Prasad Vikas, Steffen Ingo G, Pavel Marianne, Denecke Timm, Tischer Elisabeth, Apostolopoulou Konstantina, Pascher Andreas, Arsenic Ruza, Brenner Winfried
Department of Nuclear Medicine, Charité Universitätsmedizin, Berlin, Germany.
Department of Hepatology and Gastroenterology, Charité Universitätsmedizin, Campus Virchow Klinikum, Berlin, Germany.
EJNMMI Res. 2015 Dec;5(1):53. doi: 10.1186/s13550-015-0130-2. Epub 2015 Oct 12.
To assess the role of somatostatin receptor (SR) PET/CT using Ga-68 DOTATOC or DOTATATE in staging and restaging of typical (TC) and atypical (AC) lung carcinoids.
Clinical and PET/CT data were retrospectively analyzed in 27 patients referred for staging (N = 5; TC, N = 4; AC, N = 1) or restaging (N = 22; TC, N = 8; AC, N = 14). Maximum standardized uptake value (SUVmax) of SR-positive lesions was normalized to the SUVmax of the liver to generate SUVratio; SR PET was compared to contrast-enhanced (ce) CT. The classification system proposed by Rindi et al. (Endocr Relat Cancer. 2014;21(1):1-16, 2014) was used for classification of patients in TC and AC groups.
Only 18/27 patients were found to have metastases on PET/CT. Of the 186 lesions, 101 (54.3 %) were depicted on both PET and CT, 53 (28.5 %) lesions only on CT, and 32 (17.2 %) only on PET. SUVratio of lesions was significantly higher in AC as compared to TC (p < 0.001). In patients referred for restaging, additional findings on PET lead to upstaging with change in management strategy in 5/22 (22.7 %) patients (AC, N = 5; TC, N = 1). In four patients (all AC) referred for restaging and in one patient (TC) referred for staging, additional findings on CT missed on PET lead to correct staging.
Typical and atypical carcinoid patients have complex patterns of metastases which make it necessary to combine functional SR PET and contrast-enhanced CT for appropriate restaging. In patients referred for restaging SR, PET may have a relevant impact on treatment strategy in up to 22.7 of patients with typical and atypical lung carcinoids.
评估使用Ga-68 DOTATOC或DOTATATE的生长抑素受体（SR）PET/CT在典型（TC）和非典型（AC）肺类癌分期及再分期中的作用。
对27例因分期（n = 5；TC，n = 4；AC，n = 1）或再分期（n = 22；TC，n = 8；AC，n = 14）而接受检查的患者的临床和PET/CT数据进行回顾性分析。将SR阳性病变的最大标准化摄取值（SUVmax）根据肝脏的SUVmax进行归一化以生成SUV比值；将SR PET与增强（ce）CT进行比较。采用Rindi等人（《内分泌相关癌症》。2014年；21(1):1 - 16，2014）提出的分类系统对TC组和AC组患者进行分类。
在PET/CT检查中仅18/27例患者发现有转移。在186个病变中，101个（54.3%）在PET和CT上均被显示，53个（28.5%）病变仅在CT上被显示，32个（17.2%）仅在PET上被显示。与TC相比，AC病变的SUV比值显著更高（p < 0.001）。在接受再分期检查的患者中，PET上的额外发现导致5/22（22.7%）例患者分期上调并改变治疗策略（AC，n = 5；TC，n = 1）。在4例接受再分期检查的患者（均为AC）和1例接受分期检查的患者（TC）中，PET上遗漏但CT上发现的额外发现导致了正确分期。
典型和非典型类癌患者具有复杂的转移模式，这使得有必要将功能性SR PET与增强CT相结合以进行恰当的再分期。在接受SR再分期检查的患者中，PET可能对高达22.7%的典型和非典型肺类癌患者的治疗策略产生相关影响。
