Y Hge VigT NAIVI T H A N G t • S 6 1/2012
llNG DUNG KY THUAT CHUP PET/CT TRONG CHAN OOAN B | N H U LYMPHO AC TiNH KHONG HODGKIN (NON HODGKIN LYMPHOMA)
Mai Tr^ng Khoa*
T 6 M TAT
M^lc Ueu. l.Odnh gia d$c diem hinh dnh PET/CT cua u lympho ac tinh khong Hodgkin (Non Hodgkin Lymohoma). 2. Ddnh gia gia tn ciJa PET/CT trang xdc djnh giai do?n b^nh u lympho dc tinh khong Hodgkin.
Doi tutfitg ngiiien ciitr. 21 b^nh nhSn d3 du^c chSin dodn xdc djnh Id u lympho dc tinh khfing Hodgkin bSng giai phau b?nh duttc chyp PET/CT tir 6-2010 den 6-2011 t?i TT YHHN vd UB BV B?ch Mai. KSt qua nghien cihi:l.D^ di^ hinh anh f^T/CT oia bdnh nhan u lympho ac b'nh /ch3ng Hodgkin: PET/CT xdc djnh ton thuUng tai 16 vi tri, trong d6 hay g$p nhat la hach c6 (33,3%), h?ich trung thSt (28,6%), hach 6 byng (23,8%), h?ch ndch (14,3%), cac vi tri cdn lai c6 ti le gdp thap hdn. Gia tn hSp thu FDG (max SUV) d cdc ton thuUng: cao nhat d nao (15,24), h§u nhSn dSu (11,35), tuyen thu'dng thdn (11,34), da (11,04), cac vj tri khac CO gid tri WiSp hOn. Gia trj hap thu FDG tnjng binh cua nhom co dp ac tfnh trung binh (WF4-7): la 9,92-15,33 cao hdn so vdi nhom cd dp ac ti'nh thap (WF2-3): 6,23-7,18. 2. Gii tri cua PET/CT tmng xac dinh glal doan benh u lymf^o ic b'nh Ichong Hodgkin.
Tnr6c chup V^fcy-. benh nhan d giai doan I I : 38,1%
va n i : 33,3%, I: 23,8% va IV: 4,8%. Sau chup PET/CT: tSng ty le benh nhan d giai doan III len 47,6% va IV len 9,6%, giam so benh nhan giai doan II con 28,5% va I cdn 14,3%. Ket qua PET/CT da lam thay doi glai doan d 5/21(23,8%) benh^ nhan. Ket lu$n: PET/CT dac biet co gia tri de chan doan giai doan benh tn/dc dieu tri trong u lympho dc tfnh khong Hodgkin, giup cho viec iuTa chpn phu'dng thu'c dieu tri hdp ly nhat va dem lai hieu qua dieu tri cao nhat cho benh nhan,
SUiVtMARY
PET/CT APPLICATION IN THE DIAGNOSIS OF NON HODHKIN LYMPHOMA Purposes: 1. To evaluate the specificity of PET/CT in initial diagnosis of Non-Hodgkin's lymphoma. 2. To assess the value of PET/CT scan in staging Non-Hodgkin's lymphoma. Subjects: We enrolled 21 patients diagnosed Non-Hodgkin's lymphoma (histopathology confirmed) from June 2010 to June 2011. All the patients have been underwent PET/CT in The Nuclear Medicine and Oncology center, Bach Mai hospital. Results: 1. Specificity of PET/CT in Non-Hodgkin's lymphoma: PET/CT revealed lesions in 16 positions, most common were: neck lymph nodes
* Trung tSm Y hoc hat nhin va Ung bUdu-B§nh viSn Bach Mai Phan bl^ khoa hoc: GS.TSKH. Phan Sy An
(33,3%), mediastinal lymph nodes (28,6%), abdominal lymph nodes (23,8%), axillary lymph nodes (14,3%), and a lower percentage for other positions. FDG uptake (SUV max) of the lesions: brain tissue (15,24), post-ocular (11,35), adrenal gland (11,34), etc. WF4-7 group has average SUV of 9,92-15,33 which is higher than WF2-3 group (6,23-7,18). 2. The value of PET/CT scan in staging Non Hodgkin's lymphoma: PET/CT scan changed the stage of 5/21 (23,8%) patients.
