Sainz-Esteban Aurora, Olmos Roberto, González-Sagrado Manuel, González María Luisa, Ruiz María Ángeles, García-Talavera Paloma, Gamazo Claudia, Villanueva Juan Gabriel, Cobo Amparo, de Luis Daniel
aDepartment of Nuclear Medicine, Hospital Clínico Universitario de Valladolid bInstitute of Endocrinology cDepartment of Endocrinology, Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain.
Nucl Med Commun. 2015 Mar;36(3):251-9. doi: 10.1097/MNM.0000000000000239.
The aim of the study was to assess the contribution of 111In-pentetreotide single-photon emission computed tomography/computed tomography (SPECT/CT) imaging to conventional somatostatin receptor scintigraphy (SRS) in terms of lesion characterization and localization in the detection of neuroendocrine tumours (NETs).
A total of 107 patients with suspected or confirmed NET underwent SRS and SPECT/CT after the injection of 148-222 MBq of 111In-pentetreotide. SRS and SPECT/CT images were interpreted independently. Each site of abnormal tracer uptake was recorded according to the anatomical localization, and as being consistent or not with NET. The findings were confirmed with pathological and/or clinical/imaging follow-up data.
A final diagnosis of NET was achieved in 49/107 patients (45.8%). No evidence of NET was found in the rest. SPECT/CT resulted in a significant reduction of indeterminate cases [14/107 (13.1%) vs. 1/107 (0.9%); P<0.001] and correctly reclassified one patient as negative for NET and another as positive for NET. SPECT/CT had 87.8% sensitivity and 96.6% specificity on a patient-based analysis, statistically higher than SRS (P<0.001). A total of 160 foci were detected (108 NETs and 52 physiological/benign tumours). SRS correctly classified 105/160 foci (65.6%) and remained inaccurate for 55 lesions. These 55 included 31 indeterminate lesions, 12 lesions detected only by SPECT/CT and 12 false-positive lesions. The number of foci correctly classified on the SPECT/CT images was 151/160 (94.4%), whereas two remained indeterminate and seven were false-positive findings.
SPECT/CT provides incremental diagnostic value over SRS, mainly because of a precise anatomical localization that helps discriminate between tumour lesions and physiological uptake. SPECT/CT may detect unsuspected lesions in a small proportion of patients.
本研究旨在评估铟-111 喷替肽单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）成像在神经内分泌肿瘤（NETs）检测中对传统生长抑素受体闪烁显像（SRS）在病变特征描述和定位方面的贡献。
107 例疑似或确诊为 NET 的患者在注射 148 - 222 MBq 的铟-111 喷替肽后接受了 SRS 和 SPECT/CT 检查。SRS 和 SPECT/CT 图像由独立人员解读。根据解剖定位记录每个异常示踪剂摄取部位，并判断其是否与 NET 一致。研究结果通过病理和/或临床/影像随访数据得以证实。
107 例患者中有 49 例（45.8%）最终确诊为 NET。其余患者未发现 NET 证据。SPECT/CT 显著减少了不确定病例数[14/107（13.1%）对 1/107（0.9%）；P<0.001]，并正确地将 1 例患者重新分类为 NET 阴性，另 1 例为 NET 阳性。基于患者分析，SPECT/CT 的敏感性为 87.8%，特异性为 96.6%，在统计学上高于 SRS（P<0.001）。共检测到 160 个病灶（108 个 NET 和 52 个生理性/良性肿瘤）。SRS 正确分类了 160 个病灶中的 105 个（65.6%），对 55 个病变判断不准确。这 55 个病变包括 31 个不确定病变、12 个仅通过 SPECT/CT 检测到的病变和 12 个假阳性病变。SPECT/CT 图像上正确分类的病灶数为 160 个中的 151 个（94.4%），其中 2 个仍不确定，7 个为假阳性结果。
SPECT/CT 相对于 SRS 具有更高的诊断价值，主要是因为其精确的解剖定位有助于区分肿瘤病变和生理性摄取。SPECT/CT 可能在一小部分患者中检测到未被怀疑的病变。
