Soler C, Beauchesne P, Maatougui K, Schmitt T, Barral F G, Michel D, Dubois F, Brunon J
Service de Médecine Nucléaire, CHU de Saint-Etienne, Saint-Etienne, France.
Eur J Nucl Med. 1998 Dec;25(12):1649-57. doi: 10.1007/s002590050344.
Technetium-99m sestamibi (MIBI), an alternative radiopharmaceutical for myocardial perfusion imaging, has also been proposed for use as an imaging agent for various tumours, including breast cancer, lung cancer, lymphomas, melanomas and brain tumours. After routine radiation therapy, deteriorating clinical status or treatment failure may be due to either radiation-induced changes or recurrent tumour. Computed tomography and magnetic resonance imaging offer imperfect discrimination of tumour viability and radionecrosis. Against this background we undertook a retrospective study of 35 malignant glioma patients in whom clinical deterioration had occurred, in order to clarify the value of 99mTc-MIBI SPET in identifying tumour recurrence. SPET was performed 15 min after intravenous injection of 1110 MBq with a dual-headed gamma camera using a fan-beam collimator. Transverse, coronal and sagittal views were reconstructed. Intense MIBI uptake was found in 31 patients. This uptake was correlated with tumour recurrence as proved by histology and/or rapid, fatal evolution of these cases. The statistical analysis performed on this population of patients with MIBI uptake revealed a group of patients with a long mean survival and a group with a short mean survival. Two subgroups were found within each of these groups, according to the functional index ratio (tumour uptake/pituitary gland uptake ratio). No MIBI uptake was found in four patients who are still alive and can be considered to be disease-free. In those cases showing MIBI uptake, death occurred an average of 6.69 months following brain SPET. According to our results, the specificity and sensitivity of 99mTc-MIBI brain SPET seem to be high. Moreover, this technique is more accurate than computed tomography or magnetic resonance imaging for discriminating between tumour recurrence and radionecrosis.
锝-99m 甲氧基异丁基异腈（MIBI）是一种用于心肌灌注显像的替代性放射性药物，也被提议用作多种肿瘤的显像剂，包括乳腺癌、肺癌、淋巴瘤、黑色素瘤和脑肿瘤。常规放射治疗后，临床状况恶化或治疗失败可能是由于放射诱导的改变或肿瘤复发。计算机断层扫描和磁共振成像对肿瘤存活和放射性坏死的鉴别并不理想。在此背景下，我们对 35 例发生临床恶化的恶性胶质瘤患者进行了一项回顾性研究，以阐明 99mTc-MIBI 单光子发射计算机断层显像（SPET）在识别肿瘤复发方面的价值。静脉注射 1110 MBq 后 15 分钟，使用双头伽马相机和扇形准直器进行 SPET 检查。重建横断面、冠状面和矢状面图像。31 例患者发现有强烈的 MIBI 摄取。这种摄取与肿瘤复发相关，组织学检查和/或这些病例的快速、致命进展证实了这一点。对这群有 MIBI 摄取的患者进行的统计分析显示，有一组患者平均生存期长，另一组平均生存期短。根据功能指数比（肿瘤摄取/垂体摄取比），在每组中又发现了两个亚组。4 例仍然存活且可被认为无疾病的患者未发现 MIBI 摄取。在那些显示有 MIBI 摄取的病例中，脑部 SPET 检查后平均 6.69 个月死亡。根据我们的结果，99mTc-MIBI 脑 SPET 的特异性和敏感性似乎很高。此外，在区分肿瘤复发和放射性坏死方面，这项技术比计算机断层扫描或磁共振成像更准确。
