Brandt-Mainz K, Müller S P, Sonnenschein W, Bockisch A
Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Essen, Germany.
J Nucl Med. 1998 Sep;39(9):1536-41.
Tumor scintigraphy with flow tracers, such as 201TI-chloride, has an established role in the follow-up of differentiated thyroid cancer. We investigated a new tracer, 99mTc-furifosmin (Technescan Q12, Mallinckrodt Diagnostika, Hennef, Germany), in patients with elevated thyroglobulin levels or sonographic suspicion of lymph node metastases or recurrent disease.
In a prospective study, we examined 20 patients with 99mTc-furifosmin. All patients underwent a 18F-fluorodeoxyglucose (FDG) PET scan of the neck and chest. Positive 99mTc-furifosmin findings were validated by biopsy, (131)I scan, CT or 18F-FDG PET examinations.
In three patients with cervical lymph node metastases detected on a planar 99mTc-furifosmin scan, we found a rapid tracer accumulation in the tumor (maximum < 2 min) and a significant washout in 2 of 3 patients after 4 hr. The visual contrast and the tumor-to-nontumor ratio was rather poor (average 1.2:1). In 3 additional patients, 3 pulmonary and 2 mediastinal lymph node metastases were detected by the 99mTc-furifosmin SPECT scan. Two patients were true-negative, and in 13 of 18 patients, the tumor could be localized by 18F-FDG PET (10 cervical, 6 mediastinal, 4 pulmonary metastases, 1 bone metastasis); 5 patients were false-negative. In 3 of these false-negative cases we could not localize the tumor with other diagnostic methods. Two patients had a true-negative PET examination.
The statistical analysis of our data on 99mTc-furifosmin reveals that the sensitivity and 95% confidence interval of 33% (11%-56%) on a patient-by-patient basis and of 34% (17%-57%) for the lesion-by-lesion analysis is significantly lower than the sensitivity and 95% confidence interval of 72% (50%-89%) on a patient-by-patient basis and of 91% (78%-100%) on lesion-by-lesion basis for 18F-FDG. The sensitivity of 99mTc-furifosmin appears to be poor, even for cervical and mediastinal tumor manifestations where the value of 201TI-chloride is established.
使用诸如氯化亚铊之类的血流示踪剂进行肿瘤闪烁扫描在分化型甲状腺癌的随访中具有既定作用。我们对一种新的示踪剂99m锝-呋磷胺（Technescan Q12，德国亨内夫马林克罗特诊断公司）在甲状腺球蛋白水平升高或超声怀疑有淋巴结转移或复发性疾病的患者中进行了研究。
在一项前瞻性研究中，我们用99m锝-呋磷胺检查了20例患者。所有患者均接受了颈部和胸部的18F-氟脱氧葡萄糖（FDG）PET扫描。99m锝-呋磷胺的阳性结果通过活检、（131）I扫描、CT或18F-FDG PET检查进行验证。
在平面99m锝-呋磷胺扫描中检测出有颈部淋巴结转移的3例患者中，我们发现示踪剂在肿瘤中迅速积聚（最大<2分钟），3例患者中有2例在4小时后有明显的洗脱。视觉对比度和肿瘤与非肿瘤的比值相当差（平均1.2:1）。在另外3例患者中，99m锝-呋磷胺SPECT扫描检测出3处肺转移和2处纵隔淋巴结转移。2例患者为真阴性，18例患者中有13例肿瘤可通过18F-FDG PET定位（10处颈部转移、6处纵隔转移、4处肺转移、1处骨转移）；5例患者为假阴性。在这些假阴性病例中有3例我们无法用其他诊断方法定位肿瘤。2例患者PET检查为真阴性。
我们关于99m锝-呋磷胺的数据的统计分析显示，逐例分析时其敏感性和95%置信区间为33%（11%-56%），按病灶分析时为34%（17%-57%），显著低于18F-FDG逐例分析时的敏感性和95%置信区间72%（50%-89%）以及按病灶分析时的91%（78%-100%）。99m锝-呋磷胺的敏感性似乎较差，即使对于已确立氯化亚铊价值的颈部和纵隔肿瘤表现也是如此。
