99Tcm-3P4-RGD2显像探测肺癌骨骼转移的临床价值研究
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江苏省自然科学基金(BK20130082);南京市杰出青年基金课题(JQX14049)


Imaging of bone metastasis from lung cancer with 99Tcm-3P4-RGD2
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    摘要:

    目的:探讨99Tcm-HYNIC-PEG4-E[PEG4-c(RGDfk)]2(99Tcm-3P4-RGD2)显像探测肺癌骨骼转移灶的临床应用价值。方法:回顾性分析2012年7月—2013年9月45例经病理证实的肺癌患者,所有患者均接受99Tcm-3P4-RGD2显像(RGD显像,包括平面和断层显像)-99Tcm-MDP显像(MDP显像,包括平面和断层显像),同时行SPECT-CT融合显像。所有病灶均以病史-病理检查或6个月以上的影像学随访为最终诊断结果。探讨RGD显像对肺癌骨骼转移病变的诊断效能。结果:45例肺癌并发骨骼病灶122处,成骨性转移病灶102处,溶骨性病灶20处 (其中5处尚未出现明显骨质密度改变),良性骨病变51处。溶骨性转移灶对99Tcm-3P4-RGD2摄取(T/NT:6.90 ± 2.31)显著高于99Tcm-MDP(1.18 ± 1.24,P=0.010),RGD显像对溶骨性-成骨性转移灶的探测灵敏度(84.8%和55.9%)分别与MDP显像(25.0%和91.2%)差异显著(P均<0.05),融合CT显像后,两种显像方法对骨转移的诊断特异性无统计学差异,但MDP融合显像对骨转移灶的探测灵敏度(92.6%)和准确性(93.4%)均高于RGD融合显像(78.7%,P=0.008;80.3%,P=0.010)。另外,RGD融合显像可对骨骼病变原发肺癌灶和其他转移灶进行有效探测。结论:99Tcm-3P4-RGD2靶向结合肿瘤细胞-破骨细胞的整合素αvβ3受体,在肺癌溶骨性骨转移的早期发现中具有一定优势,是常规骨显像的有效补充。

    Abstract:

    Objective:To investigate the value of imaging with 99Tcm-HYNIC-PEG4-E[PEG4-c(RGDfk)]2(99Tcm-3P4-RGD2) as radiotracer in the dectection of lung cancer bone metastases. Methods: A total of 45 patients (25 males and 20 females) with lung cancer were retrospectively studied in our hospital from July 2012 to September 2014. All patients received 99Tcm-3P4-RGD2 imaging (RGD imaging,including plane and tomography) and 99Tcm-MDP imaging(MDP imaging,including plane and tomography),meanwhile undergoing SPECT-CT fusion imaging. The final diagnosis was made based on history, pathology,and 6 months follow-up. RGD imaging in the diagnosis of lung cancer with bone metastasis lesions was investigated. Results:Within 122 bone metastasic lesions, 102 was osteolytic, 20 was osteoblastic metastases (5 were demonstrated no bone density changes)and there were 51 benign bone lesions. Regional accumulation of 99Tcm-3P4-RGD2 (T/NT:6.90 ± 2.31) was higher than that of 99Tcm-MDP (1.18 ± 1.24,P=0.010). The diagnotic sensitivity of RGD imaging to osteolytic metastases was 84.8%, higher than that of MDP imaging(25.0%) while the diagnostic sensitivity of RGD imaging to osteoblastic metastases was 55.9%, lower than that of MDP imaging(91.2%)(both P < 0.05). When combined with 6 slice-CT imaging, the diagnostic specificity difference of bone metastases between RGD fusion imaging and MDP fusion imaging was insignificant. The diagnostic sensitivity and accuracy of MDP fusion imaging(92.6% and 93.4%) were higher than those of RGD fusion imaging(78.7%,P=0.008;80.3%,P=0.010). Furthermore, RGD imaging also detected primary lung cancer and lymph node metastases. Conclusion: Specifically targeting integrin αvβ3, which was highly expressed on osteoclast and lung cancer cells,99Tcm-3P4-RGD2 imaging has great potential for detection of lung cancer osteolytic metastasis.

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邵国强,崔 璨,罗 瑞,孟庆乐,杨 瑞,梁 凯,赵 骏,王 峰,王自正.99Tcm-3P4-RGD2显像探测肺癌骨骼转移的临床价值研究[J].南京医科大学学报(自然科学版),2015,(11):1659-1663

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  • 收稿日期:2015-04-30
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  • 在线发布日期: 2015-11-30
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