Conclusion: PET/CT is very useful in initial diagnosis and staging Non Hodgkin's lymphoma. Overall survival benefit and patient quality of life during and after treatment may also be optimized with tailored therapy defined by more accurate staging with PET/CT.
I.
DAT VANo f
Benh u lympho dc tfnh khong Hodgkin (Non Hodgkin Lymohoma) la mpt trong hai nhdm benh ac tinh cua te IMO lympho (benh Hodgkin vd u lympho dc ti'nh khong Hodgkin), mot trong mu'di benh ung thU pho bien d nhieu nude tren the gidi. 6 Viet Nam benh co ty le mac chuan theo tuoi la 5,2/100.000 dan va dijftig hdng thir 7 trong cac loai ung' thu" thu'dng gap. Neu benh du'dc phat hien sdm vd dieu trj dung phu'dng phdp ngay tHr dau thi khd nang chiici khdi rat cao hoac thdi gian benh on djnh cung keo ddi trong nhieu ndm.
Ddnh gia chinh xdc giai doan benh cd y nghTa quyet djnh den viec liTa chpn phu'dng thu'c dieu tri va ket qud dieu tri. Hien nay viee danh gia giai doan benh u lympho ac tfnh khong Hodgkin ehu yeu duci vao chyp cat ldp vi tinh, cpng hu'dng tir nhu'ng cac phu'dng phdp ndy ehl phat hien nhOhg hach Idn hdn l e m va khong danh gid du'dc tinh chat eua hach. Trong nhDhg nam gan day ky thuat PET/CT du'dc uhg dung d Viet Nam da dem lai rat ntiieu ldi I'eh trong chan dodn benh, dac biet la cac benh Iy ung thu". Chup PET/CT toan than vdl 18F-FDG ket hdp hinh anh chuyen hod, chu'c nang d mure do phan tu', te bao cua PET vdi hinh anh ve glal phau, cau true ciia CT cho kha nang phat hien chfnh xac vj tri cac hach benh ly cDng nhu' mu'c dp lan rpng cua benh vdi dp nhay va dp dae hieu cao hdn han cae phu'dng
phip chin doin hinh inh thSng thudng.
Trin th§ gl6i dS cd nhDng nghlSn ciru vS gii tr| cOa PET/CT trong chin doin b$nh ly u lympho ic tinh khdng Hodgkin. T?l V l ^ nam, chgp PET/CT mdi duljc tnen khai trong vii nim trd l^il diy t?l m^t s8 cd sd y tS Idn nhutig cho din nay chua cd nghiin ciu nio dinh gii v l gii tr| ciia PET/CT trong chin doin, xie d|nh glal do?n trong b|nh ly u lympho ic tinh khfing HodgWn. VI vjy diOng l£l tIStt hinh d l tM niy nhim muc tHu:
1. Xie a/nh mdt sd die itim hinh inh PET/CT cia u lympho ic tinh khdng Hodgkin.
2. Oinh gii gti trt cda PET/CT trong xie dlnh glal do^n bfnh u lympho ic Unh khdng Hodgkin,
11. o 6 l TUQNG VA PHUONG PHAP N G H I I N COU
1.061 tiling nghien cihi: 21 blnh nhin (BN) d i dutjc chin doin xie dlnh li u lympho ic tinh khong Hodgkin bSng kS qui glai phiu b|nh, dul?c chgp PET/CT de chin doin giai doan trade dieu tri.
2. Phirong phip nghiin culi.
ZLThlSikSnghiin ciiti: nghien ciixi dieh te hpc mo t i hoi cCru va tien eu'u.
2,2. Qui trinh Itfi thuit.
