in prediction of chemotherapy response. Moreover, in cases of tumor progression, we show that MIBI SPECT is an earlier indicator of escape from chemotherapy, an average 4 months before MRI changes.
恶性脑肿瘤预后不良，需要积极治疗。化疗可用于肿瘤复发的情况。由于复发性胶质瘤患者对化疗的反应率有限且存在潜在毒性，可靠的反应评估至关重要。
确定99m锝六甲氧基异丁基异腈（99mTc-MIBI）单光子发射计算机断层扫描（SPECT）在监测复发性原发性脑肿瘤化疗反应中的作用。
在一项回顾性分析中，对30例患者进行了MIBI SPECT检查。使用专用SPECT系统，在静脉注射555 MBq的99mTc-MIBI后1小时进行成像。计算MIBI摄取指数（UI），即病变部位计数与对侧区域计数的比值。对于所有患者，我们比较了UI随时间的变化与MRI及临床数据。
97%的病例中，UI的变化与基于临床和MRI的评估结果高度一致。在这些病例中，44%的病例闪烁扫描反应先于MRI反应出现。在治疗失败或病情反弹的情况下，闪烁扫描与MRI的一致性为52%，48%的病例闪烁扫描反应先于MRI反应出现。
本研究证实了我们之前在一小系列复发性胶质瘤患者中获得的结果，即MIBI SPECT在预测化疗反应方面的有用性。此外，在肿瘤进展的情况下，我们表明MIBI SPECT是化疗逃逸的早期指标，平均比MRI变化早4个月。
