【作者】 董华； 张遵城； 郭永涛； 杨景魁； 董萍；

【Author】 DONG Hua,ZHANG Zun-cheng,GUO Yong-tao,YANG Jing-kui,DONG Ping (1.Department of Nuclear Medicine,The Second Hospital;2.Department of Thoracic Surgery, The Second Hospital,Tianjin Medical University,Tianjin 300211,China)

【机构】 天津医科大学第二医院核医学科； 天津医科大学第二医院胸外科；

【摘要】 目的探讨SPECT/CT引导靶区定位技术,在经皮穿刺种植放射性125I粒子治疗中心型肺癌并发阻塞性肺不张中的应用价值。方法选择35例术前CT检查可疑为中心型肺癌导致阻塞性肺不张,但不能分辨肿瘤和肺不张边界的患者,行¹⁸F-FDGSPECT/CT检查。根据采集到的¹⁸F-FDGSPECT/CT图像勾画GTV,将CT图像和SPECT/CT图像输入TPS对病灶进行三维重建,计算植入通道、粒子数和放射剂量,在TPS下模拟布源,生成剂量体积直方图（Dose volume histogram,DVH）。并在CT引导下经皮穿刺植入放射性125I粒子,治疗后6个月,根据CT检查比较肿瘤体积,按国际标准判定疗效。结果所有病例经SPECT/CT检查均可清晰显示肿块与肺不张的界限,肿瘤靶区体积平均约为64cm3,而CT检查的靶区体积平均约为112cm3,治疗6个月后,完全缓解率+部分缓解率为91.4%,未发生与治疗相关的严重并发症。1年生存率为88.6%。结论¹⁸F-FDG SPECT/CT检查对于确定中心型肺癌并发阻塞性肺不张肿瘤靶区勾画的价值明显优于CT检查,有利于放射性粒子植入治疗。更多还原

【Abstract】 Objective To evaluate percutaneous puncturing 125I seeds implantation by using SPECT/CT guided target localization technique in treating central lung cancer complicated by obstructive pulmonary atelectasis. Methods A total of 35 patients with suspected central lung cancer complicated by obstructive pulmonary atelectasis on preoperative CT were enroll in this study.As no clear distinction existed between the tumor and the atelectatic consolidation shadow on CT scanning,an additional SPECT/CT scanning was adopted.After ascertaining the location of the lung cancer,percutaneous puncturing implantation of 125I seeds under SPECT/CT guidance was performed.The clinical data and the therapeutic results were evaluated.The carcinoma were scanned by CT and compared with 6 months after treatment.All the patients were followed-up for 6 to 18 months.Results A sharp distinction between the tumor and the atelectatic consolidation shadow was demonstrated on SPECT/CT scans in 35 cases.The mean volume of the targeted lesion reckoned from SPECT/CT scans was 64cm3,and the 125I seeds were implanted.The mean volume of the targeted lesion calculated on CT scans was 112cm3.Among the 35 followed-up cases,the complete and partial remission rate was 91.4%(32/35),and no major complications. One year survival rate was 88.6%(31/35).Conclusion SPECT/CT scans is more accurate than CT alone in the determining the radiation target volume in patients with central lung cancer complicated by obstructive pulmonary atelectasis.更多还原