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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WHOⅡ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MR I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;③CHO-PET对WHOⅡ、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);④MR I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。
Objective 11 The role of functional imaging of 11C-Choline PET / CT (CHO-PET) in the diagnosis and optimization of chemoradiotherapy for gliomas. Methods The results of CHO-PET imaging in 23 patients with WHO grade Ⅱ, 9 in grade Ⅲ, 5 in grade Ⅳ, who were confirmed by postoperative pathology from January 2008 to June 2009 were analyzed. In the same period, MR I imaging was compared with that of radiotherapy and chemotherapy based on CHO-PET imaging of tumor biological target (BTV). Results ① The lesions of CHO-PET showed good contrast with normal brain tissue and the border of tumor was clearer; ② The diagnosis and target area of 10 cases (43.5%) were changed by functional imaging of CHO-PET, 5 patients (31.3%) were in the former patients and 5 patients (71.4%) were patients after radiotherapy. Among them, the range of tumor target (GTV) in one case (grade Ⅲ) increased and the GTV radiotherapy was enlarged. One case (grade Ⅱ) recurred and changed to chemotherapy during the scheduled period. The residual tumor in 4 cases (grade Ⅱ) (CTV) radiotherapy for CTV + GTV radiotherapy; 4 cases (1 case of grade Ⅲ; 3 cases of grade Ⅱ) no tumor recurrence, modified treatment for regular review; ③ CHO-PET WHO Ⅱ, Ⅲ, Ⅳ grade treatment of patients The rate of change was 88.9% (8/9), 22.2% (2/9), 0 (0/5), respectively; ④The diagnostic coincidence rate of MRI for high grade gliomas (WHO III and IV) was 85.7% (12/14). Conclusions The functional imaging of CHO-PET can clearly show the pathological changes of gliomas and clear boundary of tumor. It is of benefit to the diagnosis of WHO II and III patients, to optimize the treatment regimen, to the judgment of curative effect and to the differential diagnosis of tumor recurrence and necrosis .