Perri M, Erba P, Volterrani D, Lazzeri E, Boni G, Grosso M, Mariani G
Regional Center of Nuclear Medicine, University of Pisa Medical School, Pisa, Italy.
Q J Nucl Med Mol Imaging. 2008 Dec;52(4):323-33. Epub 2008 May 16.
The aim of the present study was to prospectively evaluate the add value provided by [(111)In]DTPA-octreotide single-photon emission computed tomography/computed tomography (Octreo-SPECT/CT) with respect to [(111)In]DTPA-octreotide SPECT (Octreo-SPECT) in terms of diagnostic accuracy and localization of neuroendocrine tumors (NETs).
Eighty-one consecutive patients with known or suspected NET underwent [(111)In]DTPA-octreotide scintigraphy using an integrated SPECT/low-energy-CT system (Infinia & Hawkeye; GE Medical Systems, Milwaukee, WI, USA). SPECT and fused SPECT/CT images were interpreted separately and a lesion-by-lesion analysis was performed with regard to classification (probability of NET graded on a 5-point scale) and localization of each abnormal focal tracer uptake. A subgroup analysis, distinguishing between abdominal and thoracic lesions, and a patient-by-patient analysis for likelihood of NET in each patient was also performed. Standard of reference for confirming presence or absence of NET was either histopathology or clinical/imaging follow-up data. The value of SPECT/CT imaging was assessed by ROC analysis and McNemar test.
A final diagnosis of NET was achieved in 43 out of 81 patients and a total of 169 areas (138 NET and 31 benign/physiological) with focal tracer uptake were included in the final lesion-by-lesion analysis. SPECT/CT imaging led to a significantly higher proportion of patients (75/81=92.6% vs 64/81=79%) and lesions (163/169=96.4% vs 138/169=81.1%) correctly classified vs SPECT alone. ROC analysis confirmed that Octreo-SPECT/CT performed significantly better than Octreo-SPECT for the detection of NET on both patient- and lesion-based analysis, improving especially evaluation of abnormal tracer uptake in the abdomen. Moreover, Octreo-SPECT/CT accurately localized 160/169 (94.7%) lesions, significantly higher than SPECT alone (77/169= 45.6%).
Octreo-SPECT/CT allows more accurate detection and localization of NETs than simple Octreo-SPECT, with major benefits for lesions located in the abdomen.
本研究的目的是前瞻性评估[（111）铟]二乙三胺五醋酸奥曲肽单光子发射计算机断层扫描/计算机断层扫描（Octreo-SPECT/CT）相对于[（111）铟]二乙三胺五醋酸奥曲肽单光子发射计算机断层扫描（Octreo-SPECT）在神经内分泌肿瘤（NETs）诊断准确性和定位方面的附加价值。
81例已知或疑似NET的连续患者使用集成SPECT/低能CT系统（Infinia & Hawkeye；GE医疗系统公司，美国威斯康星州密尔沃基）进行[（111）铟]二乙三胺五醋酸奥曲肽闪烁扫描。分别解读SPECT和融合的SPECT/CT图像，并对每个异常局灶性示踪剂摄取进行逐病灶分析，涉及分类（NET概率按5分制分级）和定位。还进行了区分腹部和胸部病变的亚组分析以及对每位患者NET可能性的逐个患者分析。确认NET存在与否的参考标准是组织病理学或临床/影像随访数据。通过ROC分析和McNemar检验评估SPECT/CT成像的价值。
81例患者中有43例最终诊断为NET，最终逐病灶分析纳入了总共169个有局灶性示踪剂摄取的区域（138个NET和31个良性/生理性区域）。与单独的SPECT相比，SPECT/CT成像使正确分类的患者比例（75/81 = 92.6%对64/81 = 79%）和病灶比例（163/169 = 96.4%对138/169 = 81.1%）显著更高。ROC分析证实，在基于患者和基于病灶的分析中，Octreo-SPECT/CT在检测NET方面的表现明显优于Octreo-SPECT，尤其改善了对腹部异常示踪剂摄取的评估。此外，Octreo-SPECT/CT准确地定位了160/169（94.7%）个病灶，显著高于单独的SPECT（77/169 = 45.6%）。
与单纯的Octreo-SPECT相比，Octreo-SPECT/CT能更准确地检测和定位NETs，对位于腹部的病灶有显著益处。