+ Du'dc chat phdng xa: Dung djch F-18 FDG (2-fluoro-2-deoxy-D-glucose), lieu diing 0,15 - 0,20 mCl/Kg can ning (7 -12 mCi).
+ Chuin bi b|nh nhan: theo quy trinh danh rieng cho blnh nhan chuan bj chup PET/CT
+ Chup hinh PET/CT (cua hang Siemen):
Y HOC VI$T NAM THANO 8 • 86 1/2012
tiln hinh sau tllm F-18 FDG 45 - 60 phut + XiJ iy hinh inh v i nhin djnh kit qui: KS qui duljc phin tich, dinh gii v i duS ra nh§n d|nh cu6i ciing sau khi khio sit hinh inh CT, hinh inh PET, hinh ISng ghdp PET/CT v l d'nh diS hip thu, phin bS ho?t chat phdng x? F-18 FDG.
Cic chi sS djnh tfnh nhu kich thuCc, the tfdi oia t^n thu'dng, ty tnjng v i dlnh lu^ng qua chi s5 hip thu ho^t chit phdng x? chuin (Standard uptalie value : SLW) duijc do - tfnh cho mil tSn thuBng dS kit hdP dinh gii kit qua cuoi eiing.
Z3. Xip lofl gliiphSu bfnh vi phtn hfl gitiaafn bfnh tnA»c vi sau chfip PCT/CT
a. T n / f c chgp PET/CT: tSt c i cic b|nli nhin trong nghiin cOm dutdc xlp k>al glil phSu b|nh v i chin doin glai do^n b#nh.
+ Xlp ioai glil phiu blnh theo Hudng dSn thUc hinh iim sing (WF-woridng formulation) tir WFl din WFIO vdl dO ac d'nh thip (WFl, WF2, WF3), d§ ie tinh trung binh (W/F4, VKF5, WF6, WF7), dO i c tinh cao (WFB, VI/F9, WFIO).
+ Phan ioai glai doan benh theo hi thong Ann Bornor, gom 4 glal do?n 1; 2; 3; 4.
b. Sau chvp PET/CT: Blnh nhan du^c phin iai giai do^n b|nh theo so luting v i vi tri cic t&i thutJng du^e xie dinh tren hinh inh PET/CT.
2,4. Thin gian tri dja dl&n nghlSn ahi:
tir thing 6 nim 2010 den thing 6 nim 2011 tai Trung tam Y hge h^t nhin va Ung bUdu - BInli vi|n B?ch Mai.
25, MlYsS»$u: bSng pten man Slala lOA
III. KET QUA NGHIEN COU
1. Tuoi v i gidi cua doi tUdng nghien cihj (DTNC)
DTNCNam
Nir
Chunqn 12 9 21
Tv le (%) 57,1 42,9 100
Tu^l trung binh 54,8 55,6 55.1
Tuoi nhd nhSit 13 19
TuSl Idn nhit 81 86 Nh$n xit: Tuoi trung binh eua doi lu'dng nghien ciru Id 55,1. Ty le nam/nu" la 4/3, Benh nhan nhd tuoi nhat la 13, benh nhan Idn tuoi nh§t Id 86.
2. Xlp lo^i g i i i phSu b|nh
Bing 2: Loai mo tKnh hoc ciia doi tUdng nghien eifu Loal md blnh h^c
WF2 WFB WF4 WF5 WF6 WF7 Tonq
Blnh nhan 1 2 1 3 5 9 21
T v l K W
4.8
9.5
4,8
14.3
23.8
42,8
100
Y Hpc VigT NAM THANG 6 • SO 1/2012
Nhfn xit: Kit qui eho thiy 21 b|nh nhin cd cic lof I giii ph3u b|nh tU WF2 din WF7 trong dd nhdm b|nh nhin cd dp ic ti'nh trung blnh gip nhilu nhit (85,7%), s8 edn 1^1 l i nhdm cd dd ic tinh thip, khong gip b|nh nhin nio thuOc nhdm ed dp ie tfnh cao.
