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悪性骨軟部腫瘍の64例に対し,99mTc-MIBI,201Tl,血管造影を施行し,化学療法の効果を判定した.99mTc-MIBI,201Tlのuptake ratioの%reductionと血管造影での評価を病理組織学的評価と比較した.血管造影像で新生血管を消失(CR),減少(PR),不変(NC),増大(PD)に分類し,CRとPRを反応群とした.99mTc-MIBIでは%reduction25%以上を反応群,201Tlでは%reduction30%以上を反応群とした.すべての症例において切除標本を病理組織学的に評価し,壊死率90%以上を反応群とした.感度,特異度,正確度は99mTc-MIBIで86.7%,91.2%,89.1%,201Tlで80.0%,70.6%,75.0%,血管造影で86.7%,38.2%,60.9%であった.悪性骨軟部腫瘍に対する化学療法の効果判定において99mTc-MIBIは最も有用な検査であると考えた.
All 64 patients with malignant bone or soft tissue tumors who were the subjects of this study were examined by 99mTc-MIBI scintigram, 201Tl scintigram, and angiography to evaluate their response to chemotherapy. The percentage reductions in uptake ratios and the changes vascularity assessed by angiography were compared with histological assessments. Based on the angiographic findings the results were assessed as CR (complete response), PR (partial response), NC (no change), or PD (progressive disease). On the images, 99mTc-MIBI≧25%, 201Tl≧30%, and CR/PR in the angiograms were assessed as responders. All tumors were surgically resected, and the therapeutic effect was assessed by histopathological examination of the resected specimen. The tumors of poor responders showed less than 90% necrosis, and the tumors of good responders showed 90% or more necrosis. Sensitivity, specificity, and accuracy were 86.7%, 91.2%, and 89.1%, respectively, for 99mTc-MIBI imaging, 80.0%, 70.6%, and 75.0%, respectively for 201Tl imaging, and 86.7%, 38.2%, and 60.9%, respectively for angiography. The results of this study showed that 99mTc-MIBI scintigram could be effectively used to predict the final response of malignant bone and soft tissue tumors to chemotherapy.
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