神经内分泌肿瘤复发：68Ga-DOTATATE PET/CT 诊断。
Neuroendocrine tumor recurrence: diagnosis with 68Ga-DOTATATE PET/CT.
机构信息
From the Department of Nuclear Medicine (A.R.H., R.C., B.W., C.U., P.B., M.H.), Interdisciplinary Center of Neuroendocrine Tumors of the Gastro-Entero-Pancreatic System (A.R.H., C.J.A., C.S., P.B.), Department of Internal Medicine 2 (C.J.A., C.S.), Medizinische Klinik und Poliklinik 4 (M.R., F.B.), and Institute of Clinical Radiology (G.P.S.), Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, Munich 81377, Germany; and Department of Nuclear Medicine, Medical University of Vienna, Vienna, Austria (M.H.).
出版信息
Radiology. 2014 Feb;270(2):517-25. doi: 10.1148/radiol.13122501. Epub 2013 Oct 28.
PURPOSE
To evaluate diagnostic performance of gallium 68-tetraazacyclododecane tetraacetic acid-octreotate ((68)Ga-DOTATATE) in detection of recurrent neuroendocrine tumors (NETs).
MATERIALS AND METHODS
Approval was waived by the local ethics committee for this retrospective study. Between 2007 and 2011, 63 patients (mean age, 58 years) were examined with (68)Ga-DOTATATE positron emission tomography (PET)/computed tomography (CT) after primary NET curative resection. Reasons for PET/CT were regular follow-up examinations (n = 30), increased plasma levels of tumor markers (n = 27), or clinical suspicion of recurrence (n = 6). Final diagnosis was determined with histopathologic verification (n = 25) or clinical follow-up (n = 38). PET/CT scans were evaluated in consensus by two readers without blinding to clinical information and independently by two readers with blinding. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.
RESULTS
Final diagnosis of NET recurrence was determined in 29 patients. In three other patients, tumors of nonneuroendocrine origin were diagnosed. (68)Ga-DOTATATE PET/CT helped identify NET recurrence in 26 of 29 patients (sensitivity, 90%) and exclude presence of recurrent NET in 28 of 34 patients (specificity, 82% ). PET/CT provided false-positive and false-negative results in six and three patients (PPV, 81% [26 of 32]; NPV, 90% [28 of 31]; accuracy, 86% [54 of 63]). In gastroenteropancreatic NET (n = 45), sensitivity was 94% (17 of 18); specificity was 89% (24 of 27); PPV was 85% (17 of 20); NPV was 96% (24 of 25); and accuracy was 91% (41 of 45). Two blinded readers achieved sensitivity of 79% (23 of 29) and 76% (22 of 29); specificity of 85% (29 of 34) and 94% (32 of 34) (κ = 0.80); and accuracy of 83% and 86%.
CONCLUSION
(68)Ga-DOTATATE PET/CT is accurate in detection of recurrent NET. Blinded PET/CT review markedly decreased sensitivity, underlining importance of considering clinical parameters in NET recurrence. Present results must be further validated to substantiate use of (68)Ga-DOTATATE PET/CT in routine follow-up after curative resection of NET.
目的
评估镓 68-四氮杂环十二烷四乙酸-奥曲肽（68Ga-DOTATATE）在检测复发性神经内分泌肿瘤（NETs）中的诊断性能。
材料与方法
本回顾性研究经当地伦理委员会批准豁免。2007 年至 2011 年间，63 例经 NET 根治性切除后接受 68Ga-DOTATATE 正电子发射断层扫描（PET）/计算机断层扫描（CT）的患者纳入研究。行 PET/CT 的原因包括常规随访检查（n=30）、肿瘤标志物血浆水平升高（n=27）或临床怀疑复发（n=6）。最终诊断通过组织病理学证实（n=25）或临床随访（n=38）确定。由两位读者进行共识评估，评估时不设盲并独立进行由两位读者进行设盲评估。计算敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
结果
29 例患者的 NET 复发最终诊断为阳性。另外 3 例患者被诊断为非神经内分泌肿瘤。68Ga-DOTATATE PET/CT 有助于在 29 例患者中的 26 例（敏感性 90%）中识别 NET 复发，并在 34 例患者中的 28 例（特异性 82%）中排除存在 NET 复发。6 例和 3 例患者出现假阳性和假阴性结果（PPV，81%[32 例中的 26 例]；NPV，90%[31 例中的 28 例]；准确性，86%[63 例中的 54 例]）。在胃肠胰腺 NET（n=45）中，敏感性为 94%（18 例中的 17 例）；特异性为 89%（27 例中的 24 例）；PPV 为 85%（20 例中的 17 例）；NPV 为 96%（25 例中的 24 例）；准确性为 91%（45 例中的 41 例）。2 位设盲读者的敏感性分别为 79%（29 例中的 23 例）和 76%（29 例中的 22 例）；特异性分别为 85%（34 例中的 29 例）和 94%（34 例中的 32 例）（κ=0.80）；准确性分别为 83%和 86%。
结论
68Ga-DOTATATE PET/CT 可准确检测 NET 复发。盲法 PET/CT 复查显著降低了敏感性，强调在 NET 复发中考虑临床参数的重要性。目前的结果需要进一步验证，以证实 68Ga-DOTATATE PET/CT 在 NET 根治性切除后的常规随访中的应用。
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