| Japanese |
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| Title | 201Tlによる骨軟部腫瘍描出能およびそのviabilityの評価 |
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| Subtitle | 原著 |
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| Authors | 津田隆俊*, 久保田昌宏*, 吉田悟**, 柴田雅仁**, 若林淳一***, 小幡宏之****, 松山敏勝****, 薄井正道****, 石井清一**** |
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| Authors(kana) | |
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| Organization | *手稲渓仁会病院放射線科, **札幌医科大学放射線科, ***病理診断部, ****整形外科 |
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| Journal | 核医学 |
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| Volume | 31 |
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| Number | 12 |
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| Page | 1477-1494 |
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| Year/Month | 1994/12 |
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| Article | 原著 |
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| Publisher | 日本核医学会 |
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| Abstract | 「要旨」骨軟部腫瘍症例50例を対象とし, 201Tlシンチグラムによる腫瘍描出能および腫瘍のvascularityおよびviabilityの評価に関する検討を, 99mTc-HMDP骨シンチグラム, 67Gaシンチグラム, 血管撮影像および病理組織像と比較して行った. 全例に血管撮影が施行され, 大腿部動静脈瘻の1例を除く病巣は手術もしくは生検にて腫瘍組織診断が病理組織学的に確定された. また, 50症例のうち14例は術前の全身化学療法もしくは経動脈的治療が行われ, その前後で上記検査による腫瘍像の変化と術後の病理組織学的抗腫瘍効果判定とを比較した. 201Tlは正常隣接組織への集積は認めず, 腫瘍描出能に優れ, その腫瘍集積パターンは骨シンチグラフィの動脈相の集積パターンに類似し, 201Tlシンチグラフィが施行された悪性腫瘍28症例の96% (27/28) に腫瘍集積を認めた. さらに, 術前に化学療法が施行された14症例の検討では, その腫瘍集積性と血管撮影像による抗腫瘍効果判定が病理組織学的壊死率判定とよく一致し, 炎症を伴う壊死組織や線維組織への集積は認めなかった. 201Tlの腫瘍集積性は, 腫瘍内新生血管, 早期静脈灌流, 動静脈短絡および腫瘍濃染と関連し, 腫瘍のviabilityを良好に表現していた. 一方, 骨シンチグラフィの血液プールおよび遅延像でみられた隣接正常骨の集積は壊死率が90%以上の5症例ではその集積の低下を認めた. 201Tlは骨軟部腫瘍のvascularityおよびviabilityを描出するものと考えられ, 特に, 腫瘍の増大および壊死に伴って生ずる腫瘍に関連する微細な腫瘍血管の増減を正常血管の変化とは区別して表現するものと考えられた. |
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| Practice | 臨床医学：一般 |
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| Keywords | Bone and soft-tissue tumor, 201Tl scintigraphy, Vascularity, Viability |
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| English |
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| Title | 201Tl Scintigraphic Evaluation of Tumor Mass and Viability of Bone and Soft-Tissue Tumors |
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| Subtitle | Original Articles |
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| Authors | Takatoshi TSUDA*, Masahiro KUBOTA*, Satoru YOSHIDA**, Masahito SHIBATA**, Jun-ichi WAKABAYASHI***, Hiroyuki OBATA****, Toshikatsu MATSUYAMA****, Masamichi USUI****, Sei-ichi ISHII**** |
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| Authors(kana) | |
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| Organization | *Department of Diagnostic Radiology, Teine-Keijinkai Hospital, **Department of Radiology, ***Division of Clinical Pathology, ****Department of Orthopedics, School of Medicine, Sapporo Medical University |
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| Journal | The Japanese Journal of nuclear medicine |
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| Volume | 31 |
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| Number | 12 |
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| Page | 1477-1494 |
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| Year/Month | 1994/12 |
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| Article | Original article |
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| Publisher | THE JAPANESE SOCIETY OF NUCLEAR MEDICINE |
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| Abstract | [Summary] To characterize 201Tl uptake in patients with bone and soft-tissue tumor, we studied 49 patients with surgically proven tumors and one patient with a tumor diagnosed arteriographically. In 37 of our 50 patients, the tumor was evaluated with 201Tl and arteriography. Moreover, in 14 of patients with pre-operative chemotherapy, pathologic changes were graded on the basis of percent tumor necrosis as defined histologically. The percent tumor necrosis histologically was compared with changes in the scintigraphic and conventional angiographic studies. Radiologic comparisons demonstrated a high degree of correlation with images of 201Tl and both arterial and blood pool phase of 99mTc-HMDP. Ninety-six percent of 28 malignant tumors had positive 201Tl uptake. None of the patients showed any thallium accumulation in the soft tissues or skeleton adjacent to the lesion. Activity of 201Tl was mainly dependent upon a tumor blood flow and a vascular density. In of 14 cases with the preoperative chemotherapeutic treatment, 201Tl scintigraphic changes showed concordance with % tumor necrosis. Thallium-201 was superior to 99mTc-HMDP in predicting tumor response to chemotherapy. Interestingly, delayed images of 99mTc-HMDP of 5 responders with >90% tumor necrosis showed decreased uptake in the adjacent bone to the tumor mass lesions. It seems to be quite all right to consider that a major determinant of 201Tl uptake is intratumoral angiogenecity, which is closely connected with tumor viability. Therefore, 201Tl is a sensitive radiopharmaceutical for detection of vascular rich bone and soft-tissue tumors, and appears to be a simple and an accurate test for evaluating the response to specific therapeutic regimens of malignant bone and soft-tissue tumors. |
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| Practice | Clinical medicine |
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| Keywords | Bone and soft-tissue tumor, 201Tl scintigraphy, Vascularity, Viability |
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