3.0$c dlSm cic tSn Vtaianq phit hifn trin PET/CT Bing 3. SS luang v i vi tri eic ton thuOng
S I I 1 2 3 4 5 6 7 8 9 10 11 12 13 14 IS 16
VI trl ten thuung Hach CO Hach trunq that Hach 6 bunq Hach nich XuUng Hach ben Ph«i Da NSo Hau nhan <Su Th^nh vdm /\mydai Hoc mui Gan Tuyen thUpng th§n Mang cling
56 blnh nhin c6 tSn thUdng ( n = 2 1 ) 7
6 5 3 3 2 2 2 1 1 1 1 1 1 1 1
Tv I I ( % ) 33,3 28,6 23,8 14,3 14.3 9,5 9.5 9,5 4,8 4,8 4.8 4,8 4,8 4,8 4.8 4.8
Nhin xit: Trin hinh chup PET/CT xie dlnh duBc ton thUdng tai 16 vj tri, trong dd gip nhieu nhit l i hach co p3,3%), hach trung thit (28,6%), liaeh o bung (23,8%), hach nach (14,3%), ton thudng tham nhiem xUdng (14,3%), cac v| tri con iai vdi ti II gip thap hdn.
4. Gii tri *iSv thu FDG (max SUV) theo vj tri tdn thu'dng Bing 4: Gia tri max SUV theo vi tri ton thudng
Vj trf t£n thu'dng Hach CO Hach trung that Hach 6 bung Hach nach XutJnq Hach ben Phoi Da Nio H§u nhan c^u Th^nh vom /\mvdal Hoc mui Gan Tuyen thUdnq than Tuy sonq
Gia trj max SUV trung binh
9,01 7,47 10,45 4,35 6,54 3,02 6,57 11.04 15,24 11,35 5,69 10,62 7,43 5,37 11,34 9.77
Gii trj max SUV thSp nhat
2,50 2,80 4,08 1,54 2,68 2,84 1,69 10.62
Gia trj max SUV cao nhat
18,12 24,74 3414 9,63 11,52 3,19 12,33 13.27
/Vfta/7 jref; Gid trj hap thu max SUV trung binh cua cdc vj tri ton thu'dng: cao nhat d nao (15,24), vung hau nhan eau (11,35), tuyen thu'dng than (11,35), da (11,04), tiep theo la hach 6 bung (10,45), hach CO (9,01), hach trung that (7,47), ton thu'dng d cae vj tri eon lai co mirc hap thu FDG thap hdn.
5. Gii trj max SUV cua ton thu'Ong theo loai giii phau blnh BingS.'Gia tri max SUV ciia ton thUdnq theo ioai qiai phau benh
So benh nhan fn=21)WF2 1
WF3 2
WF4 1
WF5 3
WF6 5
WF7 9
Y Hpc VI$T NAM THANG 8 • 36 1/2012 Sd ludno hach
Max SUV trunq blnh SD Max SUV t h i o nhit Max SUV cao n h i t
7 7.18 4,07 4,30 10,50
15 6,23 2,93 4,15 8,30
4 9.92 5,44 6,53 16,80
7 10,21 9,70 4,80 24,74
18 15.33
0,85 14,55 16,10
38 11,83
5,23 8,44 18,10 waxsuv caonnat I lu.su i p.ju i io,ou i ^•*,i-^ i ^Q.**^ I *°'*W I Nhfn xit: Gii tri hip Uiu max SUV trung binh cCia cdn nhdm b|nh nhin cd d$ ic tfnh trang blnh: WF5; 10,21; WF6: 15,33; WF7; 11,83, cao hdn hSn so vdi nhdm od d? i c Hnh tfiip: WF2: 7,18;
VI/F3; 6,23; WF4: 9,92.
6. Phin lof I glal do^n b^nh tru'dc vi sau chgp PET/CT 6.1 JUrtfc chyp PET/CT:
Cic doi tUdng nghiin cuU dude phin giai do?n theo h i thdng Ann Arbor di/a vio kit qui chup CT hoic c^ng hudng tir.
