Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
Ann Surg. 2010 Nov;252(5):850-6. doi: 10.1097/SLA.0b013e3181fd37e8.
To evaluate the impact of 68Ga-DOTATOC positron emission tomography (PET)/computed tomography (CT) on the multimodal management of neuroendocrine tumors (NET).
Establishment of the extent and progression of NET are necessary to decide which treatment option to choose. However, morphological imaging with CT or magnetic resonance imaging (MRI) is often inadequate in identifying the primary tumor and/or in detecting small metastatic lesions.
In total, 52 patients (27 women and 25 men) with histologically proven NET could be included in the protocol of comparison between 68Ga-DOTATOC PET/CT and CT and/or MRI. The examinations were performed in terms of tumor staging and, in some instances, also of primary tumor site identification to evaluate the patient's eligibility for treatment. Each patient presented with either CT and/or MRI performed elsewhere and consecutively underwent 68Ga-DOTATOC PET/CT in our institution.
In all 52 patients, 68Ga-DOTATOC PET/CT demonstrated pathologically increased uptake for at least 1 tumor site, yielding a sensitivity of 100% on a patient basis. In 3 of 4 patients with unknown primary tumor site, 68Ga-DOTATOC PET/CT visualized the primary tumor region (jejunum, ileum, and pancreas, respectively) not identified on CT and/or MRI. 68Ga-DOTATOC PET/CT detected additional hepatic and/or extrahepatic metastases in 22 of the 33 patients diagnosed with hepatic metastases on CT and/or MRI. Of the 15 patients evaluated for liver transplantation, we omitted 7 (46.6%) from further screening because of evidence of metastatic deposits not seen by conventional imaging. Overall, 68Ga-DOTATOC PET/CT altered our treatment decision based on CT and/or MRI alone, in 31 (59.6%) of the 52 patients.
In this study, 68Ga-DOTATOC PET/CT proved clearly superior to CT and/or MRI for detection and staging of NET. More important, 68Ga-DOTATOC PET/CT impacted our treatment decision in more than every second patient.
评估 68Ga-DOTATOC 正电子发射断层扫描（PET）/计算机断层扫描（CT）对神经内分泌肿瘤（NET）多模态管理的影响。
确定 NET 的范围和进展对于决定选择哪种治疗方案是必要的。然而，CT 或磁共振成像（MRI）等形态影像学检查在识别原发肿瘤和/或检测小转移病灶方面往往不够充分。
共有 52 名经组织学证实的 NET 患者符合本协议的比较条件，包括 68Ga-DOTATOC PET/CT 与 CT 和/或 MRI。这些检查是为了进行肿瘤分期，在某些情况下，还为了确定原发肿瘤部位，以评估患者接受治疗的资格。每位患者均在其他地方进行 CT 和/或 MRI 检查，然后在我院连续进行 68Ga-DOTATOC PET/CT 检查。
在所有 52 名患者中，68Ga-DOTATOC PET/CT 显示至少 1 个肿瘤部位存在病理性摄取增加，患者的敏感性为 100%。在 4 名原发肿瘤部位未知的患者中，68Ga-DOTATOC PET/CT 显示了 CT 和/或 MRI 未识别的原发肿瘤区域（空肠、回肠和胰腺）。在 33 名 CT 和/或 MRI 诊断为肝转移的患者中，68Ga-DOTATOC PET/CT 检测到了另外 22 例肝内和/或肝外转移。在 15 名接受肝移植评估的患者中，我们因常规影像学未见转移灶而排除了 7 名（46.6%）患者进一步筛查。总体而言，在 52 名患者中，有 31 名（59.6%）患者因 68Ga-DOTATOC PET/CT 改变了我们基于 CT 和/或 MRI 的治疗决策。
在这项研究中，68Ga-DOTATOC PET/CT 在 NET 的检测和分期方面明显优于 CT 和/或 MRI。更重要的是，在超过一半的患者中，68Ga-DOTATOC PET/CT 影响了我们的治疗决策。
