99m Tc-HYNIC-TOC显像和131 I-MIBG显像在嗜铬细胞瘤和副神经节瘤中的诊断价值OACSTPCD
Evaluation of 99m Tc-HYNIC-TOC and 131 I-MIBG imaging in diagnosis of pheochromocytoma and paraganglioma
目的 探讨99m Tc标记肼基烟酰胺奥曲肽类似物(99m Tc-HYNIC-TOC)显像与131 I-间碘苄胍(131 I-MIBG)肾上腺髓质显像对嗜铬细胞瘤和副神经节瘤(PPGL)的临床诊断价值.方法 回顾性研究 359 例经手术病理确诊、临床资料完整的PPGL患者的临床资料,分析99m Tc-HYNIC-TOC生长抑素受体显像与131 I-MIBG肾上腺髓质显像的诊断敏感性及影响因素.结果 319 例行 99m Tc-HYNIC-TOC 生长抑素受体显像,病灶检出阳性 184 例,诊断敏感性为57.7%;279 例行131 I-MIBG肾上腺髓质显像,病灶检出阳性 232 例,诊断敏感性为 83.2%,原发灶位于肾上腺、腹膜后、头颈部、心脏及纵膈、盆腔及膀胱部位的99m Tc-HYNIC-TOC生长抑素受体显像敏感性分别为 53.3%、62.5%、95.0%、66.7%、50.0%和 11.0%,131 I-MIBG肾上腺髓质显像敏感性分别 86.7%、88.5%、45.4%、50.0%、75.0%和33.3%.不同遗传背景[包括琥珀酸脱氢酶(SDH)、希佩尔-林道(VHL)及RET原癌基因(RET)基因突变]的PPGL患者中,两种方法诊断PPGL的敏感性差异无统计学意义(P＞0.05).肿瘤最大径的中位数为 4.4(3.0,6.1)cm.99m Tc-HYNIC-TOC生长抑素受体显像和131 I-MIBG 肾上腺髓质显像对较大肿瘤组(≥4.4 cm)的诊断敏感性均显著高于较小肿瘤组(＜4.4 cm)(64.0%vs.51.3%;92.3%vs.74.1%)(P＜0.01);19 例患者(占5.3%)的肿瘤对这两种显像方法均不摄取.结论 本研究为迄今中国最大PPGL队列的99m Tc-HYNIC-TOC生长抑素受体显像及131 I-MIBG肾上腺髓质显像的研究.总体而言,131 I-MIBG肾上腺髓质显像敏感性较99m Tc-HYNIC-TOC生长抑素受体显像高,但对部分部位的肿瘤,如头颈副神经节瘤,后者有明显优势,两者有互补性,临床中需要结合患者的特点进行选用.
Objective To evaluate 99mTc-HYNIC-TOC somatostatin receptor and 131 I-MIBG imaging in clinical diag-nostic of pheochromocytoma and paraganglioma(PPGL).Methods This was a retrospective study.359 PPGL pa-tients diagnosed by pathology microscopy were included.The diagnostic sensitivity and influencing factors on 99mTc-HYNIC-TOC somatostatin receptor and 131 I-MIBG imaging were analyzed.Results The positive rate of 99mTc-HYN-IC-TOC somatostatin receptor scintigraphy was 57.7%(184/319)and 131I-MIBG imaging was 83.2%(232/279).The positive rates of 99m Tc-HYNIC-TOC somatostatin receptor imaging in the adrenal glands,retroperitoneum,head and neck,heart and mediastinum,pelvis and bladder were 53.3%,62.5%,95.0%,66.7%,50.0%and 11.0%respec-tively and the positive rates of 131I-MIBG imaging were 86.7%,88.5%,45.4%,50.0%,75.0%and 33.3%respec-tively.The positive rate of the two imaging did not showed difference among patients with different genetic back-grounds(SDH,VHL,RET mutations).The median maximum diameter of tumors was 4.4(3.0,6.1)cm.and the diag-nostic sensitivity of somatostatin receptor imaging and 131 I-MIBG imaging for larger tumors(≥4.4 cm)was signifi-cantly higher than those for the smaller tumor group(＜4.4 cm)(64.0%vs.51.3%;92.3%vs.74.1%)(P＜0.01).Tumors in 19 patients(5.3%)failed to uptake neither imaging method.Conclusions This is the largest PPGL cohort in China concerning 99m Tc-HYNIC-TOC somatostatin receptor imaging and 131 I-MIBG imaging.The sensitivity of 131 I-MIBG imaging is higher than that of 99m Tc-HYNIC-TOC somatostatin receptor imaging,but for some tumors,such as head and neck paraganglioma,the latter has obvious advantages.These two imagings technol-ogies are complementary and the choice of them should depend the individual situation of patients.
王宇;童安莉;周玥;张文倩;崔云英;景红丽;李玉秀
中国医学科学院 北京协和医学院 北京协和医院 内分泌科 国家卫生健康委员会内分泌重点实验室,北京 100730||河北北方学院 研究生学院,河北张家口 075000中国医学科学院 北京协和医学院 北京协和医院 内分泌科 国家卫生健康委员会内分泌重点实验室,北京 100730
临床医学
嗜铬细胞瘤副神经节瘤99m Tc-HYNIC-TOC生长抑素受体显像131 I-MIBG显像诊断敏感性
pheochromocytomaparaganglioma99m Tc-HYNIC-TOC somatostatin receptor imaging131 I-MIBG imagingdiagnostic sensitivity
《基础医学与临床》 2024 (003)
374-378 / 5
国家重点研发计划(2021YFC2501600,2021YFC2501603);中央高水平医院临床科研业务费(2022-PUMCH-C-028);中国医学科学院医学与健康科技创新工程(2021-I2M-C&T-B-002)
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