Bing 6: Phin ioai giai doan blnh trUdc khi chup PET/CT Glal doan
n-21 Ty II %
Glal doan I 5 23,8
Glai doan I I 8 38,1
Glal doan i n 7 33,3
Glal doan IV 1 4,8 Nh^n xifTriidc kU\ chyp PET/CT c6 8 b^nh nhdn (38,1%) d giai doan U, 7 b#nh nhan (33,3%) d glal do^n III, 5 b^nh nhdn d glai do^n I (23,8%) vd 1 b^nh nhdn d giai doan IV (4,8%).
e.2. Sau chyp P£T/CT:
Cdc b^nh nhan duV;fc phdn Igi glai dogn d i ^ vdo so lu'dng vd vj tri cdc t6n thudng dudc xdc dlnh tren hinh dnh PET/CT so vdl V.^ qud tru'dc chyp PFT/CT:
- 2 b|nh nhan d giai dogn I phdt hl^n thSm hach vd ton thuang n ^ cd quan khde phia cd hodnh chuyen len glai doan III.
- 2 benh nhan d glal doan II phat hien them ton thu'dng hgch, ton thu'dng mpt od quan Ichde ph^
cd hoanh chuyen thdnh giai doan III.
- 1 benh nhan glai doan HI phdt hi#n thSm t6n thu'dng tham nhilm mot s5 od quan ngoai hach ehuyen len giai doan IV.
Bing 7: Phan ioai qiai doan b l n h sau chup PET/CT n=21
TV le %
Glal doan I 3 14,3
Giai doan n 6
28,5
Giai doan m 10 47,6
G l a i d b a n l V 2 9.6 Nh$n xit: Sau khi chup PET/C tdng so b?nh nhan d giai doan i n len 47,6%, d giai dogn IV len 9,6%, giam so benh nhan d giai doan II eon 28,5% vd glai dogn I eon 14,3%.
IV. BAN LUAN
Trong so 21 benh nhan trong nghien cu\j eua chung toi, do tuoi trung binh ciia benh nhan la 55,1 tuoi, trong dd nhom >40 tuoi chiem ty le cao (69,9%); ty le mdc benh d nam/nij la 4/3 (bdng 1). Ket qud ndy cung phu hdp vdi cdc nghien eihj eua eae tdc gid trong va ngodi nuide, benh u lymphoma dc cd ty le mdc eao d dp tuoi
>50, nam gdp nhieu hdn ni? [1, 2, 3].
Ve xep loai gidi phau benh, ket qud nghien ciJru cho thay: chili yeu benh nhan cd do ae tinh trung binh, trong dd WF7 eo ty le cao nhat (42,8%), tiep theo la WF6 (23,8o/o) va WF5 (14,3%); nhom co dp ac tmh thap chiem ty le thap hdn, khong co benh nhan ndo thuoc nhom cd dp dc tinh cao (bang 2). Ket qua cua chung toi cung phii hdp vdi ket qua nghien eihj cua
Bach QuSc Khdnh vd cs [2], logi WF6 vd WR chiem ty le eao nhat (82,9%).
Mpt trong nhut>g diem manh cua PET/CT la cd the phat hi§n du^c tat cd cac ton thuWng trong cd the chi trong mpt lan chup. Ton thuWng hach la tri^u chutig pho bien nhat cua u lympho dc tinh khong Hodgkin. Ngoai hach, PET/CT cte cd the phdt hien dUdc cac ton thu'dng d xUtfng, phoi, nao, gan, Idch.... 21 benh nhan trong nghien cu\i eiia ehung toi, PETICT da phdt hi?n du'dc ton thu'dng d 16 vj trf. Vi tri gdp nhieu nhat Id cdc ton thu'dng hgch: hach co (33,3%), hach trung that (28,6%), hach 6 bung (23,8%), hach ndch (14,3%). Ngoai vj tri ke tren VETjCT con phat hien eac vj tri ton thu'dng d xu'dng, phoi, nao, hau nhan cau, hoc mui, tiianh vom, amydal, phan mem thdnh ngy'c, thdnh bung, gan, tuyen
28
Y HQC VigT NAM T H A N G 6 - S 6 1/2012 thu'dng than va tuy song nhutig vdi t y IS thSp
hdn (bang 3). Ty l | u lympho tai hach gdp d 18/21 benh nhan (chiem 85,7%) vd u lympho ngoai hgch la 3/21 (14,3%).
