新发进展性转移性前列腺癌患者的18F-FDG与11C-蛋氨酸联合PET扫描

Combined 18F-FDG and 11C-methionine PET scans in patients with newly progressive metastatic prostate cancer.

作者信息

Nuñez Rodolfo, Macapinlac Homer A, Yeung Henry W D, Akhurst Tim, Cai Shangde, Osman Iman, Gonen Mithat, Riedel Elyn, Scher Howard I, Larson Steven M

机构信息

Nuclear Medicine Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.

出版信息

J Nucl Med. 2002 Jan;43(1):46-55.

PMID:11801702

Abstract

UNLABELLED

Metastatic prostate cancer may respond initially to hormone suppression, with involution of tumor sites, but ultimate tumor progression is inevitable. Our aim was to detect the proportion of bone and soft-tissue lesions that represent metabolically active tumor sites in patients with progressive metastatic prostate cancer.

METHODS

In a prospective study, we compared 18F-FDG and L-methyl-11C-methionine (11C-methionine) PET with conventional imaging modalities (CIM), which included the combination of 99mTc-methylene diphosphonate scintigraphy, CT, or MRI. Twelve patients with prostate cancer, increasing levels of prostate-specific antigen (PSA), and at least 1 site (index lesion) with new or increasing disease on CIM were studied. The total numbers of soft-tissue and bone-tissue lesions, in a site-by-site comparison, were calculated for all imaging modalities.

RESULTS

The sensitivities of 18F-FDG PET and 11C-methionine PET were 48% (167/348 lesions) and 72.1% (251/348 lesions), respectively, with CIM being used as the 100% reference (348/348). 11C-Methionine PET identified significantly more lesions than 18F-FDG PET (P < 0.01). All 12 patients with progressive metastatic prostate cancer had at least 1 lesion site of active metabolism for 18F-FDG or 11C-methionine, which could be used as an index lesion to monitor the metabolic response to therapy. A significant proportion of lesions (26%) had no detectable metabolism of 18F-FDG or 11C-methionine. Although technical factors cannot be totally excluded, we believe that metabolically inactive sites may be necrotic or dormant. More than 95% (251/258) of metabolically active sites (72% of the total number of lesions detected by CIM) metabolize 11C-methionine. 18F-FDG uptake is more variable, with 65% of metabolically active sites (48% of the total number of lesions detected by CIM).

CONCLUSION

These findings reflect the different biologic characteristics of the lesions in a heterogeneous tumor such as prostate cancer and suggest that a time-dependent metabolic cascade may occur in advanced prostate cancer, with initial uptake of 11C-methionine in dormant sites followed by increased uptake of 18F-FDG during progression of disease.

摘要

未标记

转移性前列腺癌最初可能对激素抑制有反应，肿瘤部位会 involution（此处可能有误，推测为“消退”），但最终肿瘤进展是不可避免的。我们的目的是检测在进展性转移性前列腺癌患者中代表代谢活跃肿瘤部位的骨和软组织病变的比例。

方法

在一项前瞻性研究中，我们将 18F - FDG 和 L - 甲基 - 11C - 蛋氨酸（11C - 蛋氨酸）PET 与传统成像方式（CIM）进行比较，传统成像方式包括 99mTc - 亚甲基二膦酸盐闪烁显像、CT 或 MRI 的组合。研究了 12 例前列腺癌患者，其前列腺特异性抗原（PSA）水平升高，且在 CIM 上至少有 1 个部位（索引病变）有新的或进展性疾病。在逐个部位比较中，计算了所有成像方式下软组织和骨组织病变的总数。

结果

18F - FDG PET 和 11C - 蛋氨酸 PET 的敏感性分别为 48%（167/348 个病变）和 72.1%（251/348 个病变），以 CIM 作为 100%参考（348/348）。11C - 蛋氨酸 PET 识别出的病变明显多于 18F - FDG PET（P < 0.01）。所有 12 例进展性转移性前列腺癌患者至少有 1 个 18F - FDG 或 11C - 蛋氨酸的活跃代谢病变部位，可作为监测治疗代谢反应的索引病变。相当比例的病变（26%）未检测到 18F - FDG 或 11C - 蛋氨酸的代谢。尽管不能完全排除技术因素，但我们认为代谢不活跃部位可能是坏死的或休眠的。超过 95%（251/258）的代谢活跃部位（占 CIM 检测到的病变总数的 72%）代谢 11C - 蛋氨酸。18F - FDG 的摄取更具变异性，65%的代谢活跃部位（占 CIM 检测到的病变总数的 48%）摄取 18F - FDG。