CHO PET功能显像:脑胶质瘤诊断和优化放化疗方案

目的 11碳-胆碱正电子发射断层扫描(11C-Choline PET/CT,CHO-PET)功能显像在脑胶质瘤诊断和优化放化疗治疗方案中的作用.方法 分析2008年1月至2009年6月经术后病理确诊的23例(其中WHO Ⅱ级9例、Ⅲ级9例、Ⅳ级5例)脑胶质瘤患者的CHO-PET功能显像结果,与同期MRI结构影像结果相比较,依据CHO-PET显像肿瘤生物靶区(BTV)优化放化疗治疗方案.结果 ①CHO-PET功能显像的病变靶区与正常脑组织对比度良好,肿瘤边界更清晰;②CHO-PET功能显像改变了10例(43.5%)患者的诊断及靶区范围,包换术后放疗前患者5例(31.3%);放疗后患者5例(71.4%).其中1例(Ⅲ级)肿瘤靶区(GTV)范围增大而扩大GTV放疗;1例(Ⅱ级)肿瘤复发,改定期复查为化疗;4例(Ⅱ级)术后肿瘤残留,改临床肿瘤靶区(CTV)放疗为CTV+GTV放疗;4例(1例Ⅲ级;3例Ⅱ级)未见肿瘤复发,改化疗为定期复查;③ CHO-PET对WHO Ⅱ、Ⅲ、Ⅳ级患者治疗方案的改变率分别为88.9%(8/9)、22.2%(2/9)、0(0/5);④ MRI对高级别胶质瘤患者(WHO III、Ⅳ级)的诊断符合率为85.7%(12/14).结论 CHO-PET功能显像对脑胶质瘤病变显示清楚,肿瘤边界清晰;有利于WHO II、III级患者的诊断;有利于优化治疗方案;有利于疗效的判断以及肿瘤复发与坏死的鉴别诊断.

Application of 11C-CHO PET functional imaging in diagnosis and optimization of radiochemotherapy treatment regimen of brain gliomas

Objective To explore the role of Choline positive-emission tomography （CHO-PET） functional imaging in the diagnosis and optimization of radiochemotherapy treatment of brain gliomas.Methods The CHO-PET imaging of 23 cases of glioma （9 cases, WHO grade II; 9 cases, WHO grade Ⅲ; 5 cases, WHO grade Ⅳ） confirmed by pathological examination from January 2008 to June 2009 was analyzed and compared with MRI. Co-registered biology tumor volume （BTV） of CHO-PET imaging was used as an index for the choice of therapeutic treatment regimen for brain gliomas.Results CHO-PET imaging displayed clear border between glioma and surrounding normal tissue. The diagnosis and the target volume of 10 patients （43.5%） were changed because of the integrated CHO-PET results, including 5 （31.3%） pre-radiotherapy （post-operation） cases and 5 （71.4%） post-radiotherapy cases. Gross tumors volume （GTV） radiotherapy expanded in 1 case （grade Ⅲ） because of the increase of target volume; the follow-up was changed to chemotherapy in 1 case （grade II） because of the recurrence of tumor during follow-up; clinical tumors volume （CTV） radiotherapy was changed to CTV＋GTV radiotherapy because of the postoperative tumor residue in 4 cases （grade II）; 4 cases （1 case, grade Ⅲ; 3 cases, grade II） were followed up because no recurrence occurred. CHO-PET changed treatment regime of gliomas of grade II （88.9%, 8/9）, Ⅲ （22.2%, 2/9）, Ⅳ （0%, 0/5）, respectively. The diagnostic accuracy of MRI was 85.7% for high-grade glioma. Conclusion Integrated CHO-PET imaging displays the circumscribed glioma clearly. It is helpful for the diagnosis of glioma of grade II and Ⅲ, the optimization of treatment regime of glioma, judgement of the clinical effect and the differential diagnosis of recurrence and necrosis.