| Objective:99mTc-3PRGD2is short for99mTc-HYNIC-3PEG4-E[c(RGDfK)2].We picked some patients who had a undiagnosed lungneoplasm to undergo99mTc labeled whole body scan and local tomography.They also had computed tomography and pathological examination. All ofthese examinations will be compared each other to find a more efficient wayto evaluate lung neoplasm.Methods:During2012.10to2013.10, we picked fifteen patients who had aundiagnosed lung neoplasm to undergo the whole body scan and localtomography. Content include hospitalization data, follow-up diagnosises orexact clinical diagnosis after discharge.199mTc-3PRGD2SPECT/CT imagingThis group of fifteen patients,fasting eight hours, record the patient’sgeneral information and whether use RGD targeted drugs or not such asendu,vataxin and so on during inspection.We give patients99mTc-3PRGD2invein,injection dose was11.1MBq/kg(0.3mCi/kg)(±10﹪);About40minutesafter injection(exam window1h±20min) they undergo whole body scan andlocal tomography,they have to urinate before the start of scanning.They keep asupine position,put their arms aside in the whole body scan,hands lace behindhead in local tomography chest scan. Whole body scan range from head tofoot, local tomography chest scan range include the lung.Use the GE InfiniavcHawkeye II SPECT imaging device for acquisition.We use the Xeleris workstation (GE healthcare) to perform reconstruction,proceeding, reading and analysis. The whole body scan data can use theroutine whole body scan software to acquisite; tomographic data can use theroutine tomographic process software to acquisite. Qualitative analysis: Two experienced nuclear medicine physician readtogether, diagnosis by experience on visual analysis considering volume effectand necrosis of the central part of neoplasm and so on.Semi-quantitative analysis: ues the same standard to measure, in the wholebody and tomographic images of the tumor with a normal divide contralaterallung radioactive count ratio (T/B ratio), tumor and mediastina radioactivecount ratio (T/M ratio). Wholo Body image analysis: draw the minimumround including tumor ROI (regions of interest), as the axis, copy the ROI ofthe same size before the midline in the contralateral site, T/B ratio use theaverage counts of tumor ROI counts/the average counts of the contralaterallung tissue ROI to calculate; T/M ratio use the average counts of tumor ROIcounts/the average counts of mediastinum count ROI. Tomographic imageanalysis: find the highest intake level of the lesions uptake, draw the minimumround including tumor ROI, calculate the radioactive average count, repeatedthree times note for T, compared with the contralateral normal tissue (B), anddraw the same size in the contralateral normal lung tissue of ROI; ROI of thesame size in the mediastinum and calculate the radioactive count note forM.Compare the T/B and T/M value use paired T test.2Other examinations2.1CT examinationTwo experienced CT physicians read together, diagnosis by experience onvisual double-blind analysis. Observe whether there is lobulation sign, spiculesign, vocule sign and so on.2.2pathological examinationPatients’ surgical results and neoplasm biopsy results were sent topathology department regularly.With pathologic results as the gold standard, considering the final clinicaldiagnosis, compare SPECT image with CT image respectively to evaluate thetwo methods.Result:1Basic informations Fifteen lung neoplasm patients were selected in this study，we successfulfollowed-up fifteen about a year.Nine cases of men and six of women; agerange was between fourty-seven to eighty-three,The average age: sixty-five±ten years old. None of them use RGD targeted drugs.299mTc-3PRGD2SPECT/CT imaging2.1Distribution resultAbout99mTc-3PRGD2SPECT/CT imaging,99mTc-3PRGD2almostaccumulated in the kidney, bladder with large amount, accumulated in theliver, spleen, intestinal tract, pharynxnasalis, and marrow and so on withmoderate amount, accumulated in the lung and mediastinum with low amount.2.2Qualitative resultOf the qualitative results, with pathologic results as the gold standard,considering the final clinical diagnosis, we listed the four-fold table ofdiagnostic test evaluation, the statistical results:99mTc-3PRGD2whole bodyscan diagnosis lung neoplasm, the sensitivity, specificity, accuracy, positivepredictive value and negative predictive value severally was82%,25%,67%,75%,67%.2.3Semi-quantitative result2.3.1Of semi-quantitative results, a normal distribution of our data was shownusing the normality test. So we used paired T test to evaluate the dates. Theresult showed T/B value in tomography image was more efficient todistinguish lung neoplasm.2.3.2With pathologic results as the gold standard, considering the finalclinical diagnosis, we set T/B value≥1.5as positive result, T/B value<1.5asnegative result, using tomography image T/B value listed the four-fold table ofdiagnostic test evaluation, the statistical results:T/B ratio of tomographyimages diagnosis lung neoplasm, the sensitivity, specificity, accuracy, positivepredictive value and negative predictive value severally was91%,50%,80%,83%,67%.2.3.3With pathologic results as the gold standard, considering the finalclinical diagnosis, we listed the four-fold table of diagnostic test evaluation, the statistical results: CT image diagnosis lung lesion, the sensitivity,specificity, accuracy, positive predictive value and negative predictive valueseverally was73%,67%,73%,89%,50%.Conclusion:199mTc-3PRGD2is a new agent for tumor angiogenesis imaging positive，valuable for the diagnosis of lung neoplasm.299mTc-3PRGD2SPECT/CT imaging is a noninvasive detection method,it contributes to the identification of lung nodules, neoplasm and chronicinflammation.3The T/B value of SPECT imaging is more sensitive than CT imaging ofthe diagnosis of lung neoplasm. |
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