Fisher Michael J, Basu Sandip, Dombi Eva, Yu Jian Q, Widemann Brigitte C, Pollock Avrum N, Cnaan Avital, Zhuang Hongming, Phillips Peter C, Alavi Abass
Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
J Neurooncol. 2008 Apr;87(2):165-71. doi: 10.1007/s11060-007-9501-5. Epub 2007 Dec 11.
The role of FDG-PET for managing patients with plexiform neurofibromas (PN) is unclear. While many PN tumors exhibit periods of rapid growth, others grow slowly or unpredictably and may have periods of relative quiescence. The ability to predict which PN are likely to progress should facilitate a more timely initiation of medical treatments. Since conventional radiographic techniques have limited prognostic value, the use of a functional imaging modality to predict tumor progression is desirable. We hypothesized that PN tumors with high metabolic activity as demonstrated by FDG-PET are more likely to progress in the following year.
All patients were clinically stable, but were considered at high-risk for progression based on anatomical location of PN. FDG-PET scans were performed within two weeks of the baseline MRI study. Standardized uptake values (SUV) were calculated for all focally active index lesions and analyzed for correlation with changes in quantitative MRI over the ensuing year.
Fifteen of the 18 enrolled patients showed various degrees of FDG uptake as focal abnormalities, and these abnormalities corresponded to those noted on the MRI scans. Thirteen patients and 19 lesions were evaluable for PN volume change. The SUVmax ranged from 0.9 to 4 (median 1.5). There was a significant difference in the percent increase in PN volume in the following year for lesions that had an SUV > 2 compared to those with lower values (P = 0.016).
These findings support the hypothesis that FDG-PET imaging predicts PN growth rate, and, therefore, may assist clinician decision making with regard to treatment of PN and enrollment in clinical trials.
氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）在丛状神经纤维瘤（PN）患者管理中的作用尚不清楚。虽然许多PN肿瘤有快速生长阶段，但其他肿瘤生长缓慢或不可预测，且可能有相对静止期。预测哪些PN可能进展的能力应有助于更及时地开始医学治疗。由于传统的放射学技术预后价值有限，因此需要使用功能成像模式来预测肿瘤进展。我们假设，FDG-PET显示具有高代谢活性的PN肿瘤在接下来的一年中更有可能进展。
所有患者临床稳定，但根据PN的解剖位置被认为有进展的高风险。在基线MRI研究的两周内进行FDG-PET扫描。计算所有局灶性活跃指数病变的标准化摄取值（SUV），并分析其与随后一年定量MRI变化的相关性。
18名入组患者中有15名显示出不同程度的FDG摄取作为局灶性异常，这些异常与MRI扫描中发现的异常相对应。13名患者和19个病变可评估PN体积变化。SUVmax范围为0.9至4（中位数1.5）。与SUV值较低的病变相比，SUV>2的病变在接下来一年中PN体积增加百分比有显著差异（P = 0.016）。
这些发现支持了FDG-PET成像可预测PN生长速度的假设，因此可能有助于临床医生在PN治疗和临床试验入组方面做出决策。
