Balogova Sona, Huchet Virginie, Kerrou Khaldoun, Nataf Valerie, Gutman Fabrice, Antoine Martine, Ruppert Anne-Marie, Prignon Aurélie, Lavolée Armelle, Montravers Francoise, Mayaud Charles, Cadranel Jacques, Talbot Jean-Noël
Department of Nuclear Medicine, Hôpital Tenon AP-HP, Paris, France.
Nucl Med Commun. 2010 May;31(5):389-97. doi: 10.1097/MNM.0b013e3283369654.
Bronchioloalveolar (BAC) cancer is a source of false-negative F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) results. A few studies reported better diagnostic performances with PET tracers of lipid metabolism, C-choline, or C-acetate, for the detection of well-differentiated adenocarcinoma or BAC. F-fluorocholine (FCH) is a lipid analogue for PET imaging, with advantages in terms of logistics and image resolution. We carried out this prospective pilot study to evaluate whether FCH PET/CT could detect lung cancer with a BAC component and could be more sensitive than FDG in this aim.
Fifteen patients with a lung nodule or lesion suspected for BAC on CT and/or with a history of BAC had PET/CT 60-90 min after 5 MBq FDG/kg body mass and, on a separate day, 10-20 min after 4 MBq FCH/kg body mass. The standard of truth was histology and a 6-month follow-up.
Nine patients (12 lesions) presented BAC or adenocarcinoma with BAC features, two patients presented adenocarcinoma without BAC features (five lesions) and four patients presented benign lesions (15 non-malignant sites). For both FCH and FDG, patient-based sensitivity was 78% for detecting cancer with a BAC component and 82% for detecting malignancy. Site-based sensitivity for detecting malignancy was 76 and 75% for detecting cancer with BAC features, for both radiopharmaceuticals. Specificity was similar for FCH and FDG (site-based 93 vs. 81%, NS). In these early-stage cancers, only one adrenal metastasis was observed that took up FCH and FDG.
In this population of patients with ground-glass opacities selected on CT suggestive of BAC or with a history of BAC and a recent lung anomaly on CT, FCH detected all malignant lesions with at least a 2.0 cm short axis. However, FDG had similar performance.
细支气管肺泡癌（BAC）是导致F-氟脱氧葡萄糖（FDG）正电子发射断层显像（PET）/计算机断层扫描（CT）结果出现假阴性的原因之一。少数研究报告称，使用脂质代谢PET示踪剂、C-胆碱或C-醋酸盐在检测高分化腺癌或BAC方面具有更好的诊断性能。F-氟胆碱（FCH）是一种用于PET成像的脂质类似物，在物流和图像分辨率方面具有优势。我们开展了这项前瞻性初步研究，以评估FCH PET/CT能否检测出具有BAC成分的肺癌，以及在这方面是否比FDG更敏感。
15例CT上怀疑为BAC的肺结节或病变患者和/或有BAC病史的患者，在静脉注射5 MBq FDG/kg体重后60 - 90分钟进行PET/CT检查，并在另一天，静脉注射4 MBq FCH/kg体重后10 - 20分钟进行PET/CT检查。诊断的金标准是组织学检查和6个月的随访观察。
9例患者（12个病灶）表现为BAC或具有BAC特征的腺癌，2例患者表现为无BAC特征的腺癌（5个病灶），4例患者表现为良性病变（15个非恶性部位）。对于FCH和FDG，基于患者的检测具有BAC成分癌症的敏感性为78%，检测恶性肿瘤的敏感性为82%。两种放射性药物检测具有BAC特征癌症的基于病灶的恶性肿瘤检测敏感性均为76%和75%。FCH和FDG的特异性相似（基于病灶分别为93%和81%，无显著性差异）。在这些早期癌症中，仅观察到1例摄取FCH和FDG的肾上腺转移瘤。
在这群CT上表现为提示BAC的磨玻璃影或有BAC病史且近期CT上有肺部异常的患者中，FCH检测到了所有短轴至少为2.0 cm的恶性病变。然而，FDG也有类似的表现。