TSng sir dung glucose td ddc tfnh cua u lympho dc tinh. Chinh tfnh chSt tdng c h u y i n hod mgnh glucose cua cdc ton thuUng tnsng u lympho dc tfnh khong Hodgkin da giup PET/CT trd thanh cong cu rSt ed gia trj trong chSn dodn, d^e bi^t trong phdn giai dogn b^nh, ddnh gid ddp utig dieu t n vd tien lutfng benh. Cde u lympho ed do ac tfnh cao thu'dng hap thu FDG mgnh hdn logi cd dp dc tfnh thap. Trong nghiSn cu'u cua chung toi, tat cd ede ton thuUng dSu co m i i t dp hap tiiu FDG (SUV) cao (bang 4). Gid trj SUV trung binh tgi hgch d nhdm b^nh nhan co dp de tfnh trung binh cao hdn nhdm cd dp ae tfnh thap, tUdng img Id 6,23 - 7,18 va 9,92 - 15,33 (bdng 5). Theo ket qua nghien eifu ciia Schoder va cs (2005) thi gid trj hap thu FDG ciia cac ton thutfng trong u lympho dc tfnh dao dpng tir 6,3
± 2,7 den 18,2 ±10,0. NhU vgy ket qua nghien ciru eua chung toi cung phii hdp vdi ket qua nghien ajfu cua tac gid tren [4, 5 ] .
Viec xdc djnh chi'nh xdc giai dogn benh tru'dc dieu tri trong u lympho ac b'nh rat quan tn?ng vi nd quyet djnh den viec lu^ chpn phu'cfiig t h u t dieu tn, tien luWng benh cung nhu' hieu qua dieu trj.
PET/cf rat ed gia tri trong ehan dodn giai doan benh trong u lympho dc tfnh khong Hodgkin. Theo nghien cCCu eiia Naumann vd es (2004), PET/CTco the phat hien them 3 0 % cae ton thu'dng so vdi cac ton thu'dng ban dau da dUdc phat hien bdng cae phUdng phap ehan dodn khde nh'u CT, MRI. Ket qud PET/CT lam thay doi giat dogn ban dau d 10-40% benh nhan (Jerusalem va cs 1999; Schoder va cs 2001), ctiii yeu la do phat hien them cae ton thu'dng mdL Viee thay doi giai doan benh da lam thay doi phu'dng thirc dieu t n d khodng 2 5 % so benh nhan NHL (Buchmann va es, 2001) [4, 6, 7 ] .
Trong nghien cCtu ciia chiing toi, cae benh nhan trUdc chup PET/CT dUdc phan giai doan benh theo he thong Ann Arbor di/a tren ket qua eliup CT, MRI. Sau chup PET/CT benh nhan dUdc phan tai giai doan benh theo dUa vdo so lu'dng va vi tri cdc ton thu'dng du'dc xac djnh tren hinh anh PET/CT. Trong nghien cihj ciia chiing toi, sau khi _ chup PET/CT da thay lam dot giai doan benh d 5 ' trong so 21 benh nhan, chiem ty ie 23,8% (tir giai doan I , giai doan I I len giai doan I I I va chuyen tiT giai doan I I I len giai doan IV (bang 7).
K@t qud thu du'dc ciia chung toi khdng c6 s i / khde bigt so vdl ket qud nghien c i ^ ciia cdc tdc gid nuyfrc ngodi.
Tir ket qud trgn cd the? thdy Id PFT/CT ddc bi#t cd gid trj trong ch^n dodn glal dogn bgnh tru'dc dlSu trl. Viee ddnh gid chfnh xdc glal dogn benh giup cho cdc bdc sT dieu trj li/ci chpn phudng thirc dieu tr| phu hpp nhSt vd dem Igi hlgu qua dieu trj eao nhdt eho benh nhdn.
