Tc-99m MIBI 显像对骨肉瘤和软组织肉瘤术前化疗组织病理学反应的早期预测。

Early prediction of histopathological tumor response to preoperative chemotherapy by Tc-99m MIBI imaging in bone and soft tissue sarcomas.

机构信息

Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Japan.

出版信息

Clin Nucl Med. 2010 Mar;35(3):154-9. doi: 10.1097/RLU.0b013e3181cc637d.

DOI:10.1097/RLU.0b013e3181cc637d

PMID:20173444

Abstract

PURPOSE

Tc-99m-methoxyisobutylisonitrile (MIBI) accumulates in only viable cells. In patients with bone and soft tissue sarcomas, preoperative chemotherapy is essential and the early prediction of the tumor response to chemotherapy would be beneficial for the planning of treatment strategy. The purpose of this study was to assess whether the change of Tc-99m-MIBI images from the prechemotherapy state to the early to midportion of chemotherapy can predict the final histopathological tumor response as accurately as the change of imaging after completion of chemotherapy.

METHODS

Seventy-three patients with bone and soft tissue sarcomas underwent Tc-99m-MIBI scintigraphy before chemotherapy and at least 2 times after the second or third or fifth course of chemotherapy. The changes of the tracer uptake (DeltaUR) and perfusion (DeltaPI) from prechemotherapy to postchemotherapy were compared with histologic response.

RESULTS

The sensitivity, specificity, and accuracy for the prediction of effective chemotherapy in DeltaPI were 88%, 83%, 85% after second, 85%, 72%, 78% after third, and 81%, 71%, 76% after 5th chemotherapy, and those in DeltaUR were 88%, 83%, 85% after 2nd, 85%, 92%, 89% after 3rd, and 94%, 77%, 85% after fifth chemotherapy, respectively. The area under the receiver operator characteristic curve of the DeltaPI after second, third, and fifth chemotherapy were similarly good (0.842, 0.858, 0.811, respectively) and those of DeltaUR were similarly excellent (0.915, 0.936, 0.931, respectively).

CONCLUSION

In patients with bone and soft tissue sarcomas, the change of Tc-99m-MIBI images from prechemotherapy to early to middle of chemotherapy can predict the final histopathological tumor response to chemotherapy as accurately as the change of Tc-99m-MIBI images from prechemotherapy to the completion of the preoperative chemotherapy.

摘要

目的

Tc-99m-甲氧基异丁基异腈（MIBI）仅在存活细胞中积累。对于患有骨和软组织肉瘤的患者，术前化疗是必不可少的，并且早期预测肿瘤对化疗的反应将有助于治疗策略的规划。本研究的目的是评估从化疗前状态到化疗早期到中期的 Tc-99m-MIBI 图像的变化是否可以像化疗前完成后的成像变化一样准确地预测最终的组织病理学肿瘤反应。

方法

73 例患有骨和软组织肉瘤的患者在化疗前和第二次或第三次或第五次化疗后至少进行了 2 次 Tc-99m-MIBI 闪烁显像。将化疗前至化疗后的示踪剂摄取（DeltaUR）和灌注（DeltaPI）变化与组织学反应进行比较。

结果

DeltaPI 预测有效化疗的敏感性、特异性和准确性分别为第二次化疗后 88%、83%和 85%，第三次化疗后 85%、72%和 78%，第五次化疗后 81%、71%和 76%，DeltaUR 分别为第二次化疗后 88%、83%和 85%，第三次化疗后 85%、92%和 89%，第五次化疗后 94%、77%和 85%。第二次、第三次和第五次化疗后 DeltaPI 的受试者工作特征曲线下面积相似（分别为 0.842、0.858 和 0.811），DeltaUR 的受试者工作特征曲线下面积均非常优秀（分别为 0.915、0.936 和 0.931）。