Oudoux Aurore, Salaun Pierre-Yves, Bournaud Claire, Campion Loïc, Ansquer Catherine, Rousseau Caroline, Bardet Stéphane, Borson-Chazot Françoise, Vuillez Jean-Philippe, Murat Arnaud, Mirallié Eric, Barbet Jacques, Goldenberg David M, Chatal Jean-François, Kraeber-Bodéré Françoise
Nuclear Medicine, University Hospital, 44093 Nantes, France.
J Clin Endocrinol Metab. 2007 Dec;92(12):4590-7. doi: 10.1210/jc.2007-0938. Epub 2007 Sep 18.
Patients with progressive medullary thyroid carcinoma (MTC) undergo multiple imaging procedures for diagnosis of relapse and staging.
Our objective was to assess the sensitivity and prognostic value of 18F-2-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)/computed tomography (CT), and the imaging sensitivity of pretargeted iodine-131-radioimmunotherapy (RIT) in patients with progressive MTC.
DESIGN/SETTING/PATIENTS: We performed a prospective multicenter study in high-risk patients with rapidly progressing MTC enrolled in a phase-II pretargeted RIT study, as documented by short serum calcitonin (Ct) or carcinoembryonic antigen (CEA) doubling time (DT). INTERVENTIONS/MAIN OUTCOME MEASURES: Patients underwent neck-thoracic-abdominal CT, spine and pelvic magnetic resonance imaging, whole-body post-RIT immunoscintigraphy (IS) with iodine-131, and whole-body 18F-FDG-PET/CT imaging. Imaging sensitivity and the correlation between FDG uptake and biomarkers DT were evaluated.
A total of 33 patients with mean CEA and Ct DTs of 1.90 yr (range 0.21-8.50) and 1.52 yr (range 0.09-6.01), respectively, were evaluated. Sensitivity of FDG-PET/CT was 83% for neck, 85% for mediastinal, 75% for lung, 60% for liver, and 67% for bone metastases; overall sensitivity was 76%. Median standardized uptake value (SUVmax) was 5.23 (2.06-13.90). SUVmax correlated significantly with Ct DT (P = 0.011) and minimal DT (minimal value between CEA DT and Ct DT) (P = 0.027). Overall sensitivity of post-RIT IS, CT, and bone magnetic resonance imaging were 94, 74, and 85%, respectively.
These results demonstrate the value of FDG-PET/CT for staging of patients with progressive MTC, especially in the neck and mediastinum, with possible prognostication by SUV quantification. Post-RIT IS was the most sensitive of the imaging modalities studied prospectively.
进展期甲状腺髓样癌（MTC）患者需接受多种影像学检查以诊断复发和分期。
我们的目的是评估18F - 2 - 氟 - 2 - 脱氧 - D - 葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）的敏感性和预后价值，以及预靶向碘 - 131放射免疫治疗（RIT）在进展期MTC患者中的成像敏感性。
设计/地点/患者：我们对参加一项II期预靶向RIT研究的快速进展型高危MTC患者进行了一项前瞻性多中心研究，血清降钙素（Ct）或癌胚抗原（CEA）短倍增时间（DT）可证明这一点。干预措施/主要观察指标：患者接受颈 - 胸 - 腹CT检查、脊柱和骨盆磁共振成像、碘 - 131全身RIT后免疫闪烁显像（IS）以及全身18F - FDG - PET/CT成像。评估成像敏感性以及FDG摄取与生物标志物DT之间的相关性。
共评估了33例患者，其CEA和Ct的平均DT分别为1.90年（范围0.21 - 8.50）和1.52年（范围0.09 - 6.01）。FDG - PET/CT对颈部转移的敏感性为83%，纵隔转移为85%，肺部转移为75%，肝脏转移为60%，骨转移为67%；总体敏感性为76%。标准化摄取值（SUVmax）中位数为5.23（2.06 - 13.90）。SUVmax与Ct DT（P = 0.011）和最小DT（CEA DT与Ct DT之间的最小值）（P = 0.027）显著相关。RIT后IS、CT和骨磁共振成像的总体敏感性分别为94%、74%和85%。
这些结果证明了FDG - PET/CT在进展期MTC患者分期中的价值，尤其是在颈部和纵隔，通过SUV定量可能具有预后意义。RIT后IS是前瞻性研究的成像方式中最敏感的。
