| Lung cancer is one of the leading causes of cancer-related death in both men and women in our country. Solid tumors, including lung cancer, are known to contain significant areas of hypoxia. So, the hypoxic tissue imaging agent can be accumulated in hypoxic regions.This study is to explore the clinical usefulness of Tc-4,9-diaza-3,3,10,10-tetramethy-ldodecan-2,11-dione dioxime(HL91)for diagnosing lung cancer, predicting and monitoring the chemotherapeutic and radiotherapeutic response, and evaluating patient prognosis in patients with lung cancer. The results will provide scientific evidence that Tc-HL91 SPECT imaging should be routinely applied in patients with lung cancer.Part I The value of Tc-HL91 imaging for diagnosing lung cancer .To evaluate the clinical value of Tc-4, 9-diaza-3, 3,10,10-tetrame-thyldodecan -2, 11-dione dioxime(HL91) imaging in the diagnosis of lung cancer, fifty-one patients with suspected lung cancer underwent thoracic Tc-HL91 planar imaging and SPECT at 0.5 ~1h and 3.5~4h. T(the tumor)/N(contralateral normal lung tissue) value by using SPECT slices was calculated and T/N value in malignant foci was compared with that of benign lesions. Thirty-three patients with lung cancer and eighteen cases with benign lesions were enrolled in this study. The T/N values of benign and malignant lesions at 0.5~lh and 3.5~4h SPECT slices were1.22 ?0. 27, 1. 21 ?0. 37 and 1. 4.1 ?. 29, 1.72 ?.46, respectively, there were significant difference between both lesions ateach time point. T/N value at 3.54h was significantly higher than that at 0.5 1h in the lung cancer group. But there was nosignificant difference among benign lesions. The sensitivity, specificity, accuracy obtained with Tc-HL91 SPECT for malignant lung tumor were 84. 8%, 88. 9% , 86. 3. This preliminary clinical study indicates that Tc-HL91 imaging is an excellent modality in the diagnosis of lung cancer. Tc-HL91 exhibits a good imaging characteristics,especially at 3.5 4h, it is further enhanced by SPECT.Part II Diagnostic value of combination of Tc-HL91 SPECT, CT and measuring tumor markers for lung cancer.To explore the clinical value of combination of three methods including Tc-HL91 SPECT, CT and measuring tumor markers(CEA, CYFRA21-1, NSE) for detecting the lung neoplasm, forty-six patients with suspected lung cancer underwent Tc-HL91 SPECT, CT and measurements of tumor markers within one week. Twenty-six patients were found be with primary malignancy of lung, whereas twenty cases with benign diseases. The sensitivity and specificity obtained with Tc-HL91 SPECT, CT, tumor markers and combination of three methods were 77%, 80%; 96%, 60%; 50%, 60% and 96%, 90%, respectively. The diagnostic efficacy of combination of three methods is superior to any one of three methods. The result implies that the combination of three methods may be the best choice for differentiating benign and malignant pulmonary lesions in current conditions.Part III Correlation between uptake of Tc-HL91 and prognostic factors of lung cancer.The purpose of this study is to investigate the correlation between Tc-HL91 uptake and some prognostic factors of lung cancer. The following prognostic factors were included in this study: gender, age,histological type, grading of tumor with WHO standard, TNM stage, tumor size and patient hemoglobin levels. Thirty patients were enrolled in this study confirmed as primary lung cancers. T/N value using 3.5 4h SPECT slices was calculated. Assessment of correlation between the known prognostic factors of lung cancer and T/N value of Tc-HL91 uptake was performed using non-parametric(KendaH's tau-b correlation) statistical analysis. The result showed that there was no obvious correlation between T/N value and known prognostic factors. T/N value reveals clinically unique information about tumor oxygenation status and may be an independent prognostic factor. Future studies are needed to confirm this result in a larger number of patients with primary lung cancer.Part Predicting chemotherapeutic outcome using...
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