摘要
目的探讨基于SPECT/CT的多模态融合影像实时引导经皮胸腔穿刺活组织检查（PTNB）技术，并测试其临床可行性及安全性。方法2016年3月至6月12例临床疑诊恶性病变的胸部肿块患者行99Tcm－甲氧基异丁基异腈（MIBI） SPECT/CT引导下PTNB，其中男7例、女5例，平均年龄（59.2±13.2）岁。根据术前影像进行体位设计后行SPECT/CT显像，以具有安全穿刺路径的最大浓聚区作为取样靶区。同机CT扫描与^99Tc^m－MIBI SPECT进行融合，以逐步引导活组织检查（简称活检）针到达最大浓聚取样靶区，取样送病理。记录病理结果、总检查时间、活检操作时间、并发症及CT辐射剂量。结果11例患者活检针均能准确到达最大浓聚部位，1例患者无明显放射性摄取病灶，按常规PTNB原则进行取样。所有取样均获得足够量组织样本，12例患者均获得明确诊断（11例恶性病变，1例炎性病变）；患者无严重并发症发生。12例患者平均总检查时间（74.3±10.4） min，活检操作时间（33.5±9.1） min；整个检查过程CT有效辐射剂量平均为（6.1±1.7） mSv，其中因CT引导操作产生的剂量为（2.2±1.0） mSv，占总剂量的36%。结论基于SPECT/CT的多模态融合影像实时引导PTNB安全可行。
ObjectiveTo investigate a real-time imaging guided percutaneous transthoracic needle biopsy （PTNB） for thoracic masses with SPECT/CT.MethodsFrom March to June 2016, a total of 12 patients （7 males, 5 females; average age： （59.2±13.2） years） with thoracic lesions suspicious for malignancy underwent ^99Tc^m-methoxyisobutylisonitrile （MIBI） SPECT/CT-guided PTNB. The hot spot areas were chosen from the thorax ^99Tc^m-MIBI SPECT/CT images as the sampling targets. Subsequent guiding CT scans were repeatedly fused with the prior SPECT images to realize the real-time guiding of the biopsy needle puncture step by step, until reaching to the target margin. Masses were sampled after confirming that the needle tips reached planned areas. Pathological results, total time of examination, time of PTNB procedure, complication, CT radiation dosage were recorded.ResultsBased on 99Tcm-MIBI SPECT/CT results, biopsies targeted the most suspicious areas within lesions. All biopsy procedures yielded diagnostic results. Eleven patients had positive results of malignancy, and 1 patient with inflammation. There were no severe complications. Total time of examination was （74.3±10.4） min, and （33.5±9.1） min for PTNB. Radiation dosage of CT was （6.1±1.7） mSv, 36% of which was caused by CT-guiding （（2.2±1.0） mSv）.ConclusionMultimodal of SPECT/CT fusion imaging is useful for thorax biopsy planning and guiding, and can increase overall performance of safety and feasibility.
作者
赵艳军
倪建明
唐平
华茜
Zhao Yanjun;Ni Jianming;Tang Ping;Hua Qian(Department of Nuclear Medicine, Wuxi Second Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China)
出处
《中华核医学与分子影像杂志》
CAS
北大核心
2018年第4期238-242,共5页
Chinese Journal of Nuclear Medicine and Molecular Imaging
