- 學位論文
回溯性分析[F-18]FLT正子電腦斷層掃描於頭頸癌患者之生理分布
Retrospective analysis of the biodistribution of 18F-FLT PET/CT in head and neck cancer patients
摘要
頭頸癌中常見的口腔癌位居台灣癌症十大死因多年，正子放射電腦斷層掃描(Positron Emission Tomography/Computed Tomography, PET/CT)對於癌症診斷、分期、與再分期，是目前臨床上應用最廣泛的項目。目前臨床常用的正子藥物仍以[氟-18] 去氧葡萄糖 ([F-18]Fluoro-deoxyglucose, FDG)為主，但其對感染、發炎等易造成偽陽性現象，且缺乏對腫瘤偵測之特異性而有所侷限。不受控制的細胞分裂是惡性腫瘤的特性，[氟-18] 胸腺嘧啶 ([F-18]3’-deoxy-3’fluorothymidine, FLT)已被證實與腫瘤增殖性有關。國內的FLT PET/CT相關研究甚少，本研究旨在於藉由回溯性的分析影像，了解FLT藥物的生理分布，以期提供核醫科醫師判讀影像之參考依據，並且進一步探討年齡與性別是否會影響FLT之吸收。 材料與方法： 回溯性分析50位FLT PET/CT頭頸癌患者之影像，排除參考部位具有疾病之案例，利用後處理工作站GE AW Server 3.2進行標準攝取值(Standard uptake value, SUV)的量測，分別於腦部、肺臟、肝臟、血池、脾臟、肌肉、骨髓、以及腎皮質處圈選關心區(Region of interesting, ROI)，量測體積直徑大小分別為3、3、3、2、2、1.5、1.5及1公分之圓形球體。所有數據皆利用統計產品與服務解決方案(Statistical Product and Service Solutions, SPSS) 20版進行資料統計。透過描述性統計量進行各參考部位SUV的平均值、標準差及變異數計算；利用皮爾森相關係數(Pearson’s Correlation Coefficient)統計年齡與各組織器官SUV的關係性；SUV在不同性別是否有差異之探討則採獨立樣本t檢定(Independent Sample t test)進行分析。 結果： 50位患者平均注射劑量為6.43±1.13 mCi，量測結果SUV的平均值與標準偏差為腦部0.19±0.05、肺部0.27±0.10、肝臟5.31±1.33、血池0.58±0.17、脾臟2.37±1.12、肌肉0.76±0.19、骨髓8.42±2.03以及腎皮質3.69±1.22。最終結果顯示年齡與各組織器官SUVmean之間沒有相關性(腦部r=0.24、肺臟r=0.04、肝臟r=0.06、血池r=0.16、脾臟r=0.14、肌肉r=0.21、骨髓r=-0.05、腎皮質r=0.11)。女性和男性組織器官SUVmean的差異無統計學意義(腦部p=0.22、肺臟p=0.12、肝臟p=0.37、血池p=0.23、脾臟p=0.77、肌肉p=0.82、骨髓p=0.13、腎皮質p=0.27)。 結論： 年齡與性別不同並不會造成FLT攝取的差異。本研究結果，除了能夠了解FLT於正常器官累積的情形、病灶攝取的表徵外，藉由許多的臨床案例探討及實際量化後的數據，期待在未來FLT PET/CT檢查普及後，可提供核醫科醫師在影像上癌症病灶判讀之參考。
並列摘要
Purpose: Among all head and neck cancers, oral cancer is ranked in the top 10 of cancer death in Taiwan for many years. Integrated positron emission tomography/computed tomography (PET/CT) is an advanced imaging tool for the diagnosis, staging, and restaging of cancer. 2-[F-18] Fluro-2-deoxy-D-glucose (FDG) is the most common PET radiopharmaceutical, but false positives for infection and inflammation will decrease its specificity and tumor detection rate. Uncontrolled cell division is a characteristic of malignant tumors, and 3-deoxy-3-[F-18]-fluorothymidine (FLT) has been confirmed to be associated with tumor proliferation. In Taiwan, there is little research on the knowledge of FLT PET/CT. The purpose of the study was to investigate FLT biodistribution by retrospective analysis of PET/CT images, to provide a helpful reference for nuclear medical physicians to interpret images, and to explore whether age and gender affect FLT absorption. Material and method： Retrospective analysis FLT PET/CT images of 50 patients with head and neck cancer, excluding cases with disease in reference organs by using GE AW Server 3.2 to measure standard uptake value (SUV) in brain, lung, liver, blood pool, spleen, muscle, bone marrow and renal cortex with a spheres region of interest of 3, 3, 3, 2, 2, 1.5, 1.5 and 1 cm in diameter, respectively. All data were calculated using statistical product and service solutions (SPSS). Using descriptive statistics to calculate the mean, standard deviation and variance of SUV in different tissues and organs. The correlation with age and SUV were analyzed by Pearson’s correlation coefficient and the independent sample t test was used to investigate whether there are differences in SUV in different genders. Results: The average FLT average injection dose for 50 patients was 6.43±1.13 mCi. The mean and standard deviation of SUV were 0.19±0.05 in brain, 0.27±0.10 in lung, 5.31±1.33 in liver, 0.58±0.17 in blood pool, 2.37±1.12 in spleen, 0.76±0.19 in muscle, 8.42±2.03 in bone marrow and 3.69±1.22 in renal cortex. In the final result, there was no correlation between age and the SUVmean (brain r=0.24, lung r=0.04, liver r=0.06, blood pool r=0.16, spleen r=0.14, muscle r=0.21, bone marrow r=-0.05and kidney cortex r=0.11). There were no statistically significant differences in SUVmean between male and female (brain p=0.22, lung p=0.12, liver p=0.37, blood pool p=0.23, spleen p=0.77, muscle p=0.82, bone marrow p=0.13and kidney cortex p=0.27. Conclusion: Within the results, in addition to understand the accumulation of FLT in normal tissues and the characterization of the uptake values in lesions, through the discussion of many clinical cases and the quantified data, it is expected to provide reference for nuclear medicine physicians in FLT PET/CT images interpretation.