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目的探讨符合线路SPECT/CT辅助引导靶区定位技术,在经皮穿刺种植125Ⅰ粒子治疗中心型肺癌并发阻塞性肺不张中的价值。方法选择35例术前CT检查可疑为中心型肺癌导致阻塞性肺不张,但不能分辨肿瘤和肺不张边界的患者,行符合线路SPECT/CT检查,根据采集到的图像勾画肿瘤靶区,将CT图像和SPECT/CT图像输入治疗计划系统(TPS)对病灶进行三维重建,计算粒子数和放射剂量,在TPS下模拟布源,并在CT引导下经皮穿刺植入125Ⅰ粒子,治疗后6个月,根据CT检查比较肿瘤体积,按国际标准判定疗效。结果所有病例经SPECT/CT检查均可清晰显示肿块与肺不张的界限,肿瘤靶区体积平均约为64 cm3,而CT检查的靶区体积平均约为112 cm3,治疗6个月后,完全缓解率+部分缓解率为91.4%,未发生与治疗相关的严重并发症。结论符合线路SPECT/CT检查对于确定中心型肺癌并发阻塞性肺不张肿瘤靶区勾画的价值明显优于CT检查,有利于放射性粒子植入治疗。
Objective To evaluate the value of SPECT / CT-assisted target localization in the treatment of central lung cancer complicated with obstructive atelectasis by 125I seed implantation. Methods 35 patients with suspicious central lung cancer leading to obstructive atelectasis, but unable to distinguish between tumor and atelectasis were selected as the suspicious preoperative CT examination. The patients were eligible for line SPECT / CT examination and the tumor target areas were drawn according to the collected images. The CT images and SPECT / CT images were input into the treatment planning system (TPS) for three-dimensional reconstruction of the lesion, the number of particles and radiation dose were calculated, the cloth source was simulated under TPS, and the 125 I seeds were implanted under the guidance of CT. 6 months, according to CT examination of tumor volume, according to international standards to determine efficacy. Results All cases were clearly diagnosed by SPECT / CT. The volume of tumor target area was about 64 cm3, while the volume of CT target area was about 112 cm3. After 6 months of treatment, Remission rate + partial response rate was 91.4%, no serious complications associated with treatment. Conclusion The coincidence line SPECT / CT examination is more effective than CT in determining the outline of the target area of obstructive pulmonary atelectasis in patients with central type of lung cancer, which is good for the implantation of radioactive particles.