Yamamoto Shinji, Wassberg Cecilia, Hellman Per, Sundin Anders
Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Neuroendocrinology. 2014;100(1):60-70. doi: 10.1159/000365516. Epub 2014 Jul 5.
Accurate detection of recurrent disease and restaging are essential in the postoperative surveillance of many patients with pheochromocytomas (PHEOs) and paragangliomas (PGLs). In this study, the impact of positron emission tomography (PET) and PET/computed tomography (CT) with (11)C-hydroxyephedrine (HED) was evaluated for the postoperative surveillance and diagnosis of recurrent disease and for functional monitoring of locoregional and systemic therapy.
One hundred and eleven HED-PET and PET/CT examinations performed in 48 patients after surgical intervention for PHEO/PGL were analyzed retrospectively. In a subgroup of 16 patients who underwent systemic and locoregional therapies, the tracer uptake in tumors was also measured as the functional volume (FV), maximum standardized uptake value (SUVmax), mean SUV (SUVmean) and as the total catecholamine transporter tumor volume (TCTTV) calculated as TCTTV = FV × SUVmean. The PET imaging results were correlated with CT/magnetic resonance imaging findings and biochemical and clinical follow-up data.
In the first postoperative examination, HED-PET was positive in 24/48 and negative in 24/48 patients with no false-positive results, yielding 92.3% sensitivity and 100% specificity. For the 16 patients, there was a significant correlation between FV and SUVmax and SUVmax and TCTTV. TCTTV correlated significantly with plasma and urinary catecholamines. In 11/16 patients, SUVmax and TCTTV increased/decreased in parallel but not in the remaining 5 patients.
HED-PET and PET/CT were found to be valuable in the postoperative follow-up in detecting recurrent and metastatic disease. In a subgroup of patients, functional monitoring of systemic and locoregional therapies was feasible by assessing the changes of the TCTTV, and therefore warrants further prospective evaluation.
准确检测复发性疾病和重新分期对于许多嗜铬细胞瘤（PHEO）和副神经节瘤（PGL）患者的术后监测至关重要。在本研究中，评估了正电子发射断层扫描（PET）以及（11）C - 羟基麻黄碱（HED）PET/计算机断层扫描（CT）对复发性疾病的术后监测和诊断以及局部区域和全身治疗功能监测的影响。
回顾性分析了48例接受PHEO/PGL手术干预后进行的111次HED - PET和PET/CT检查。在16例接受全身和局部区域治疗的患者亚组中，还测量了肿瘤中的示踪剂摄取，作为功能体积（FV）、最大标准化摄取值（SUVmax）、平均SUV（SUVmean）以及作为总儿茶酚胺转运体肿瘤体积（TCTTV），计算方法为TCTTV = FV×SUVmean。PET成像结果与CT/磁共振成像结果以及生化和临床随访数据相关。
在首次术后检查中，48例患者中24例HED - PET呈阳性，24例呈阴性，无假阳性结果，敏感性为92.3%，特异性为100%。对于16例患者，FV与SUVmax以及SUVmax与TCTTV之间存在显著相关性。TCTTV与血浆和尿儿茶酚胺显著相关。在16例患者中的11例中，SUVmax和TCTTV平行增加/减少，但其余5例患者并非如此。
发现HED - PET和PET/CT在检测复发性和转移性疾病的术后随访中具有价值。在一部分患者亚组中，通过评估TCTTV的变化对全身和局部区域治疗进行功能监测是可行的，因此值得进一步进行前瞻性评估。
