Tang B N T, Levivier M, Heureux M, Wikler D, Massager N, Devriendt D, David P, Dumarey N, Corvilain B, Goldman S
PET-Biomedical Cyclotron Unit and Department of Nuclear Medicine, Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium.
Eur J Nucl Med Mol Imaging. 2006 Feb;33(2):169-78. doi: 10.1007/s00259-005-1882-0. Epub 2005 Oct 15.
The detection of recurrent pituitary adenoma by magnetic resonance imaging (MRI) is rendered uncertain by the tissue remodelling that follows surgery or radiotherapy. We aimed to evaluate the contribution of PET with 11C-methionine (MET-PET) in the detection and management of recurrent pituitary adenoma.
Thirty-three patients with pituitary adenoma were evaluated postoperatively by MET-PET, either because of biological evidence of active residual tumour or because of MRI demonstration of non-functional adenoma growth. We studied 24 secreting adenomas and nine non-functional adenomas.
In 30 patients, MET-PET detected abnormally hypermetabolic tissue. In 14 out of these, MRI did not differentiate between residual tumour and scar formation. In nine of these 14 cases, major therapeutic decisions were undertaken (radiosurgery and surgery). In another group of 16 patients, both MET-PET and MRI detected abnormal tissue. In one case, neither MRI nor MET-PET detected adenomatous tissue. Finally, abnormal tissue was detected in two patients on MRI solely. In these two cases, failure of MET-PET to reveal the adenoma was attributable to concomitant inhibitory therapy. The sensitivity of MET-PET and MRI varied as a function of the tumour type: all non-functional adenomas were localised by both modalities, while MET-PET detected all adrenocorticotropic hormone-secreting adenomas whereas MRI depicted only one of these eight lesions. Fifteen out of 17 patients treated by radiosurgery showed clinical improvement after treatment.
We suggest that MET-PET is a sensitive technique complementary to MRI for the detection of residual or recurrent pituitary adenomas. It should gain a place in the efficient management of these tumours.
手术或放疗后发生的组织重塑使得通过磁共振成像（MRI）检测复发性垂体腺瘤变得不确定。我们旨在评估11C-蛋氨酸正电子发射断层扫描（MET-PET）在复发性垂体腺瘤检测和管理中的作用。
33例垂体腺瘤患者术后接受MET-PET评估，原因是有活性残留肿瘤的生物学证据或MRI显示无功能腺瘤生长。我们研究了24例分泌性腺瘤和9例无功能腺瘤。
30例患者中，MET-PET检测到代谢异常增高的组织。其中14例中，MRI无法区分残留肿瘤和瘢痕形成。这14例中的9例，做出了主要的治疗决策（放射外科手术和手术）。在另一组16例患者中，MET-PET和MRI均检测到异常组织。1例中，MRI和MET-PET均未检测到腺瘤组织。最后，仅MRI在2例患者中检测到异常组织。在这2例中，MET-PET未能发现腺瘤归因于同时进行的抑制性治疗。MET-PET和MRI的敏感性因肿瘤类型而异：所有无功能腺瘤均可通过两种方法定位，而MET-PET检测到所有促肾上腺皮质激素分泌性腺瘤，而MRI仅显示这8个病变中的1个。17例接受放射外科手术治疗的患者中有15例治疗后临床症状改善。
我们认为MET-PET是一种对MRI敏感的补充技术，用于检测残留或复发性垂体腺瘤。它应该在这些肿瘤的有效管理中占有一席之地。
