Packard Ann T, Broski Stephen M, Callstrom Matthew R, Atwell Thomas D, Schmit Grant D, Schmitz John J, Morris Jonathan M, Hunt Christopher H, Kurup A Nicholas
1 All authors: Department of Radiology, Mayo Clinic Rochester, Mayo Bldg E2, 200 First St SW, Rochester, MN 55905.
AJR Am J Roentgenol. 2017 Jun;208(6):1342-1351. doi: 10.2214/AJR.16.17222. Epub 2017 Mar 23.
The purpose of this study is to evaluate the utility of combined PET/CT for the detection of early local tumor progression after cryoablation of bone metastases.
A retrospective single-institution review revealed 61 consecutive patients with 80 separate bone metastases treated with cryoablation who were evaluated with a preablation PET/CT and at least two postablation PET/CT examinations between September 2007 and July 2015. Patients were excluded if they had local therapy or pathologic fracture after ablation. The patients were grouped according to postcryoablation disease status (i.e., local tumor progression or not) and PET radiotracer (i.e., C-choline or F-FDG) used. The maximum standardized uptake value (SUV) ratio (i.e., ratio of SUV to blood pool) was calculated within each osseous metastasis before and after cryoablation, and these were then compared between groups.
Of the 61 patients and 80 ablations performed, 32 patients were imaged with FDG PET/CT and 29 were imaged with C-choline PET/CT. Twenty-three patients imaged with FDG and 13 patients imaged with C-choline had evidence of local tumor progression on all postablation PET/CT examinations. The SUV ratio was significantly higher in patients with local tumor progression on the first and most remote postcryoablation PET/CT examinations for both FDG and C-choline (p < 0.001 in all cases). There was no significant difference in the postablation systemic therapy between the groups with and without local tumor progression.
Increased SUV ratio in patients after cryoablation for osseous metastatic disease should raise concern about local tumor progression independently of time after ablation.
本研究旨在评估联合正电子发射断层显像/计算机断层扫描（PET/CT）在检测骨转移瘤冷冻消融术后早期局部肿瘤进展方面的效用。
一项回顾性单机构研究纳入了61例连续患者，这些患者共有80处独立的骨转移瘤接受了冷冻消融治疗，并在2007年9月至2015年7月期间接受了消融前PET/CT及至少两次消融后PET/CT检查。如果患者在消融后接受了局部治疗或发生病理性骨折，则将其排除。根据冷冻消融术后疾病状态（即局部肿瘤是否进展）和使用的PET放射性示踪剂（即C-胆碱或F-FDG）对患者进行分组。计算每个骨转移瘤在冷冻消融前后的最大标准化摄取值（SUV）比值（即SUV与血池的比值），然后在组间进行比较。
在61例患者所进行的80次消融中，32例患者接受了FDG PET/CT成像，29例患者接受了C-胆碱PET/CT成像。在所有消融后PET/CT检查中，23例接受FDG成像和13例接受C-胆碱成像的患者有局部肿瘤进展的证据。对于FDG和C-胆碱，在首次及最末次冷冻消融后PET/CT检查中，局部肿瘤进展患者的SUV比值显著更高（所有情况均p < 0.001）。有或无局部肿瘤进展的组间消融后全身治疗无显著差异。
骨转移性疾病冷冻消融术后患者SUV比值升高应引起对局部肿瘤进展的关注，且与消融后的时间无关。
