定量 F-DOPA PET/CT 在嗜铬细胞瘤中的应用：肿瘤分泌与其生化表型的关系。
Quantitative F-DOPA PET/CT in pheochromocytoma: the relationship between tumor secretion and its biochemical phenotype.
机构信息
Department of Endocrinology, Conception University Hospital, Aix-Marseille University, Marseille, France.
Department of Endocrine Surgery, Conception University Hospital, Aix-Marseille University, Marseille, France.
出版信息
Eur J Nucl Med Mol Imaging. 2018 Feb;45(2):278-282. doi: 10.1007/s00259-017-3833-y. Epub 2017 Sep 16.
INTRODUCTION
F-FDOPA illustrates the properties of uptake and storage of catecholamines in pheochromocytomas (PHEOs). Until now, the relationship between F-FDOPA quantitative parameters and a PHEO secretory profile has not been specifically evaluated.
MATERIALS AND METHODS
Fifty-six patients (56% females, median age: 47.5 yrs) with non-metastatic PHEO, evaluated by F-FDOPA PET/CT, were included in this retrospective study. Forty-five patients had negative genetic testing (80.4%); five patients (8.9%) had RET, two patients (3.6%) had SDHB, two had SDHD (3.6%), one patient (1.8%) had NF1, and one patient had a VHL (1.8%) mutation. Correlation between F-FDOPA metabolic parameters (tumor SUVmax, tumor SUVmean, tumor SUVmax/liver SUVmax, MTV 42%, total lesion uptake), urinary metanephrines (MNs), and plasma chromogranin A (CgA) were evaluated.
RESULTS
All patients had positive F-FDOPA PET/CT. On univariate analysis, there was a strong correlation between all metabolic parameters and urinary MNs and plasma chromogranin A (CgA). The highest correlations were observed between total lesion (TL) uptake and the value of urinary MNs regardless of their nature (p = 8.10 and r = 0.80) and between MTV 42% and plasma CgA levels (p = 2.10, r = 0.74). On multivariate analysis, the correlation of uptake parameters and CgA levels did not persist further due to the relation of CgA and tumor diameter. A correlation between TL uptake and the normetanephrine/metanephrine ratio (NMN/MN) was also found, a finding that was in accordance with in vitro studies, which were found to have a higher catecholamine content in epinephrine producing PHEOs.
CONCLUSION
This retrospective study shows a correlation between F-FDOPA uptake, especially using TL uptake, urinary MNs, and a PHEO biochemical phenotype. This illustrates that beyond its localization value, F-FDOPA PET further enables PHEO characterization at a specific metabolic level.
介绍
F-FDOPA 表明了儿茶酚胺摄取和储存的特性在嗜铬细胞瘤（PHEO）中。到目前为止，F-FDOPA 定量参数与 PHEO 分泌特征之间的关系尚未得到专门评估。
材料和方法
本回顾性研究纳入了 56 名（56%为女性，中位年龄：47.5 岁）经 F-FDOPA PET/CT 评估的非转移性 PHEO 患者。45 名患者的基因检测结果为阴性（80.4%）；5 名患者（8.9%）存在 RET 突变，2 名患者（3.6%）存在 SDHB 突变，2 名患者（3.6%）存在 SDHD 突变，1 名患者（1.8%）存在 NF1 突变，1 名患者（1.8%）存在 VHL 突变。评估了 F-FDOPA 代谢参数（肿瘤 SUVmax、肿瘤 SUVmean、肿瘤 SUVmax/肝 SUVmax、MTV 42%、肿瘤总体摄取）、尿间甲肾上腺素（MNs）和血浆嗜铬粒蛋白 A（CgA）之间的相关性。
结果
所有患者的 F-FDOPA PET/CT 均为阳性。在单变量分析中，所有代谢参数与尿 MNs 和血浆 CgA 之间存在强烈相关性。在 TL 摄取与尿 MNs 值之间观察到最强的相关性，无论其性质如何（p=8.10，r=0.80），在 MTV 42%与血浆 CgA 水平之间也观察到最强的相关性（p=2.10，r=0.74）。在多变量分析中，由于 CgA 与肿瘤直径之间的关系，摄取参数与 CgA 水平的相关性不再持续。还发现 TL 摄取与间甲肾上腺素/去甲肾上腺素比值（NMN/MN）之间存在相关性，这一发现与体外研究结果一致，体外研究发现，在产生肾上腺素的 PHEO 中，儿茶酚胺含量较高。
结论
这项回顾性研究表明，F-FDOPA 摄取（尤其是使用 TL 摄取）与尿 MNs 和 PHEO 生化表型之间存在相关性。这表明，除了定位价值外，F-FDOPA PET 还可以进一步在特定代谢水平上对 PHEO 进行特征描述。
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