Valdés Olmos R A, van Zandwijk N, Boersma L J, Hoefnagel C A, Baas P, Baars J B, Muller S H, Lebesque J V
Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
J Nucl Med. 1996 Apr;37(4):584-8.
Early recognition of radiation pneumonitis enables adequate treatment with a reasonable chance to prevent late sequelae. The feasibility of 111In-pentetreotide in detecting this condition was explored in this study.
The degree of lung uptake of 111In-pentetreotide, evaluated both visually and quantitatively by irradiated-to-nonirradiated area ratios (INIA ratio) from planar images after 24 hr, was analyzed in relation to the radiation field and compared with ventilation/perfusion (V/Q) images and chest radiographs or CT in 11 patients who had received radiotherapy to the mediastinum or to the internal mammary nodes, 10 of whom were suspected of having clinical radiation pneumonitis. Additional SPECT studies were used to map lung uptake distribution.
Indium-111-pentetreotide scans were positive in nine symptomatic patients examined 2-5 mo after radiotherapy; strongly or moderately positive in eight patients, one of whom was receiving steroid therapy without clinical response; and weakly positive in one patient with good steroid response. Indium-111-pentetreotide studies were negative in one asymptomatic patient examined 1 mo after radiotherapy and in one symptomatic patient, with subsequent diagnosis of aspecific viral pneumonitis, examined 4 mo after irradiation. Positive 111In-pentetreotide scans delineated areas of radiation pneumonitis that adequately correlated with areas of decreased ventilation/perfusion and x-ray abnormalities. INIA ratios varied from 1.01 to 2.16 and, in irradiated areas with visible uptake, the lowest value was 1.29. SPECT showed lung uptake in both superficial and deep lying areas in patients with mantle irradiation fields whereas distribution was limited to anterior areas in internal mammary lymph node chain irradiation.
Indium-111-pentetreotide can detect radiation pneumonitis and may have a role in both the differential diagnosis of patients who have complaints after radiotherapy, and when supported by quantification in the monitoring of response to steroid therapy.
早期识别放射性肺炎可进行充分治疗，有合理机会预防晚期后遗症。本研究探讨了¹¹¹In-喷替肽检测这种情况的可行性。
在24小时后通过平面图像的照射区与非照射区比值（INIA比值）对¹¹¹In-喷替肽的肺摄取程度进行视觉和定量评估，分析其与放射野的关系，并与11例接受纵隔或内乳淋巴结放疗的患者的通气/灌注（V/Q）图像、胸部X线片或CT进行比较，其中10例怀疑有临床放射性肺炎。额外的SPECT研究用于绘制肺摄取分布。
9例放疗后2 - 5个月接受检查的有症状患者的¹¹¹In-喷替肽扫描呈阳性；8例为强阳性或中度阳性，其中1例接受类固醇治疗但无临床反应；1例对类固醇反应良好的患者为弱阳性。1例放疗后1个月接受检查的无症状患者和1例放疗后4个月接受检查的有症状患者（随后诊断为特异性病毒性肺炎）的¹¹¹In-喷替肽研究为阴性。¹¹¹In-喷替肽扫描阳性勾勒出放射性肺炎区域，与通气/灌注降低区域和X线异常区域充分相关。INIA比值在1.01至2.16之间变化，在有可见摄取的照射区域，最低值为1.29。SPECT显示，接受斗篷野照射的患者的肺摄取在浅表和深部区域均有，而在内乳淋巴结链照射中，分布仅限于前部区域。
¹¹¹In-喷替肽可检测放射性肺炎，在放疗后有症状患者的鉴别诊断中以及在类固醇治疗反应监测中得到定量支持时可能发挥作用。
