功能代谢闪烁显像靶向技术的优化及在某些难诊治疾病中的应用

发布时间：2018-03-07 15:13

本文选题：靶向诊疗　切入点：功能代谢闪烁显像　出处：《天津大学》2015年博士论文　论文类型：学位论文

【摘要】：如何设计一种能够提高难诊治疾病靶向诊疗敏感度和特异性的方法,是目前疾病诊疗领域急待解决的问题之一。本论文以传统的闪烁显像为基础,应用自行研究的功能代谢闪烁显像(functional metabolic scintigraphy,FMS)的靶向诊疗优化技术,构建出提高诊疗效能的系列方法,并成功应用于临床。1)无创门控心脏FMS诊断隐匿性冠心病(LCHD)。LCHD极易被误诊,为此本文采用无创门控心功能和心肌血流FMS的靶向诊断技术,筛选出对LCHD有确诊价值的心脏舒缩功能参数,并应用协方差分析消除年龄干扰。结果表明,通过联合应用负荷和静态心肌断层FMS成像可以提高诊断的特异性和准确性,应用门控心血池FMS成像以及整体/局部左心室的泵功能参数分析,可提高诊断的灵敏度。尤为重要的是:揭示发现了LCHD心脏生理功能的变化特点。2)脑血流灌注FMS定位诊断致癫病灶。本研究应用脑血流灌注FMS的靶向断层技术,检测大脑皮质组织局部血流灌注量的变化信息和特征,以γ刀治疗癫痫患者后长期随访的临床结果作为确诊癫痫的金标准,将公认的“癫痫发作是否停止”作为诊断试验的阈值,对脑血流灌注FMS靶向定位癫痫病灶进行诊断试验和评价。结果表明,脑FMS对致癫病灶的定位,具有靶向诊断的敏感性和准确性高的优势,可为药物难治型癫痫的外科手术或立体定向放射外科的治疗,提供致癫病灶定位的影像学依据。3)无创肝胆功能FMS诊断反流性胃炎。常规应用有创检查诊断反流性胃炎,常有假阳/阴性。为此本研究应用无创肝胆FMS诊断该病。在影像数据采集过程中贯序应用“生理介入和标记靶向器官”等优化技术。以病理诊断为依据,进行FMS诊断试验和ROC分析。结果显示它能准确诊断胆汁反流性胃炎,具有显著提高靶向诊断效能的特点。另外,本研究证实:反流性胃炎患者的胆囊排泌功能无明显减低;但幽门螺旋杆菌感染,可导致幽门括约肌功能异常,进而可能是反流性胃炎发生的主要机制之一。4)FMS等多模态影像引导125I粒子治疗非小细胞肺癌(NSCLC)。如何能有效治疗有手术和放化禁忌症的NSCLC是一个难题。为此本文应用自行研究的FMS在内的多模态显像方法参与125I粒子治疗的全过程,CT、18F-FDG符合线路FMS和纤维支气管镜(FFB)进行靶区定位;应用治疗计划系统(TPS)制定方案并进行放射剂量学的优化,以剂量—体积直方图(DVH)等评估TPS;影像引导粒子植入,并进行实时位置验证、植入后剂量学验证、疗效判定和随访。结果显示,通过组织密度影像靶区和生物靶区的明确界定,能够保证治疗的靶向性和适形性;应用包括放射剂量学优化在内的质量保证和质量控制(QA/QC)手段,能够明显提高治疗增益比和局部控制疗效,进而显著降低毒副作用的发生。
[Abstract]:How to design a method to improve the sensitivity and specificity of target diagnosis and treatment is one of the urgent problems in the field of disease diagnosis and treatment. This paper is based on the traditional scintillation imaging. A series of methods to improve the diagnostic and therapeutic efficacy of functional metabolic scintigraphy (FMS) were established by using self-developed functional metabolic scintillation imaging (FMS), and successfully applied to clinic. 1) Non-invasive gated cardiac FMS in the diagnosis of occult coronary heart disease was easy to be misdiagnosed. In this paper, the noninvasive gated cardiac function and myocardial blood flow FMS were used to screen the cardiac systolic and diastolic function parameters of LCHD, and the covariance analysis was used to eliminate the age interference. The specificity and accuracy of diagnosis can be improved by combined use of load and static myocardial tomographic FMS imaging, gated blood pool FMS imaging and pump function parameter analysis of whole / local left ventricle. It can improve the sensitivity of diagnosis. It is especially important to reveal the changes of cardiac physiological function of LCHD. (2) Cerebral blood flow perfusion FMS is used to localize the epileptic lesions. The aim of this study is to use the target tomographic technique of cerebral blood perfusion FMS. The changes and characteristics of regional blood flow perfusion in cerebral cortex were detected. The long-term follow-up results of patients with epilepsy treated with 纬 -knife were taken as the gold standard for the diagnosis of epilepsy. The diagnostic test and evaluation of epileptic foci targeted by cerebral blood flow perfusion (FMS) targeting the epileptic foci were carried out using the accepted threshold of "whether the epileptic seizures stop or not". The results showed that brain FMS could locate the epileptic foci. It has the advantage of high sensitivity and accuracy in targeted diagnosis. It can be used as surgical treatment for refractory epilepsy or for stereotactic radiosurgery. Provide imaging basis for location of epileptic foci. 3) Non-invasive hepatobiliary function FMS for diagnosis of reflux gastritis. Routine invasive examination is used to diagnose reflux gastritis. In this study, noninvasive hepatobiliary FMS was used to diagnose the disease. In the process of image data acquisition, optimization techniques such as "physiological intervention and tagging target organ" were used in sequence. The results of FMS diagnostic test and ROC analysis showed that it could accurately diagnose bile reflux gastritis and had the characteristics of significantly improving the efficacy of targeted diagnosis. In addition, this study confirmed that the gallbladder excretion function of patients with reflux gastritis was not significantly decreased. But Helicobacter pylori infection can lead to abnormal function of the pyloric sphincter. It may be one of the main mechanisms of reflux gastritis. 4FMS and other multi-mode image-guided 125i seed therapy for non-small cell lung cancer (NSCLC). How to effectively treat NSCLC with surgery and chemotherapeutic contraindication is a difficult problem. The self-developed multimodal imaging including FMS was involved in the whole process of 125I seed therapy. CT-18F-FDG was consistent with line FMS and fiberoptic bronchoscopy to locate the target area. The treatment planning system (TPS) was used to formulate the scheme and optimize the radiation dosimetry. The TPSs were evaluated by dose-volume histogram (DVH), and the particle implantation was guided by the image, and the real-time location was verified, the dosimetry was verified after implantation. The results showed that the targeting and conformability of the treatment could be ensured by the clear definition of the target and biological target in the tissue density imaging, and the quality assurance and quality control including the optimization of radiation dosimetry were used to ensure the targeting and conformability of the treatment. It can significantly improve the therapeutic gain ratio and local control effect, and then significantly reduce the occurrence of side effects.
【学位授予单位】：天津大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R445.9

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