| Background and Objective: In these days the brain glioma has become a commonly-seen and frequently-occurred disease that threatening people's life severely. Moreover, glioma can be divided into high grade malignant and low grade malignant in biopsy. Though the treatment method of these two types of glioma is operation mainly, they are different in the postoperative treatment and prognosis. CT, MRI and B supersonic wave have less ability to identify the characters of glioma though they can locate the tumor very well; puncture biopsy can identify the characters of rumor but it is limited to the location of tumors which are apt to approach and in less important position, it also has some injuries to the patients. Nuclide imaging has been taken increasingly attention for its ability of identifying the character of tumor. The brain gliomas, for it s abnormal structure and function of blood vessels ,result in the insufficient blood supply to them.These malignant tumors consume a large quantity of oxygen because growing and metabolizing quickly. So they are usually in hypoxic condition. The more serious hypoxic condition is, the more malignant tumor is. Because hypoxic condition is a main characteristic of tumor, it's a hotspot in clinic research that applying the radiopharmaceutical to detect ischemia and hypoxic condition. Some researchers from home and abroad have done a large number of animal experiments and clinic studies about 99Tcm-HL91 imaging, and they suggested that 99Tcm-HL91 imaging could greatly reflect hypoxia of tumors and tell benign or malignant of rumors and the recurrence ornecrosis of tumors. Our former study indicated that 99Tcm-HL91 imaging can reflect the nature of lung cancer. In this study, we will image gliomas with 99Tcm-HL91 in clinical works, compare the imaging results with histopathological findings, assess the value of 99Tcm-HL91 imaging on identifying the high grade and low grade of malignant gliomas.Methods: Twenty-four patients with untreated brain gliomas were studied prospectively a week before operation. After intravenous injection of 740 MBq (20mCi) (the dosage of children was reduced relevantly) 99Tcm-HL91 in the arm vein, SPECT images of the head, which including anterior, posterior, left lateral and right lateral planar images, were acquired at 10 minute, 2 hour and 4 hour in all patient after injection by using a single-head gamma camera equipped with low energy, high-resolution parallel-hole collimator. The energy peak was centered at 140 keV and with a 10% window. There are five centimeters between collimator and the patient's head. Data were acquired in a 256x256 matrix and 1.0-2.0 times zoom. The acquisition time is 300 seconds per frame. Images were interpreted visually and semi-quantitatively. One or two images were selected and a round region of interest (ROI) was drawn around the tumor on planar with a same size in three phases and its mean value was calculated, signed as T. The tumor region of interest was mirrored to the contralateral cerebral hemisphere to obtain normal tissue background regions activity and got its' mean value, signed as N. Then we calculated the radioactivity ratios tumour-to-normal tissue (T/N). Based on the MRI and 99Tcm-HL91 SPECT findings, the surgical resection or biopsy was performed. We compared histopathological findings with SPECT imaging results to judge the ability of 99Tcm-HL91 for identifying the character of the tumor. Considering the x+2SD at 2 hours as the standard for judging high or low malignant grade, we assessed malignant gliomas and calculated the sensitivity, specifity and accuracy of this method.Results:1. Biopsy results: 17 out of 24 patients were identified as high grade malignant glioma (HM), the other 7 were low grade (LM). 17 out of 19 99Tcm-HL91 positive patients were identified by biopsy as high grade malignant glioma, the remains were low grade.2. The 99Tcm-HL91 imaging results: In 19 out of 24 99Tcm-HL91 positive patients, injection was concentrated in tumors with a clear imaging at 10min, clearer at 2 h... |
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