使用 (68)Ga-DOTA-NOC 受体 PET/CT 检测未知原发神经内分泌肿瘤（CUP-NET）。
Detection of unknown primary neuroendocrine tumours (CUP-NET) using (68)Ga-DOTA-NOC receptor PET/CT.
机构信息
Department of Nuclear Medicine and Centre for PET/CT, Zentralklinik Bad Berka, Robert Koch Allee-9, 99437 Bad Berka, Germany.
出版信息
Eur J Nucl Med Mol Imaging. 2010 Jan;37(1):67-77. doi: 10.1007/s00259-009-1205-y.
PURPOSE
This bi-centric study aimed to determine the role of receptor PET/CT using (68)Ga-DOTA-NOC in the detection of undiagnosed primary sites of neuroendocrine tumours (NETs) and to understand the molecular behaviour of the primarily undiagnosed tumours.
METHODS
Overall 59 patients (33 men and 26 women, age: 65 + or - 9 years) with documented NET and unknown primary were enrolled. PET/CT was performed after injection of approximately 100 MBq (46-260 MBq) of (68)Ga-DOTA-NOC. The maximum standardised uptake values (SUV(max)) were calculated and compared with SUV(max) in known pancreatic NET (pNET) and ileum/jejunum/duodenum (SI-NET). The results of PET/CT were also correlated with CT alone.
RESULTS
In 35 of 59 patients (59%), (68)Ga-DOTA-NOC PET/CT localised the site of the primary: ileum/jejunum (14), pancreas (16), rectum/colon (2), lungs (2) and paraganglioma (1). CT alone (on retrospective analyses) confirmed the findings in 12 of 59 patients (20%). The mean SUV(max) of identified previously unknown pNET and SI-NET were 18.6 + or - 9.8 (range: 7.8-34.8) and 9.1 + or - 6.0 (range: 4.2-27.8), respectively. SUV(max) in patients with previously known pNET and SI-NET were 26.1 + or - 14.5 (range: 8.7-42.4) and 11.3 + or - 3.7 (range: 5.6-17.9). The SUV(max) of the unknown pNET and SI-NET were significantly lower (p < 0.05) as compared to the ones with known primary tumour sites; 19% of the patients had high-grade and 81% low-grade NET. Based on (68)Ga-DOTA-NOC receptor PET/CT, 6 of 59 patients were operated and the primary was removed (4 pancreatic, 1 ileal and 1 rectal tumour) resulting in a management change in approximately 10% of the patients. In the remaining 29 patients, because of the far advanced stage of the disease (due to distant metastases), the primary tumours were not operated. Additional histopathological sampling was available from one patient with bronchial carcinoid (through bronchoscopy).
CONCLUSION
Our data indicate that (68)Ga-DOTA-NOC PET/CT is highly superior to (111)In-OctreoScan (39% detection rate for CUP according to the literature) and can play a major role in the management of patients with CUP-NET.
目的
本双中心研究旨在确定使用（68）Ga-DOTA-NOC 的受体 PET/CT 在检测未确诊的神经内分泌肿瘤（NET）原发部位中的作用，并了解主要未确诊肿瘤的分子行为。
方法
共纳入 59 例（33 名男性和 26 名女性，年龄：65+/-9 岁）有明确 NET 病史但未知原发灶的患者。在注射约 100MBq（46-260MBq）（68）Ga-DOTA-NOC 后进行 PET/CT。计算最大标准化摄取值（SUV(max)），并与已知胰腺 NET（pNET）和回肠/空肠/十二指肠（SI-NET）的 SUV(max)进行比较。还将 PET/CT 的结果与单独 CT 进行了比较。
结果
在 59 例患者中的 35 例（59%）中，（68）Ga-DOTA-NOC PET/CT 定位了原发部位：回肠/空肠（14 例）、胰腺（16 例）、直肠/结肠（2 例）、肺（2 例）和副神经节瘤（1 例）。单独 CT（在回顾性分析中）在 59 例患者中的 12 例（20%）中证实了这一发现。先前未知的 pNET 和 SI-NET 的平均 SUV(max)分别为 18.6+/-9.8（范围：7.8-34.8）和 9.1+/-6.0（范围：4.2-27.8）。先前已知的 pNET 和 SI-NET 的 SUV(max)分别为 26.1+/-14.5（范围：8.7-42.4）和 11.3+/-3.7（范围：5.6-17.9）。未知的 pNET 和 SI-NET 的 SUV(max)明显较低（p<0.05），与具有已知原发肿瘤部位的患者相比；68%的患者为高级别 NET，32%为低级别 NET。基于（68）Ga-DOTA-NOC 受体 PET/CT，59 例患者中有 6 例接受手术，切除了原发灶（4 例胰腺、1 例回肠和 1 例直肠肿瘤），这导致约 10%的患者的治疗方案发生了改变。在其余 29 例患者中，由于疾病处于晚期（由于远处转移），未对原发肿瘤进行手术。1 例支气管类癌患者（通过支气管镜）可获得额外的组织病理学样本。
结论
我们的数据表明，（68）Ga-DOTA-NOC PET/CT 明显优于（111）In-OctreoScan（根据文献报道，CUP 的检出率为 39%），并可在 CUP-NET 患者的管理中发挥重要作用。
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