| 匡路,巩环宇,尚靖杰,蔡其君,黎颖昕,刘康寿,刘玉龙,郭斌,弓健,程勇,徐浩.钇90选择性内放射治疗肝癌前以99Tcm-MAA SPECT/CT评估腹部肝外分流[J].中国医学影像技术,2026,42(3):366~371 |
| 钇90选择性内放射治疗肝癌前以99Tcm-MAA SPECT/CT评估腹部肝外分流 |
| 99Tcm-MAA SPECT/CT before Yttrium-90 selective internal radiation therapy of liver cancer for evaluating abdominal extrahepatic shunts |
| 投稿时间：2025-09-26 修订日期：2025-12-07 |
| DOI：10.13929/j.issn.1003-3289.2026.03.010 |
| 中文关键词: 肝肿瘤 单光子发射断层显像和计算机体层摄影 钇放射性同位素 放射治疗 分流 |
| 英文关键词:liver neoplasms single photon emission computed tomography computed tomography yttrium radioisotopes radiotherapy shunt |
| 基金项目:河南省阳光医疗健康发展基金会·钇朵小红花健康基金项目(HKP2024002)。 |
| 作者 | 单位 | E-mail | | 匡路 | 暨南大学附属第一医院核医学科, 广东 广州 510632 | | | 巩环宇 | 暨南大学附属第一医院核医学科, 广东 广州 510632 | | | 尚靖杰 | 暨南大学附属第一医院核医学科, 广东 广州 510632 | | | 蔡其君 | 暨南大学附属第一医院核医学科, 广东 广州 510632 | | | 黎颖昕 | 暨南大学附属第一医院核医学科, 广东 广州 510632 | | | 刘康寿 | 暨南大学附属第一医院肝胆外科, 广东 广州 510632 | | | 刘玉龙 | 暨南大学附属第一医院介入血管外科, 广东 广州 510632 | | | 郭斌 | 暨南大学附属第一医院核医学科, 广东 广州 510632 | | | 弓健 | 暨南大学附属第一医院核医学科, 广东 广州 510632 | | | 程勇 | 暨南大学附属第一医院核医学科, 广东 广州 510632 | | | 徐浩 | 暨南大学附属第一医院核医学科, 广东 广州 510632 | txh@jnu.edu.cn |
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| 中文摘要: |
| 目的 观察钇90选择性内放射治疗(90Y-SIRT)肝癌前以99Tcm-聚合白蛋白(MAA)SPECT/CT评估腹部肝外分流的价值。方法 回顾性分析拟接受90Y-SIRT的268例肝癌患者的99Tcm-MAA SPECT/CT数据,观察平面显像、SPECT及SPECT/CT所示腹部肝外99Tcm-MAA积聚,以肝动脉造影为参考标准评估胃部分流。结果 平面显像、SPECT及SPECT/CT分别检出30例(30/268,11.19%)、31例(31/268,11.57%)及47例(47/268,17.54%)腹部肝外99Tcm-MAA积聚,其评估腹部肝外99Tcm-MAA积聚的敏感度分别为68.97%(20/29)、72.41%(21/29)及100%(29/29),特异度分别为95.82%(229/239)、95.82%(229/239)及92.47%(221/239),阳性预测值分别为66.67%(20/30)、67.74%(21/31)及61.70%(29/47),阴性预测值分别为96.22%(229/238)、96.62%(229/237)及100%(221/221)。SPECT/CT可定位检出的全部47例的99Tcm-MAA积聚,包括19例胃部、5例胆囊、19例前腹壁、1例脾脏及3例门静脉主干异常显影。19例胃部积聚99Tcm-MAA中,1例SPECT/CT检出胃壁局限性浓聚,由起源于肝左动脉的胃分支动脉供血,系真阳性胃部分流,其余18例均表现为胃黏膜弥漫性浓聚,为假阳性胃部分流。结论 90Y-SIRT治疗肝癌前以99Tcm-MAA SPECT/CT评估腹部肝外分流有重要临床意义,具有较高的敏感度、阴性预测值及准确的解剖定位能力。 |
| 英文摘要: |
| Objective To observe the value of 99Tcm-macroaggregated albumin (MAA) SPECT/CT before Yttrium-90 selective internal radiation therapy (90Y-SIRT) of liver cancer for evaluating abdominal extrahepatic shunts. Methods 99Tcm-MAA SPECT/CT data of 268 patients with liver cancer who would undergo 90Y-SIRT were retrospectively analyzed. Abdominal extrahepatic 99Tcm-MAA accumulation was assessed in planar imaging, SPECT and SPECT/CT, respectively. Taken hepatic arteriography as the reference standards, the exist of gastric shunting or not was judged. Results Planar imaging, SPECT, and SPECT/CT detected extrahepatic abdominal 99Tcm-MAA accumulation in 30 (30/268, 11.19%), 31 (31/268, 11.57%) and 47 (47/268, 17.54%) cases, respectively, with sensitivity of 68.97% (20/29), 72.41% (21/29) and 100% (29/29), specificity of 95.82% (229/239), 95.82% (229/239) and 92.47% (221/239), positive predictive value of 66.67% (20/30), 67.74% (21/31) and 61.70% (29/47), and negative predictive value of 96.22% (229/238), 96.62% (229/237) and 100% (221/221), respectively. SPECT/CT enabled precise localization in all 47 cases with 99Tcm-MAA accumulation, including 19 cases in stomach, 5 cases in gallbladder, 19 cases in anterior abdominal wall, 1 case in spleen and 3 cases with anomalous visualization of main portal vein. Among 19 cases with gastric 99Tcm-MAA accumulation, only 1 case detected with SPECT/CT showed focal increased uptake in gastric wall, supplied by gastric branch artery originated from the left hepatic artery and representing true-positive gastric shunting, while the rest 18 cases demonstrated diffuse uptake in gastric mucosa, consistent with false-positive gastric shunting. Conclusion 99Tcm-MAA SPECT/CT before 90Y-SIRT of liver cancer was valuable for evaluating abdominal extrahepatic shunts with high sensitivity, high negative predictive value and accurate anatomical localization. |
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