Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, CA, USA.
J Nucl Med. 2012 Mar;53(3):393-8. doi: 10.2967/jnumed.111.095711. Epub 2012 Feb 9.
We investigated the impact of (18)F-DOPA brain PET/CT on the clinical management of patients with known or suspected brain tumors.
A prospective survey of referring physicians was conducted. A pre-PET questionnaire inquired about indication, tumor histology or grade, level of suspicion for tumor recurrence, and planned management. Early post-PET questionnaires asked referring physicians to categorize PET findings as negative, equivocal, or positive; assessed the level of suspicion for primary or recurrent brain tumor; and recorded intended management changes prompted by PET findings. A late follow-up questionnaire 6 mo after the scan aimed at determining patient outcome (recurrence, survival). In addition, all referring physicians were contacted to determine whether management changes intended after (18)F-DOPA PET/CT were implemented.
Fifty-eight consecutive patients were included. The clinical suspicion for recurrence increased in 33%, remained unchanged in 50%, and decreased in 17% of patients after adding the PET/CT result to the available diagnostic data. The late post-PET questionnaire confirmed recurrence in 26 patients whereas 32 had stable disease or remained disease-free. (18)F-DOPA PET/CT resulted in intended management changes in 41% of patients. Changes in intended management from wait and watch to chemotherapy (6 patients [25%]) and from chemotherapy to wait and watch (4 patients [17%]) occurred most frequently. Clinical follow-up revealed that 75% of intended treatment changes were implemented.
(18)F-DOPA PET/CT changed the intended management of 41% of patients with brain tumors, and intended management changes were implemented in 75% of these. These changes suggest a potentially important clinical role of imaging amino acid transport in the management of brain tumor patients.
我们研究了（18）F-DOPA 脑 PET/CT 对已知或疑似脑肿瘤患者临床管理的影响。
对转诊医生进行了前瞻性调查。在 PET 检查前的调查问卷中，询问了检查的适应证、肿瘤组织学或分级、肿瘤复发的可疑程度以及计划的治疗方案。在早期的 PET 后调查问卷中，要求转诊医生将 PET 结果归类为阴性、不确定或阳性；评估对原发性或复发性脑肿瘤的怀疑程度；并记录 PET 结果引发的治疗方案的改变。在扫描后 6 个月进行的晚期随访调查问卷旨在确定患者的预后（复发、存活）。此外，还联系了所有转诊医生，以确定（18）F-DOPA PET/CT 检查后计划进行的治疗方案改变是否得到了实施。
共纳入 58 例连续患者。将 PET/CT 结果与现有诊断数据相结合后，33%的患者对肿瘤复发的怀疑程度增加，50%的患者怀疑程度不变，17%的患者怀疑程度降低。晚期的 PET 后调查问卷确认了 26 例患者的复发，而 32 例患者的疾病稳定或保持无疾病状态。（18）F-DOPA PET/CT 导致 41%的患者计划的治疗方案发生改变。最常发生的治疗方案改变是从等待观察到化疗（6 例患者[25%]）和从化疗到等待观察（4 例患者[17%]）。临床随访发现，75%的治疗方案改变得以实施。
（18）F-DOPA PET/CT 改变了 41%脑肿瘤患者的治疗方案，其中 75%的患者实施了治疗方案的改变。这些改变表明，在脑肿瘤患者的治疗中，成像氨基酸转运具有潜在的重要临床作用。
