Baumann Tobias, Rottenburger Christof, Nicolas Guillaume, Wild Damian
Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland.
Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland; Center of Neuroendocrine and Endocrine Tumors, University of Basel Hospital, Basel, Switzerland.
Best Pract Res Clin Endocrinol Metab. 2016 Jan;30(1):45-57. doi: 10.1016/j.beem.2016.01.003. Epub 2016 Jan 20.
Detection of gastroenteropancreatic neuroendocrine tumours (GEP-NETs) and monitoring of treatment response relies mainly on morphological imaging such as computed tomography (CT) and magnetic resonance imaging (MRI). Molecular imaging techniques also in combination with CT (hybrid imaging) greatly benefit patient management, including better localization of occult tumours and better staging. Somatostatin receptor scintigraphy (SRS) and somatostatin receptor (SSTR) positron emission tomography (PET) play a central role in the diagnostic work-up of patients with well-differentiated GEP-NETs. SSTR PET/CT is superior to SRS and should be used whenever available. (18)F-DOPA and (18)F-FDG PET/CT is inferior to SSTR PET/CT at least in patients with well-differentiated GEP-NETs. Both SSTR PET/CT and SRS have limitations, such as relatively low detection rate of benign insulinomas, poorly differentiated GEP-NETs and liver metastases. New innovations such as SSTR PET/MRI, radiolabelled SSTR antagonists and glucagon-like peptide-1 receptor (GLP-1R) agonists might further improve imaging of GEP-NETs.
胃肠胰神经内分泌肿瘤(GEP-NETs)的检测及治疗反应监测主要依赖于形态学成像,如计算机断层扫描(CT)和磁共振成像(MRI)。分子成像技术与CT联合应用(混合成像)对患者管理大有裨益,包括更精准地定位隐匿性肿瘤以及更准确地进行分期。生长抑素受体闪烁扫描(SRS)和生长抑素受体(SSTR)正电子发射断层扫描(PET)在分化良好的GEP-NETs患者的诊断检查中发挥着核心作用。SSTR PET/CT优于SRS,如有条件应优先使用。至少在分化良好的GEP-NETs患者中,(18)F-DOPA和(18)F-FDG PET/CT不如SSTR PET/CT。SSTR PET/CT和SRS都有局限性,如对良性胰岛素瘤、低分化GEP-NETs及肝转移灶的检出率相对较低。诸如SSTR PET/MRI、放射性标记的SSTR拮抗剂和胰高血糖素样肽-1受体(GLP-1R)激动剂等新进展可能会进一步改善GEP-NETs的成像。