Zhou Min, Wang Chenchen, Hu Silong, Zhang Yongping, Yao Zhifeng, Li Jin, Guo Weijian, Zhang Yingjian
Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China.
Nucl Med Commun. 2013 Jul;34(7):694-700. doi: 10.1097/MNM.0b013e328361663a.
The aim of this study was to evaluate the utility of 3'-deoxy-3'-F-fluorothymidine (F-FLT) PET/computed tomography (CT) imaging in the pretreatment evaluation of metastatic gastric cancer in comparison with F-fluorodeoxyglucose (F-FDG) PET/CT imaging.
A total of 39 metastatic gastric cancer patients were enrolled in the study. Attenuation-corrected whole-body F-FLT and F-FDG PET/CT (low-dose CT) imaging was performed on two consecutive days before chemotherapy.
Accumulation of focal activity was visible in primary tumors on F-FLT PET/CT in 36/39 patients and on F-FDG PET/CT in 37/39 patients, with sensitivities of 92.3 and 94.9%, respectively. Further, three of the 36 FLT-avid primary tumors were almost undetected because they were covered by a high background hepatic uptake. Because of the high physiological uptake of F-FLT in the liver [median maximum standardized uptake value (SUVmax) 5.5, range 4.5-8.3] and the bone marrow (median SUVmax 14.8, range 10.8-22.0), the sensitivity of F-FLT PET/CT versus F-FDG PET/CT for detecting liver metastases and bone metastases was 30.0% (6/20) versus 100% (20/20) and 1/5 (20.0%) versus 5/5 (100%), respectively (P<0.05). Metabolically positive findings of lymph node, peritoneal, and ovarian metastases were similar between the two modalities: 96.8% (30/31) versus 93.5% (29/31), 89.5% (17/19) versus 94.7% (18/19), and 90.9% (10/11) versus 90.9% (10/11) of patients for F-FLT versus F-FDG, respectively (P>0.05).
F-FLT PET/CT imaging is not recommended for pretreatment assessment of metastatic gastric cancer as it is not competent enough to evaluate liver and bone metastases; moreover, the high background hepatic uptake may cover the gastric primary tumors located adjacent to the liver.
本研究旨在评估3'-脱氧-3'-氟胸苷（F-FLT）正电子发射断层扫描/计算机断层扫描（PET/CT）成像在转移性胃癌术前评估中的效用，并与氟脱氧葡萄糖（F-FDG）PET/CT成像进行比较。
共有39例转移性胃癌患者纳入本研究。在化疗前连续两天进行衰减校正后的全身F-FLT和F-FDG PET/CT（低剂量CT）成像。
36/39例患者的原发性肿瘤在F-FLT PET/CT上可见局灶性放射性聚集，37/39例患者在F-FDG PET/CT上可见，敏感性分别为92.3%和94.9%。此外，36例FLT摄取阳性的原发性肿瘤中有3例几乎未被检测到，因为它们被肝脏的高本底摄取所掩盖。由于F-FLT在肝脏中的生理性摄取较高[最大标准化摄取值（SUVmax）中位数为5.5，范围为4.5 - 8.3]以及骨髓中（SUVmax中位数为14.8，范围为10.8 - 22.0），F-FLT PET/CT检测肝转移和骨转移的敏感性分别为30.0%（6/20）和100%（20/20），以及1/5（20.0%）和5/5（100%）（P<0.05）。两种检查方式在淋巴结、腹膜和卵巢转移的代谢阳性结果方面相似：F-FLT与F-FDG相比，分别为96.8%（30/31）对93.5%（29/31）、89.5%（17/19）对94.7%（18/19）、90.9%（10/11）对90.9%（10/11）（P>0.05）。
不建议将F-FLT PET/CT成像用于转移性胃癌的术前评估，因为它在评估肝转移和骨转移方面能力不足；此外，肝脏的高本底摄取可能会掩盖位于肝脏附近的胃原发性肿瘤。
