18F-NaF PET/CT用于监测前列腺癌病情的展望

2015-03-03 cmt 中国医学论坛报

前列腺癌容易出现成骨性转移，但目前主要依靠监测PSA、99mTc-MDP骨扫描、CT，但诊断方法对多发骨转移非常有效，但是在肿瘤进展初期作用有限，而此时治疗有可能达到最佳的效果，因此有必要寻找能早期发现前列腺癌骨转移的手段。 18F-NaF PET/CT是一项针对前列腺癌骨转移比较敏感的检查。其原理是成骨性转移灶能摄取氟化钠18F-NaF，故能鉴别典型良性与恶性病变。与99mTc-MDP

前列腺癌容易出现成骨性转移，但目前主要依靠监测PSA、99mTc-MDP骨扫描、CT，但诊断方法对多发骨转移非常有效，但是在肿瘤进展初期作用有限，而此时治疗有可能达到最佳的效果，因此有必要寻找能早期发现前列腺癌骨转移的手段。

18F-NaF PET/CT是一项针对前列腺癌骨转移比较敏感的检查。其原理是成骨性转移灶能摄取氟化钠18F-NaF，故能鉴别典型良性与恶性病变。与99mTc-MDP进行骨扫描检查比较，18F-NaF PET/CT扫描有着较之高10倍的灵敏性，更高的空间分辨率，并能进行CT解剖定位及三维成像。因此，18F-NaF PET/CT成为早期发现前列腺癌骨转移的有效影像检查手段。目前，18F-NaF PET/CT检查的临床研究大都在进展期骨转移病人中进行。

研究发现，18F-NaF PET/CT检查虽能发现更多转移灶，但并不能改变临床治疗方案。同时发现，某些前列腺癌患者存在18F-NaF阳性灶，但CT扫描上未见骨质密度异常，能否将患者定义为转移，尚需结合其他临床特征判断(如肿瘤级别及大小、PSA水平等)。当氟化钠PET/CT阳性发现越多时，转移性疾病的可信度越高。部分研究者认为，18F-NaF PET/CT可替代99mTc-MDP骨扫描检测前列腺癌骨转移。

然而，现今国内外治疗指南尚将99mTc-MDP骨扫描作为标准的检查技术。由于18F-NaF PET/CT发现疾病进展而改变治疗方案的临床价值尚不明确，因此开展了一些研究以明确18F-NaF PET/CT的价值。如，18F-NaF PET/CT与全身MRI检测前列腺癌复发的Ⅱ期临床试验;18F-NaF PET/CT与传统骨扫描在肺癌、乳腺癌、前列腺癌中早期骨转移诊断中应用;前列腺癌、乳腺癌中18F-NaF PET/CT与SPECT骨扫描的作用;18F-NaF PET/CT在去势抵抗性转移性前列腺癌中重复性及治疗中评效价值(化疗或抗雄激素受体治疗);前列腺癌不同治疗疗效中的18F-NaF变化等。

总之，在转移性前列腺癌治疗快速发展的当下，18F-NaF PET/CT展示出了其临床可行性，尤其是早期转移灶诊断更具临床价值。我们尚需要从18F-NaF PET/CT相应的临床研究及其临床实践中总结出更多的经验，来检测18F-NaF PET/CT能否作为前列腺癌病情监测的有效手段。

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2015-12-09 ms7524819409032184

#病情#

82 0
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2016-02-02 feather89

#PE#

82 0
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2015-05-16 ljjj1053

很不错学习了

158 0
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2015-03-05 chaojitidian

#PET/CT#

94 0
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2015-03-05 ms7514935887898259

#PET#

77 0

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