Bhatia Kunwar S S, Ismail Mohamed M, Sahdev Anju, Rockall Andrea G, Hogarth Kieran, Canizales Ana, Avril Norbert, Monson John P, Grossman Ashley B, Reznek Rodney H
Department of Academic Radiology, St. Bartholomew's Hospital, London, UK.
Clin Endocrinol (Oxf). 2008 Aug;69(2):181-8. doi: 10.1111/j.1365-2265.2008.03256.x. Epub 2008 Apr 3.
Evidence regarding the accuracy of [(123)I] metaiodobenzylguanidine (MIBG) imaging for phaeochromocytoma localization is currently limited to small series.
We present the largest series of primary phaeochromocytomas in which the performance of [(123)I]MIBG has been evaluated and correlated with cross-sectional imaging.
We identified 76 patients with both preoperative [(123)I]MIBG and cross-sectional imaging for confirmed primary phaeochromocytoma between 1995 and 2005 at our institution. This comprised 60 adrenal tumours in 55 patients and 33 extra-adrenal tumours in 23 patients (2 patients had both adrenal and extra-adrenal tumours). Phaeochromocytoma metastases were not evaluated.
MAIN OUTCOME MEASURE(S): [(123)I]MIBG studies were independently reviewed and correlated with CT and MRI examinations, as well as tumour functional status, to identify features that may predict a false negative [(123)I]MIBG result.
The overall sensitivity of [(123)I]MIBG was 75%. Tumour detection was lower for extra-adrenal (58%) vs. adrenal (85%) phaeochromocytomas (P = 0.005). For extra-adrenal tumours, [(123)I]MIBG demonstrated 8 of 14 carotid body, 2 of 2 intrathoracic, 8 of 14 retroperitoneal and 2 of 3 pelvic phaeochromocytomas. Overall, MRI and CT demonstrated 68 of 68 and 72 of 74 primary phaeochromocytomas, respectively. Tumour size correlated with [(123)I]MIBG uptake for adrenal (P = 0.009) but not extra-adrenal tumours. When tumours were adjusted for size, no other imaging feature or functional status correlated with [(123)I]MIBG negativity, although two large [(123)I]MIBG negative adrenal tumours contained large areas of necrosis or haemorrhage.
Extra-adrenal and small adrenal phaeochromocytomas are more likely to result in false negatives on [(123)I]MIBG. Tumoural necrosis or haemorrhage do not consistently relate to [(123)I]MIBG uptake, although adrenal phaeochromocytomas containing minimal solid tissue due to extensive necrosis may predict a negative [(123)I]MIBG result.
关于[（123）I]间碘苄胍（MIBG）成像用于嗜铬细胞瘤定位准确性的证据目前仅限于小样本研究。
我们展示了最大系列的原发性嗜铬细胞瘤，其中对[（123）I]MIBG的性能进行了评估，并与断层成像进行了对比。
我们确定了1995年至2005年在我们机构中76例术前接受过[（123）I]MIBG和断层成像检查以确诊原发性嗜铬细胞瘤的患者。这包括55例患者中的60个肾上腺肿瘤和23例患者中的33个肾上腺外肿瘤（2例患者同时患有肾上腺和肾上腺外肿瘤）。未评估嗜铬细胞瘤转移情况。
对[（123）I]MIBG研究进行独立评估，并与CT和MRI检查以及肿瘤功能状态进行对比，以确定可能预测[（123）I]MIBG结果为假阴性的特征。
[（123）I]MIBG的总体敏感性为75%。肾上腺外嗜铬细胞瘤（58%）的肿瘤检出率低于肾上腺嗜铬细胞瘤（85%）（P = 0.005）。对于肾上腺外肿瘤，[（123）I]MIBG显示出14个颈动脉体嗜铬细胞瘤中的8个、2个胸内嗜铬细胞瘤中的2个、14个腹膜后嗜铬细胞瘤中的8个以及3个盆腔嗜铬细胞瘤中的2个。总体而言，MRI和CT分别显示出68个原发性嗜铬细胞瘤中的68个和74个中的72个。肿瘤大小与肾上腺嗜铬细胞瘤的[（123）I]MIBG摄取相关（P = 0.009），但与肾上腺外肿瘤无关。当对肿瘤大小进行校正后，没有其他影像学特征或功能状态与[（123）I]MIBG阴性相关，尽管两个[（123）I]MIBG阴性的大肾上腺肿瘤含有大片坏死或出血区域。
肾上腺外和小的肾上腺嗜铬细胞瘤更有可能导致[（123）I]MIBG出现假阴性。肿瘤坏死或出血与[（123）I]MIBG摄取并不总是相关，尽管由于广泛坏死而含有极少实性组织的肾上腺嗜铬细胞瘤可能预测[（123）I]MIBG结果为阴性。
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