Comparative Study Between SPECT/CT And MDCT And Classification Of Syndrome Differentiation Of Monitoring Response To Therapy In Gastric Cancer

ObjectiveTo compare the value of T/B in ¹⁸F-FDG SPECT/CT (¹⁸F-FDG coincidence single photon-emission computed tomography/multi-detector computed tomography), MDCT (multi-detector computed tomography) and typing according to syndrome differentiation in the evaluation of treatment response in gastric cancer; To evaluate the values of T/B in the clinical evaluation of treatment response of gastric cancer and the correlation between treatment response and typing according to syndrome differentiation.MethodsMDCT enhancement scanning and typing according to syndrome differentiation by traditional Chinese medicine (TCM) were performed before operation in 62 patients with diagnosed gastric cancer. At the same time, ¹⁸F-FDG SPECT/CT was performed in 31 patients of the 62. Then, chemotherapy with FOLFOX4^*3Cycles was administrated on the 62 patients.2 weeks after chemotherapy, MDCT was done for the 62 paitents and ¹⁸F-FDG SPECT was also done but only for 31 patients out of the 62. MDCT evaluation results were compared with the value of T/B in ¹⁸F-FDG SPECT/CT and typing according to syndrome differentiation.Resultskappa Coefficient of the values of R_â–³T/B[1-(T/B)_{after chemotherapy}/(T/B)_{before chemotherapy}]of ¹⁸F-FDG SPECT/CT and R_â–³MD (1- MaxiDiameter_{after chemotherapy}/MaxiDiameter_{beforechemtherapy})of MDCT is 0.867 (P<0.01) .The accuracy of R_â–³T/B to predict the treatment response is 94.3%.If we make the base line of R_â–³T/B as 35%, The sensitivity, specificity, positive predictive value, negative predictive value of ¹⁸F-FDG SPECT/CT were 100%, 94.1% , 93.3% , 100% respectively. If R_â–³T/B is 40%,the results are 85.7%, 100%, 100%,89.5% respectively.There is significant difference between the outcomes of Asthenia syndrome and Sthenia syndrome, the outcome of Sthenia syndrome is better, x² =38. 489, P<0. 01. The result shows that evaluation of treatment response by MDCT had significant correlations with gastric carcinoma TCM classifications of syndromes (x²=3 0.47, P<0.01). Treatment responses in the type of Phlegm-damp Coagulation and the type of Deficiency of both Qi and Blood and the type of Asthenia Cold of the Spleen and Stomach had significant difference (x²> 16.645, P<0.01), but there is no significant difference between treatment responses in the type of Phlegm-damp Coagulation and the types of the stasis and endogenous toxics(x²=0.065, P=0.799). Treatment responses in the type of Stasis and Endogenous Toxics and the type of Deficiency of both Qi and Blood and the type of Asthenia Cold of the Spleen and Stomach had significant difference (x²> 14.031, P<0.01); Treatment responses in the type of Asthenia Cold of the Spleen and Stomach was also different from Deficiency of both Qi and Blood.The value of T/B before chemotherapy had significant correlations with gastric carcinoma TCM classifications of syndromes (P=0.008). T/B before chemotherapy in the type of Deficiency of both Qi and Blood and the type of Asthenia Cold of the Spleen and Stomach had no differences (P=0.368).The type of Phlegm-damp Coagulation and the type of Stasis and Endogenous Toxics also had no differences (P=0.962). But T/B before chemotherapy in the type of Asthenia cold of the Spleen and Stomach and the type of Phlegm-damp Coagulation and the type of Stasis and Endogenous Toxics had significant difference(P=0.032,P=0.044); T/B before chemotherapy in the type of Deficiency of both Qi and Blood and the type of Phlegm-damp Coagulation and Stasis and Endogenous Toxics had significant difference(P=0.004,P=0.006);There was significant difference in the d R_â–³T/B among the various types(P=0.001). R_â–³T/B in the type of Asthenia cold of the Spleen and Stomach and the type of Phlegm-damp Coagulation and the type of Stasis and Endogenous Toxics had significant difference(P=0.032,P=0.044); R_â–³T/B in the type of Phlegm-damp Coagulation and the type of Deficiency of both Qi and Blood and the type of Asthenia Cold of the Spleen and Stomach had significant difference(P=0.021,P=0); R_â–³T/B in the type of Stasis and Endogenous Toxics and the type of Deficiency of both Qi and Blood and the type of Asthenia cold of the Spleen and Stomach had significant difference(P = 0.031,P =0); R_â–³T/B in the type of Deficiency of both Qi and Blood and the type of Asthenia cold of the Spleen and Stomach had difference(P=0.048);But R_â–³T/B in the type of Phlegm-damp Coagulation and the type of Stasis and Endogenous Toxics had no difference(P = 0.048)。Conclusion1. R_â–³T/B is a good evaluation standard for effects, and R_â–³T/B≥35% is recommended as the standard for objective remission.2. There were obvious correlations between the treatment response and typing according to syndrome differentiation in TCM of gastric cancer. Sthenia syndrome is better.3.There were significant differences between the values of T/B and typing according to syndrome differentiation in TCM of gastric cancer. The values of T/B in Asthenia syndrome were higher. The values of T/B in ¹⁸F-FDG SPECT/CT can be used as an objective index for the Asthenia syndrome and Sthenia syndrome in gastric cancer.