Service de Médecine Nucléaire, CHU-Hôtel Dieu, Nantes, France.
Eur J Nucl Med Mol Imaging. 2010 Aug;37(9):1669-78. doi: 10.1007/s00259-010-1471-8. Epub 2010 May 19.
This prospective multicentre study assesses the usefulness of FDG PET/CT in characterizing and making the therapeutic decision concerning adrenal tumours that are suspicious or indeterminate in nature after conventional examinations (CE).
Seventy-eight patients (37 men, 41 women, 81 adrenal lesions) underwent FDG PET/CT after CE including CT scan, biological tests and optionally (131)I-metaiodobenzylguanidine (MIBG) and/or (131)I-norcholesterol scans. FDG adrenal uptake exceeding that of the liver was considered positive. PET results were not decisive. Surgery was discussed when at least one of the following criteria was found during CE: size >3 cm, spontaneous attenuation value >10 HU, heterogeneous aspect, abnormal MIBG or norcholesterol scan or hormonal hypersecretion.
Following the gold standard (histology analysis or >or=9 months follow-up), 49 lesions potentially qualified for surgery (malignant = 27, benign secreting = 22) and 32 benign non-secreting lesions did not. PET was negative in 97% of non-surgical lesions and positive in 73% of potentially surgical ones which included all the malignant lesions, except 3 renal cell metastases, and 12 of 22 benign secreting lesions. The negative predictive value for malignancy was 93% (41/44) and positive predictive value for detecting surgical lesions was 97% (36/37). A high FDG uptake (maximum standardized uptake value >or= 10) was highly predictive of malignancy.
Adrenal FDG uptake is a good indicator of malignancy and/or of secreting lesions and should lead one to discuss surgery. If there is no prior history of poorly FDG-avid cancer, the absence of FDG uptake should avoid unnecessary removal of benign adrenal lesions.
本前瞻性多中心研究评估了 FDG PET/CT 在传统检查（CE）后对性质可疑或不确定的肾上腺肿瘤进行特征描述和治疗决策的作用。
78 例患者（37 名男性，41 名女性，81 个肾上腺病灶）在 CE 后行 FDG PET/CT 检查，CE 包括 CT 扫描、生物检查和（131）I-间碘苄胍（MIBG）和/或（131）I-去甲胆固醇扫描。如果肾上腺摄取 FDG 超过肝脏，则认为是阳性。当在 CE 中发现以下至少一项标准时，将讨论手术：大小>3cm、自发衰减值>10HU、不均匀表现、异常 MIBG 或去甲胆固醇扫描或激素分泌过多。
根据金标准（组织学分析或>9 个月随访），49 个病灶有手术指征（恶性=27，分泌性良性=22），32 个良性非分泌性病灶无手术指征。非手术病灶中 97%的 PET 为阴性，73%的潜在手术病灶为阳性，包括所有恶性病灶，但 3 个肾细胞转移灶和 22 个分泌性良性病灶中的 12 个除外。恶性肿瘤的阴性预测值为 93%（41/44），检测手术病灶的阳性预测值为 97%（36/37）。高 FDG 摄取（最大标准化摄取值≥10）高度提示恶性肿瘤。
肾上腺 FDG 摄取是恶性肿瘤和/或分泌性病灶的良好指标，应促使医生讨论手术。如果没有先前低 FDG 摄取的癌症病史，无 FDG 摄取应避免不必要地切除良性肾上腺病灶。
