2012-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/645799摘要：骨性肉瘤為最常見的原發性惡性骨頭腫瘤，是一種惡性間葉腫瘤，其癌細胞保有骨性細胞的特性，會製造骨骼間質。近年來因為多重藥物化療使用，加上影像診斷以及開刀技術的進步，初次診斷時無轉移患者之總體存活率可以達到65%，但有轉移患者則降至 10-20%。肺部是骨性肉瘤最常轉移的部位。核子醫學造影有潛力運用在骨性肉瘤的正子藥物有：能呈現活體內葡萄糖的代謝影像的F-18 FDG，及表現骨性細胞活性的F-18 NaF。我們團隊在以往照護骨性肉瘤患者時會遇到下列臨床的困難，本研究目的在評估F-18 FDG 及F-18 NaF PET 對這些問題的助益：1. 在初次診斷時的正確分期可以正確做治療計劃並預測病患的預後，但是傳統平面Tc-99m MDP 骨骼掃描的敏感度和特異度不佳。F-18 FDG 及F-18 NaF PET 的高敏感度和特異度是否能夠做更準確的分期? PET 生物代謝表現和原發腫瘤的生物行為的相關性?2. 對於尚未轉移的骨性肉瘤neoadjuvant chemotherapy 後切下來的組織標本的壞死程度是最重要的預後指標。以(1) FDG 的SUV (standardized uptake value), (2)以動態PET 計算FDG 攝取常數, (3) 加入腫瘤大小改變之因子的Total Lesion Glycolysis (TLG =SUV* Tumor Volume) 做為替代指標來衡量腫瘤在化療後的生物代謝表現及預後預測效益如何?3. 在接受完neoadjuvant chemotherapy 及腫瘤切除/重建手術後，義肢或植入骨在MRI會產生假影，影響局部復發判斷。正子造影較不受假影影響，能否幫忙復發的診斷?4. 在術後追蹤最常見為肺部轉移，X-光電腦斷層發現的病灶可能是感染或轉移，利用骨性轉移病灶的癌細胞會攝取F-18 NaF 的特性，F-18 NaF PET 是否有助於區分轉移或感染病灶?<br> Abstract: Osteogenic sarcoma (OGS) is the most common primary malignant bone tumor. Thecharacteristic feature of OGS in pathology is presence of osteoid within the tumor. Sincethe 1980s, because of the use of multidrug chemotherapy, advanced diagnostic imagingtools, and refined surgical techniques, the overall survival (OS) of OGS patients have beenincreased significantly. For non-metastatic patients, the OS rate is around 65%. But forpatients with metastases, the OS rate can be as low as 10-20%. Potential PET drugs forOGS include F-18 FDG, which represent glycolytic rate of OGS tumors, and F-18 NaF,which reflect active osteogenesis of bone and soft tissue. There are several clinicalproblems which our OGS teammates have encountered during attending OGS patients. Theaim of this study is to evaluate the effectiveness of FDG and NaF PET to clarify thefollowing problems:1. Accurate staging the distant metastases is extremely important in therapy planning andoutcome prediction for OGS patients. Traditional Tc-99m MDP planar whole-body bonescan has low sensitivity and low specificity in detecting small lesions. If FDG and NaFPET can identify occult non-pulmonary metastases in OGS patients?2. Although histologic response (ie, the degree of necrosis induced by chemotherapy beforesurgery) is the most important prognostic factor for event-free survival in patients withOS, several other markers (ie, FDG PET, MRI) have been tried for pre-surgicalevaluation. Which can the best PET predictor of therapeutic response and biologicalexpression of the tumor before and after chemotherapy: SUV (maximal or average)measurement, FDG influx constant measured by dynamic PET(d-PET) or total lesionglycolysis?3. After neoadjuvant chemotherapy and surgical intervention (mostly limb salvageprocedure), the prosthesis and implant artifact in MRI images may interfere the diagnosisof local recurrence. Is PET imaging, which is less interfered by implant, can reduce thisproblem?4. Lung is the most common site of metastases from OGS. X-ray computed tomography(CT) is a sensitive modality in detecting lung lesions. However, the lesions detected byCT are not all metastastic. Some of those could be foci of infection. Can NaF uptake in alung lesion differentiate between infection and metastases from OGS and thus preventunnecessary wedge resection of lung?骨性肉瘤正子照影氟-18 去氧葡萄糖氟-18 氟化鈉分期療效評估復發追蹤Osteogenic sarcomaPETF-18 FDGF-18 NaFstagingtherapeutic response monitoringfollow-up recurrence