Palomar Muñoz A, García Vicente A M, Bellón Guardia M E, González García B, Talavera Rubio M P, Pilkington Woll J P, Núñez García A, Poblete García V M, Cordero García J M, Soriano Castrejón A
Servicio de Medicina Nuclear, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
Rev Esp Med Nucl Imagen Mol. 2012 May-Jun;31(3):124-9. doi: 10.1016/j.remn.2011.05.002. Epub 2011 Jun 30.
To evaluate the diagnostic yield of a selective brain (18)F-FDG PET/CT in neurologically asymptomatic patients with small cell lung cancer.
Twenty-one neurologically asymptomatic patients referred to our service between July 2008 and December 2009 for staging of small cell lung cancer were included in the study. All underwent a standard (18)F-FDG PET/CT study followed by a selective brain PET/CT. The neurological findings were confirmed by CT scan with intravenous contrast, MRI or minimum clinical follow-up of 6 months. The brain PET/CT was considered positive if any alteration was observed in the FDG distribution that was not related with previously known benign lesion in the CT image.
Brain metastases were detected in 5 of the 21 patients (23.8%), these being correctly classified in 3 of them by the selective brain PET/CT. The stage was upgraded in one of them with the selective brain study. Only one patient showed a hypermetabolic lesion in the PET images in relationship to the lesions observed in the CT images. Sensibility, specificity, positive predictive value and negative predictive value were 60, 100, 100 and 88.89%, respectively.
Hypometabolic areas in the cerebral parenchyma are frequently associated to metastatic lesions in patients with small cell lung cancer. The selective brain PET/CT in these patients allows correct staging and early treatment of unsuspected metastasis.
评估选择性脑（18）F-FDG PET/CT对小细胞肺癌神经无症状患者的诊断价值。
本研究纳入了2008年7月至2009年12月间因小细胞肺癌分期而转诊至我院的21例神经无症状患者。所有患者均接受了标准的（18）F-FDG PET/CT检查，随后进行选择性脑PET/CT检查。神经学检查结果通过静脉注射造影剂的CT扫描、MRI或至少6个月的临床随访得以证实。如果在FDG分布中观察到任何与CT图像中先前已知的良性病变无关的改变，则脑PET/CT被认为是阳性的。
21例患者中有5例（23.8%）检测到脑转移，其中3例通过选择性脑PET/CT正确分类。其中1例患者通过选择性脑检查使分期得以升级。只有1例患者在PET图像中显示出与CT图像中观察到的病变相关的高代谢病变。敏感性、特异性、阳性预测值和阴性预测值分别为60%、100%、100%和88.89%。
小细胞肺癌患者脑实质内的低代谢区域常与转移病变相关。对这些患者进行选择性脑PET/CT检查可实现正确分期并对未被怀疑的转移灶进行早期治疗。
