68Ga-DOTANOC PET/CT 成像在多发性内分泌肿瘤综合征患者中的准确性。

Accuracy of 68Ga DOTANOC PET/CT Imaging in Patients With Multiple Endocrine Neoplasia Syndromes.

机构信息

From the *Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi; †Department of Nuclear Medicine and PET/CT, Eastern Diagnostics India Ltd, Kolkata; and ‡Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.

出版信息

Clin Nucl Med. 2015 Jul;40(7):e351-6. doi: 10.1097/RLU.0000000000000775.

DOI:10.1097/RLU.0000000000000775

PMID:25783509

Abstract

OBJECTIVE

The aim of this study was to evaluate the role of ⁶⁸Ga DOTANOC PET/CT imaging in patients with multiple endocrine neoplasia (MEN) syndromes.

PATIENTS AND METHODS

Data of 33 patients (age, 33.5 [13.8] years; male 14/female 19) with MEN syndromes (MEN 1, 9; MEN 2A, 19; MEN 2B, 5) who underwent 41 ⁶⁸Ga DOTANOC PET/CT studies were retrospectively analyzed. Twenty PET/CTs were done for staging and 21 for restating. PET/CT images were evaluated in consensus by 2 nuclear medicine physicians, qualitatively and semiquantitatively (SUV(max)). A combination of histopathology, clinical, and biomarker follow-up was taken as reference standard.

RESULTS

Of the total 41 ⁶⁸Ga DOTANOC PET/CTs, 34 were interpreted as positive for neuroendocrine tumors (NETs) and 7 as negative. The patientwise sensitivity of PET/CT was 94% (95% confidence interval [CI], 80-99), specificity was 71% (95% CI, 29-96), positive predictive value was 94% (95% CI, 80-99), negative predictive value was 71% (95% CI, 29-96), and accuracy was 90%. A total of 74 disease sites were demonstrated on PET/CT, including 41 primary NETs (pancreas, 10; stomach, 2; pheochromocytoma, 10; medullary thyroid carcinoma, 19), 31 metastatic sites (lymph node, 15; liver, 10; bone, 4; lung, 1; breast, 1), and 2 parathyroid adenomas. Lesionwise sensitivity, positive predictive value, and accuracy of PET/CT were 93%, 96%, and 90% overall, 89%, 95%, and 85% for primary tumors, and 100%, 97%, and 97% for metastasis, respectively. Among primary tumors, the SUV(max) of medullary thyroid carcinoma was significantly lower than gastro pancreatic NETs (P = 0.003) and pheochromocytomas (P = 0.003). No site-specific difference was seen in SUV(max) of metastatic lesions.

CONCLUSIONS

⁶⁸Ga DOTANOC PET/CT shows high diagnostic accuracy in MEN syndrome and can demonstrate both primary and metastatic NETs in these patients.

摘要

目的

本研究旨在评估 ⁶⁸Ga DOTANOC PET/CT 成像在多发性内分泌肿瘤（MEN）综合征患者中的作用。

患者和方法

回顾性分析了 33 例 MEN 综合征（MEN 1 9 例；MEN 2A 19 例；MEN 2B 5 例）患者的 41 次 ⁶⁸Ga DOTANOC PET/CT 检查数据（年龄 33.5[13.8]岁；男 14 例/女 19 例）。20 次 PET/CT 用于分期，21 次用于重新分期。由 2 名核医学医师对 PET/CT 图像进行定性和半定量（SUV(max)）分析。以组织病理学、临床和生物标志物随访的综合结果作为参考标准。

结果

在总共 41 次 ⁶⁸Ga DOTANOC PET/CT 中，34 次被解释为神经内分泌肿瘤（NETs）阳性，7 次为阴性。PET/CT 的患者敏感性为 94%（95%置信区间 [CI]，80-99），特异性为 71%（95% CI，29-96），阳性预测值为 94%（95% CI，80-99），阴性预测值为 71%（95% CI，29-96），准确性为 90%。PET/CT 共显示 74 个病灶，包括 41 个原发性 NETs（胰腺 10 个；胃 2 个；嗜铬细胞瘤 10 个；甲状腺髓样癌 19 个）、31 个转移性病灶（淋巴结 15 个；肝 10 个；骨 4 个；肺 1 个；乳腺 1 个）和 2 个甲状旁腺腺瘤。病灶水平的 PET/CT 敏感性、阳性预测值和准确性分别为 93%、96%和 90%，原发性肿瘤分别为 89%、95%和 85%，转移瘤分别为 100%、97%和 97%。在原发性肿瘤中，甲状腺髓样癌的 SUV(max)明显低于胃胰腺 NETs（P=0.003）和嗜铬细胞瘤（P=0.003）。转移性病变的 SUV(max)无明显的部位特异性差异。