Mann Gary N, Link Jeanne M, Pham Pam, Pickett Cheryl A, Byrd David R, Kinahan Paul E, Krohn Kenneth A, Mankoff David A
Department of Surgery, University of Washington, Box 356410, 1959 N.E. Pacific Street, Seattle, Washington 98195, USA.
Ann Surg Oncol. 2006 Feb;13(2):187-97. doi: 10.1245/ASO.2006.04.022. Epub 2006 Jan 19.
Pheochromocytomas are rare tumors of chromaffin cells for which the optimal management is surgical resection. Precise diagnosis and localization may be elusive. We evaluated whether positron emission tomography (PET) scanning with the combination of [18F]fluorodeoxyglucose (FDG) and the norepinephrine analogue [11C]metahydroxyephedrine (mHED) would allow more exact diagnosis and localization.
Fourteen patients with suspected pheochromocytoma were evaluated by anatomical imaging (computed tomography or magnetic resonance imaging) and [131I]metaiodobenzylguanidine (MIBG) planar imaging. PET imaging was performed by using mHED with dynamic adrenal imaging, followed by a torso survey and FDG with a torso survey. Images were evaluated qualitatively by an experienced observer.
Eight patients had pathology-confirmed pheochromocytoma. Of the other six, two patients had normal adrenal tissue at adrenalectomy, and the other four had subsequent clinical courses inconsistent with a diagnosis of pheochromocytoma. In four of eight patients with pheochromocytoma, MIBG failed to detect one or more sites of pathology-confirmed disease. The mHED-PET detected all sites of confirmed disease, whereas FDG-PET detected all sites of adrenal and abdominal disease, but not bone metastases, in one patient. MIBG and FDG-PET results were all negative in the six patients without pheochromocytoma. One patient with adrenal medullary hyperplasia had a positive mHED-PET scan. PET scanning aided the decision not to operate in three of six patients. The resolution of PET functional imaging was superior to that of MIBG.
PET scanning for pheochromocytoma offers improved quality and resolution over current diagnostic approaches. PET may significantly influence the clinical management of patients with a suspicion of these tumors and warrants further investigation.
嗜铬细胞瘤是一种罕见的嗜铬细胞肿瘤，其最佳治疗方法是手术切除。精确的诊断和定位可能具有挑战性。我们评估了正电子发射断层扫描（PET）联合[18F]氟脱氧葡萄糖（FDG）和去甲肾上腺素类似物[11C]间位羟基麻黄碱（mHED）是否能实现更准确的诊断和定位。
对14例疑似嗜铬细胞瘤患者进行了解剖成像（计算机断层扫描或磁共振成像）和[131I]间碘苄胍（MIBG）平面成像评估。PET成像采用mHED进行动态肾上腺成像，随后进行全身扫描，以及采用FDG进行全身扫描。由经验丰富的观察者对图像进行定性评估。
8例患者经病理证实为嗜铬细胞瘤。在另外6例患者中，2例患者肾上腺切除术后肾上腺组织正常，另外4例患者随后的临床病程与嗜铬细胞瘤诊断不符。在8例嗜铬细胞瘤患者中，有4例MIBG未能检测到一处或多处经病理证实的病变部位。mHED-PET检测到了所有经证实的病变部位，而FDG-PET检测到了1例患者肾上腺和腹部病变的所有部位，但未检测到骨转移。6例无嗜铬细胞瘤的患者MIBG和FDG-PET结果均为阴性。1例肾上腺髓质增生患者mHED-PET扫描呈阳性。PET扫描帮助6例患者中的3例做出了不进行手术的决定。PET功能成像的分辨率优于MIBG。
针对嗜铬细胞瘤的PET扫描比目前的诊断方法具有更高的质量和分辨率。PET可能会显著影响疑似这些肿瘤患者的临床管理，值得进一步研究。
