| The bone neoplasm metastasis is a frequent complication of later tumor, which is often seen in the carcinoma of prostate, breast carcinoma and the lung cancer, whose appearance will often signify the decline of the quality of life and the short life span. It is also a very important factor that leads the patients to death. Therefore, the earlier to diagnose and treatment the bone neoplasm metastasis, the better the patients will get. It is very important for the patients to enhance the survival rate of malignant tumor and improve their quality of life, whose effect is unquestionable.During several years of clinical application, it has been confirmed that 99Tcm-MDP bone imaging is a very sensitive method to check out the bone neoplasm metastasis, but whose shortage is bad specificness. Some of nonmalignant diseases may be also assuming the positive result, such as: bone fracture, bone inflammation et al. PET imaging has a good application value in the discrimination between malignant and benign bone lesions, but whose price is expensive. Many researches try to search for a single photon tumor positive imaging method, which can discriminate the malignant from the benign bone lesions, such as: 99Tcm-MIBI, 99Tcm (V)-DMSA imaging, et al, but the ideal outcomes have not been found yet. Recently, 99Tcm-HL91 has been developed as a new type of hypoxic agents, a lot of research indicates that it has a selectivity to be detained in tumor hypoxic tissue, and it also can be used to distinguish the hypoxic from normal tissues and is a better tumour's positive imaging agent.Objective: Patients with bone focus of infection were performed 99Tcm-HL91 imaging. The purpose is to evaluate the value of 99Tcm-HL91 imaging in the diagnosis of bone neoplasm metastasis.Material and methods: 19 patients with bone pain, include 12 primarily malignant tumor patients by histopathological findings or clinical manifestation (7 patients with bone neoplasm metastasis of lung cancer and 5 patients with bone neoplasm metastasis of prostatic carcinoma), and during other 7 patients with benign lesions (include 1 antisternum angioneoplasm, 2 bone cyst and 4 bone arthrophlogosis) confirmed with histopathological findings after surgical resection, biopsy or clinical manifestation. They underwent 99Tcm-HL91 SPECT imaging at 4h based on MDP imaging result after the intravenous injection of 740 MBq 99Tcm-HL91. SPECT imaging: step by step acquisition with 60 stops separated by 6 degrees, matrix was 128x128, and zoom was 1.28. CT scan was performed with 120Kv, 2.5mAs, and 1cm collimation. Image processing: After iterative reconstruction, SPECT image and CT image was fused. Semiquantitative analysis: The tumor-to-normal ratio (T/N) was calculated by drawing ROI. One image was selected and a round region of interest (ROI) was drawn around the tumor and its mean value was calculated, signed as T. The tumor ROI was mirrored to the normal muscle tissue to obtain normal tissue background region activity and got its mean value, signed as N. The radioactivity ratios of tumor-to-normal tissue (T/N) were calculated. The definition of sensitivity is the ratio of all of bone neoplasm metastasis focuses' positive result and the definition of specificity is the ratio of all of benign lesions focuses' negative result. To judge the ability of 99Tcm-HL91 for identifying the character of the bone neoplasm metastasis and benign bone lesions, we compared the 99Tcm-HL91 imaging results with histopathological findings after surgical resection or biopsy.Results:1. In the range of HL91 SPECT imaging, 99Tcm-HL91 was showed visible uptake in 53 out of 55 focuses in 12 patients of bone neoplasm metastasis, sensitivity reached 96.4%, and 11 focuses of 7 patients of benign lesions were all negative, specificity reached 100%.2. The T/N values of malignant and benign lesions in 4h SPECT slices were 1.900±0.342 and 0.758±0.232, there were significant difference between both lesions (P<0.05). 3. The T/N values of lung cancer and prostatic carcinoma in 4h SPECT slices were 1.959±0.414 and 1.823±0.197, respectively, there were no significant (P>0.05).4. After injection of 99Tcm-HL91, no adverse or subjective side effects were noticed in any of the patients.Conclusion:1. The T/N values of malignant and benign lesions were significant difference, the results indicate that as tumour's positive imaging agent HL91 is useful in diagnosing malignant from benign bone lesions. Combined with 99Tcm-MDP imaging, it can offer a method for diagnosis bone neoplasm metastasis, which is not only sensitive but also specific.2. 99Tcm-HL91 is easy to be prepared, cheap, no cytotoxicity and it is fit for SPECT imaging, which has a widespread prospect of clinical application.
|
PDF Full Text Request