Johnbeck Camilla B, Knigge Ulrich, Loft Annika, Berthelsen Anne K, Mortensen Jann, Oturai Peter, Langer Seppo W, Elema Dennis R, Kjaer Andreas
Department of Clinical Physiology, Nuclear Medicine, and PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
ENETS Neuroendocrine Tumor Center of Excellence, Rigshospitalet, Copenhagen, Denmark.
J Nucl Med. 2017 Mar;58(3):451-457. doi: 10.2967/jnumed.116.180430. Epub 2016 Sep 22.
Somatostatin receptor imaging is a valuable tool in the diagnosis, follow-up, and treatment planning of neuroendocrine tumor (NET). PET-based tracers using Ga as the radioisotope have in most centers replaced SPECT-based tracers as the gold standard. Cu-DOTATATE is a new PET tracer that has been shown to be far superior to the SPECT tracer In-diethylenetriaminepentaacetic acid-octreotide. Because of the advantages of Cu over Ga, we hypothesized that the tracer has a higher sensitivity than Ga-based tracers. To test this hypothesis, we compared on a head-to-head basis the diagnostic performance of Cu-DOTATATE with that of Ga-DOTATOC in NET patients. Fifty-nine NET patients were scanned with both Cu-DOTATATE and Ga-DOTATOC PET/CT and compared on a head-to-head basis. Discordant lesions were verified during at least 30 mo of follow-up. A total of 701 lesions were concordantly detected on both Cu-DOTATATE and Ga-DOTATOC PET/CT scans, whereas an additional 68 lesions were found by only one of the scans. Cu-DOTATATE showed 42 lesions not found on Ga-DOTATOC, of which 33 were found to be true-positive on follow-up. Ga-DOTATOC showed 26 lesions not found on Cu-DOTATATE, of which 7 were found to be true-positive on follow-up. False-positives were mainly lymph node lesions. Accordingly, 83% of the additional true lesions found on only one of the scans were found by Cu-DOTATATE. On a patient-basis, additional true lesions were found by Cu-DOTATATE and Ga-DOTATOC in 13 and 3 patients, respectively. All patients with additional lesions also had concordant lesions found by both scans. Cu-DOTATATE has advantages over Ga-DOTATOC in the detection of lesions in NET patients. Although patient-based sensitivity was the same for Cu-DOTATATE and Ga-DOTATOC in this cohort, significantly more lesions were detected by Cu-DOTATATE. Furthermore, the shelf life of more than 24 h and the scanning window of at least 3 h make Cu-DOTATATE favorable and easy to use in the clinical setting.
生长抑素受体显像在神经内分泌肿瘤（NET）的诊断、随访及治疗规划中是一项有价值的工具。在大多数中心，以镓作为放射性同位素的基于正电子发射断层扫描（PET）的示踪剂已取代基于单光子发射计算机断层扫描（SPECT）的示踪剂成为金标准。铜[64Cu] - DOTATATE是一种新型PET示踪剂，已被证明远优于SPECT示踪剂铟[111In] - 二乙三胺五乙酸 - 奥曲肽。由于铜相较于镓的优势，我们推测该示踪剂比基于镓的示踪剂具有更高的灵敏度。为验证这一假设，我们在NET患者中对铜[64Cu] - DOTATATE与镓[68Ga] - DOTATOC的诊断性能进行了直接比较。59例NET患者接受了铜[64Cu] - DOTATATE和镓[68Ga] - DOTATOC PET/CT扫描，并进行直接比较。在至少30个月的随访期间对不一致的病灶进行了核实。在铜[64Cu] - DOTATATE和镓[68Ga] - DOTATOC PET/CT扫描中总共一致检测到701个病灶，而另外68个病灶仅在其中一次扫描中被发现。铜[64Cu] - DOTATATE显示有42个病灶未在镓[68Ga] - DOTATOC上发现,其中33个在随访中被证实为真阳性。镓[68Ga] - DOTATOC显示有26个病灶未在铜[64Cu] - DOTATATE上发现，其中7个在随访中被证实为真阳性。假阳性主要是淋巴结病灶。因此，仅在一次扫描中发现的额外真病灶中有83%是由铜[64Cu] - DOTATATE发现的。以患者为基础，分别有13例和3例患者通过铜[64Cu] - DOTATATE和镓[68Ga] - DOTATOC发现了额外的真病灶。所有有额外病灶的患者在两次扫描中也都有一致的病灶被发现。在NET患者病灶检测方面，铜[64Cu] - DOTATATE优于镓[68Ga] - DOTATOC。尽管在该队列中，以患者为基础的铜[64Cu] - DOTATATE和镓[68Ga] - DOTATOC的灵敏度相同，但铜[64Cu] - DOTATATE检测到的病灶明显更多。此外，超过24小时的保质期和至少3小时的扫描窗口使得铜[64Cu] - DOTATATE在临床环境中更有利且易于使用。