V. KIT LUAN
Tir ket qua nghien CLTU trSn 21 bSnh nhan u lympho dc tfnh chup PET/CT tai Trung tdm Y hpe hgt nhan vd Ung bUdu bpnh vi?n Bgch Mai, chiing toi rut ra mpt so ket luan nhU sau:
i . D^c di^m hinh inh PET/CT oia b$nh nhin u iympho ic tinh Irhdng HodgKin,
- PET/CT xdc dinh ton tiiudng Igi 16 vj tri, trong do hay gdp nhdt Id hach co (33,3%), hach trung that (28,6%), hach 6 byng (23,8%), hach ndch (14,3%), cdc vj tri c6n Igi cd ti le gdp thap hdn.
- Gid tn hap thu FDG (max SUV) d ede ^ n thu'dng: cao nhat d nao (15,24), tiep theo d vung hau nhan rau (11,35), tuyen thudng than (11,34), da (11,04), cac vi tri khac od gia tri thap txfti.
- Gid tri hap thu FDG trung binh eua nhdm cd do ae tfnii trung binh ( W H - 7 ) la 9,92 - 15,33 eao hdn han so vdi nhom ed dp ac tfnh thap (WF2-3): 6 , 2 3 - 7 , 1 8 .
2. Gii trl cua PET/CT trong xie dinh giai doan benh u iympho ic tinh Ichong Hodgkin.
- Tru'de khi chyp PET/CT: benh nhan d giai doan I I ehiem 3 8 , 1 % , giai doan I I I la 33,3%, giai doan I : 23,8% va giai doan IV: 4,8%.
- Sau khi chup PCT/CT: tdng ty le benh nhan d giai dogn I I I len 47,6% va giai doan IV len 9,6%, giam so benh nhan giai doan I I xuong con 28,5% va giai doan I con 14,3%.
- Ket qua PCT/CT da thay doi giai doan benh d 5 trong so 21 benh nhan, ehiem ty le 23,8%.
TAI LI|U THAAA KHAO^
1. NguySn Bd Ou'c. Chan doan va dieu trj benh ung thu', Nha xuat ban Y hpc Ha Npi, 2009.
2. Bach Qucic Khdnh. Nhan x ^ va ket qua chan doan va dieu tri u lympho ac tinh tai Vien huyet hoc va truyen mau Trung u'dng, 2008.
3. Do Trung Phan. Benh ly te bao nguon tao mau, Nha xuat ban Y hpc Ha Npi 2003, trang 364-365.
4. HansOurgen Blersack, Leonard Freeman.
Clinical Nuclear Medicine, 2007: 331-337.
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Y HQC VI$T NAM T H A N G 8 • s61^2012 La Fougere C, Hundt W, Brackel N, et a l .
Value of PET/CT versus PET and CT performed as separate investigations In patients with Hodgkin's disease and non-Hodgkin's lymphoma. Eur J Nuci Med Moi Imaging 2006; 33{12):1417-1425
Peter G laaacson; Postgraduate Haematology, 5 edition, 2005: 714
Tatauml M, Cohade C, Nalcamoto Y, Fishman EK, Wahl R L Direct comparison of FDG PET and a findings In patients with lymphoma: inrtial experienoe.
Radiology 2005; 237(3): 1038-1045 51.
OANH GIA HICU QUA DI CHUYDN RANG THEO 3 cmiu KHONG GIAN BANG VIT NEO Giff Ph^m Nllir Hil>
T 6 M TAT
Sit dung vit neo glO c6 hl^u q u i rd r^t trong dl chuy&i r3ng, d^c bl$t \i nhOng tnii&ng h ^ cSn neo giO ten da, nhOng truiiing h9p c3n can thi^p theo chiiu dOmg m i vdl cic neo glQ' tnKiilc dSy khd cd thJ thi/c hl$n du^c. NghiSn cOU cho ttiSy vlt neo glO khdng nhdng giup neo giO' tdi da m i cdn o i t h ! l i m^t diSm ty^ ly tudng cho v i ^ dl chuydn nguySn khoi toin bd hjm trSn hay him dudi d?c biSt l i v5 phia xa. MCrc dd dl xa tdi da cho r^ng cu^ tren l i 9mm, rSng dta dudi l i 7mm, ring 6 dUdl l i 7mm, ring 6 trgn l i 6 mm.
