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胃癌是我国常见的消化系统恶性肿瘤之一,患者就诊时常处于中晚期,预后较差,5年生存率不足30%[1]。国家癌症中心最新统计数据显示,中国胃癌的发病率和病死率均位居所有癌症的第3位,2016年中国新发病例约39.6万例,死亡病例约28.8万例[2]。
早期诊断与准确的术前TNM分期对胃癌患者的临床管理至关重要。超声内镜(endoscopic ultrasonography,EUS)、CT、MRI是诊断胃癌的常规影像方法,它们有各自的优势和临床价值,同时也存在一定的局限性。EUS在直接观察胃肠道黏膜病变的同时,还可以清晰显示胃壁的5层结构,其鉴别T1和T2期肿瘤的灵敏度和特异度分别为85%和90%,但EUS的诊断准确率依赖于医师的检查技能,且对远处淋巴结转移和脏器转移的诊断效能较差[3]。增强CT是胃癌术前分期的首选影像检查方法,其优势在于可识别进展期胃癌的胃壁外侵犯,评估邻近脏器的受累情况,但对早期胃癌的诊断效能有限,在鉴别反应性增生淋巴结与转移性淋巴结方面存在困难[4]。近年来,MRI扫描技术不断进步,且其具有无电离辐射的优势,动态增强MRI在胃癌中的应用也逐渐增多,但由于扫描时间长、生理性蠕动容易产生运动伪影等原因,在一定程度上限制了其在临床应用中的普及[5]。
放射性核素显像基于活体组织代谢水平和分子生化水平进行显像,可使用特异性探针示踪体内的分子过程,能够在常规影像检查发现解剖结构变化之前发现病变[6]。近年来,由于PET/CT和PET/MR等放射性核素显像设备以及新型放射性核素药物的不断发展,放射性核素显像在肿瘤的早期诊断、分期、再分期及疗效评估方面显示出独特的优势,从而为胃癌患者临床决策的制定提供了进一步的帮助。笔者就PET/CT分子影像探针在胃癌中的临床应用现状和研究进展进行综述。
胃癌PET/CT分子影像探针的研究进展
Advances of PET/CT molecular imaging probes for gastric cancer
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摘要: 胃癌是最常见的消化系统恶性肿瘤之一,预后较差,准确地诊断及分期对胃癌临床治疗决策的制定具有重要意义。放射性核素显像如PET/CT或PET/MR可以在分子或细胞水平对肿瘤进行显像,在胃癌的诊断、分期、再分期和疗效评估方面提供重要的信息。由于传统的正电子核素示踪剂18F-FDG在胃癌的应用中存在一些局限性,多种新型分子探针逐渐被开发并应用于胃癌诊断中。笔者就PET/CT分子影像探针在胃癌诊断中的临床应用现状和研究进展进行综述。
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关键词:
- 胃肿瘤 /
- 分子探针 /
- 正电子发射断层显像术 /
- 体层摄影术,X线计算机
Abstract: Stomach neoplasm is one of the most common malignant tumor of the digestive system, with a poor prognosis. Accurate qualitative diagnosis and staging are of great value for the formulation of treatment plans for gastric cancer. Radionuclide imaging such as PET/CT or PET/MR can perform in vivo imaging of tumors at the molecular or cellular level, thereby providing important information in the diagnosis, staging, restaging and therapeutic efficacy evaluation of gastric cancer. As some limitations of the conventional positron tracer 18F-FDG in gastric cancer applications still exist, a variety of novel molecular probes have been developed for gastric cancer diagnosis. In this paper, the current clinical application and research progress of PET/CT molecular imaging probes in the diagnosis of gastric cancer are reviewed. -
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DOI: 10.1016/j.omto.2022.11.003.
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