镓-多柔比星PET/CT在复发性甲状腺髓样癌中的应用：与铟-奥曲肽SPECT/CT及传统影像学的逐病灶比较
Ga-DOTATATE PET/CT in recurrent medullary thyroid carcinoma: a lesion-by-lesion comparison with In-octreotide SPECT/CT and conventional imaging.
作者信息
Yamaga Lilian Yuri Itaya, Cunha Marcelo L, Campos Neto Guilherme C, Garcia Marcio R T, Yang Ji H, Camacho Cleber P, Wagner Jairo, Funari Marcelo B G
机构信息
Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05651-901, Brazil.
, Rua Jose Maximo Monteiro de Oliveira, 196, Parque dos Príncipes, Osasco, São Paulo, CEP 06030-362, Brazil.
出版信息
Eur J Nucl Med Mol Imaging. 2017 Sep;44(10):1695-1701. doi: 10.1007/s00259-017-3701-9. Epub 2017 Apr 20.
PURPOSE
The aim of this study was to prospectively compare the detection rate of Ga-DOTATATE PET-CT with In-octreotide SPECT-CT and conventional imaging (CI) in medullary thyroid carcinoma (MTC) patients with increased calcitonin (Ctn) levels but negative CI after thyroidectomy.
METHODS
Fifteen patients with raised Ctn levels and/or CI evidence of recurrence underwent Ga-DOTATATE PET-CT, In-octreotide SPECT-CT and CI. Histopathology, CI and biochemical/clinical/imaging follow-up were used as the reference standard. PET/CT, SPECT/CT and CI were compared in a lesion-based and organ-based analysis.
RESULTS
PET/CT evidenced recurrence in 14 of 15 patients. There were 13 true positive (TP), 1 true negative (TN), 1 false positive (FP) and no false negative (FN) cases, resulting in a sensitivity and accuracy of 100% and 93%. SPECT/CT was positive in 6 of 15 cases. There were 6 TP, 2 TN, 7 FN and no FP cases, resulting in a sensitivity of 46% and accuracy of 53%. CI procedures detected tumor lesions in 14 of 15 patients. There were 13 TP, 1TN, 1 FP and no FN cases with a sensitivity of 100% and accuracy of 93%. A significantly higher number of lesions was detected by PET/CT (112 lesions, p = 0.005) and CI (109 lesions, p = 0.005) in comparison to SPECT/CT (16 lesions). There was no significant difference between PET/CT and CI for the total number of detected lesions (p = 0.734). PET/CT detected more lesions than SPECT/CT regardless of the organ. PET/CT detected more bone lesions but missed some neck nodal metastases evidenced by CI. The number of lesions per region demonstrated by PET/CT and CI were similar in the other sites.
CONCLUSION
Ga-DOTATATE PET/CT is superior to In-octreotide SPECT/CT for the detection of recurrent MTC demonstrating a significantly higher number of lesions. Ga-DOTATATE PET/CT showed a superior detection rate compared to CI in demonstrating bone metastases.
目的
本研究旨在前瞻性比较镓-多柔比星PET-CT与铟-奥曲肽SPECT-CT及传统成像（CI）在甲状腺髓样癌（MTC）患者中的检测率，这些患者降钙素（Ctn）水平升高，但甲状腺切除术后CI检查结果为阴性。
方法
15例Ctn水平升高和/或有CI复发证据的患者接受了镓-多柔比星PET-CT、铟-奥曲肽SPECT-CT和CI检查。组织病理学、CI及生化/临床/影像学随访被用作参考标准。在基于病灶和基于器官的分析中对PET/CT、SPECT/CT和CI进行比较。
结果
PET/CT显示15例患者中有14例复发。有13例真阳性（TP）、1例真阴性（TN）、1例假阳性（FP）且无假阴性（FN）病例，灵敏度和准确率分别为100%和93%。SPECT/CT在15例中有6例呈阳性。有6例TP、2例TN、7例FN且无FP病例，灵敏度为46%，准确率为53%。CI检查在15例患者中检测到14例肿瘤病灶。有13例TP、1例TN、1例FP且无FN病例，灵敏度为100%，准确率为93%。与SPECT/CT（16个病灶）相比，PET/CT（112个病灶，p = 0.005）和CI（109个病灶，p = 0.005）检测到的病灶数量明显更多。PET/CT和CI检测到的病灶总数之间无显著差异（p = 0.734）。无论在哪个器官，PET/CT检测到的病灶都比SPECT/CT多。PET/CT检测到更多的骨转移病灶，但遗漏了一些CI显示的颈部淋巴结转移。PET/CT和CI在其他部位显示的每个区域的病灶数量相似。
结论
对于复发性MTC的检测，镓-多柔比星PET/CT优于铟-奥曲肽SPECT/CT，显示出明显更多的病灶。在显示骨转移方面，镓-多柔比星PET/CT的检测率优于CI。
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