MCrc dd toi da o5 thS dinh lun doi vdi r^ng him Idn him tren b^ng nhdm doi tU[?ng nghien cCru l i 3mm, r^ng cCTa l i 2mm.
ABSTRACT;
evaluation of dental mouvement In 3 dimensions by minivis anchorages Minivis anchorages have a significant effect on dental movement, especially in case of maximum anchorage cases require, or case of vertical anchorage require. The study shows a big advantage of minivis in maximum anchorage case event it can help to move distally the whole maxilla or mandibular teeth. The maximum distal movement of upper incisors Is 9 mm, the one of lower Incisors is 7 mm, lower fist molar Is 7 mm, upper fist molar is 6 mm. maximum dental Impaction of upper molars is 3 mm and upper incisors is 2 mm.
I. Of T
VA'Noi
^ NSn chinh rSng i i mot chuySn nganh phat trien tCr lau d cac nUdc Ben tien, vi da dat dUtfc nhieu thanh tuU vtlt)t bac. Vl$c ra ddi ciia he thong mSc cai day thSng da iam nen cuoc cacli m j n g trong nan chinh rSng vao nhifng nSm 70, tiep day la viec sir dgng day cung dan hoi vao nhCTng n5m 90 ciia the ky 20 cung da iam nen
* Tn/dng khoa Ring Bti VAI Cuba Ha ndi Phan bi$n kfioa /ipc; PGS.TS. Mai Dinh Hi/ng 30
m$t cu^c c^ch mang Idn.
Tuy nhien cung nhu" c ^ phutJng phdp dieu trj k h i c , n j n chinh r j n g cung cd t h ^ gSy la mdt s5 tai bi€n, trong d d mSt neo giO' la tai bid) hay g$p nhSt. 0 3 cd r S nhiSu nghidn cu\i v i cac nguySn t i c du'iTc dS ra d £ phdng tranh v i dSu bi tai biSn n i y . Tuy nhiSn vdi c i c phutdng t i | n dilu tri <S dien thi rat khd ki^m s o i t duOc neo gii?.
Vit neo giij' tao ra m ^ diem bfa iy tudng giup cho vi?c keo dl chuyen r i n g , giup kiem soit di chuyen r i n g theo 3 chieu khdng gian, biy nhien cho den nay vSn chus cd m$t nghlSn din n i o d i n h g i i vS k h i n i n g v i m u t dp di diuyen r i n g mot c i c h cd he thong d i e biet l i is ngufll Viet Nam. Chinh vi v i y chiing toi nghien culli de t i l vdi myc tiSu:
L Dinh gii dc gicn h^n vi khi ning dl chuyen ring theo 3 chdu khdng gan bing vit neo giu'.
2. Dui ra khuyen do vS siy dung vit neo giO'trong nin chinh ring.
II. O d i TUqMG v A PHUONG P H A P N G H I E N COU 2 . 1 . T i e u c h u i n Itra c h ^ n b | n h n h i n : Doi hrtjng nghien diu cua de tai la b?nh n h i n lech i?c r i n g h i m , dutfc kham v i chi dinli sir dung vit neo giff de n i n chinh r i n g tai bSnli vl$n Hull nghj Viet Nam - Cu ba, Tieu chuan igS chon (chi djnh sir dung vit neo giuO:
o Cac truSng hdp n i n r i n g ran neo gii?
tuyet doi.
o Khoing xu'dng 5 r i n g glDs 2 chan ring dii rong de c i m vEt.
o Chat lu'dng xu'dng 6 r i n g tdt.
o Benh nhan ve sinh r i n g mieng tot.
