Bongiovanni Alberto, Recine Federica, Celli Monica, Marcantognini Giulia, Foca Flavia, Liverani Chiara, Fausti Valentina, De Vita Alessandro, Miserocchi Giacomo, Mercatali Laura, Amadori Dino, Ibrahim Toni
aOsteoncology and Rare Tumors Center bDiagnostic Nuclear Medicine Unit cUnit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
Medicine (Baltimore). 2017 Nov;96(46):e8567. doi: 10.1097/MD.0000000000008567.
Choline (CH) positron emission tomography (PET)/computed tomography (CT) with fluorine 18 (F) CH is increasingly used not only to evaluate patients with biochemically recurrent prostate cancer but also to assess metastatic lesions that are difficult or impossible to identify using more conventional modalities. Our experience with CH PET/CT has shown that it can also be used for many other malignancies.
A 71-year-old male with a neuroendocrine tumor (NET) of unknown origin showed osteoblastic bone metastases positive to F-CH PET.
Diffuse bone and liver metastases were gallium-DOTATOC PET-positive with only mild uptake on FDG PET/CT. An increased prostate specific antigen (8 μg/L) gave rise to a suspicion of concurrent prostate cancer and the patient underwent F-CH PET/CT which showed diffuse uptake in the bone. A CT-guided bone biopsy confirmed osteoblastic bone metastases from NET.
Given the aggressiveness of the tumor, the patient underwent treatment with temozolomide from July 2015 to December 2015, maintaining stable disease. However, progression was documented in January 2016 and the patient was enrolled onto a phase II peptide receptor radionuclide therapy retreatment trial, which is currently ongoing.
Our study highlights that NETs should be taken into consideration in the differential diagnosis of osteoblastic bone metastases showing F-CH uptake. A prognostic role for this imaging technique can also be hypothesized.
使用氟-18（F）胆碱（CH）进行正电子发射断层扫描（PET）/计算机断层扫描（CT），不仅越来越多地用于评估生化复发前列腺癌患者，还用于评估使用更传统方法难以或无法识别的转移病灶。我们使用CH PET/CT的经验表明，它也可用于许多其他恶性肿瘤。
一名71岁男性患有起源不明的神经内分泌肿瘤（NET），F-CH PET显示成骨性骨转移呈阳性。
弥漫性骨和肝转移在镓-DOTATOC PET上呈阳性，在FDG PET/CT上仅轻度摄取。前列腺特异性抗原升高（8μg/L）引发了对并发前列腺癌的怀疑，患者接受了F-CH PET/CT检查，结果显示骨内弥漫性摄取。CT引导下的骨活检证实为NET的成骨性骨转移。
鉴于肿瘤的侵袭性，患者在2015年7月至2015年12月期间接受了替莫唑胺治疗，病情保持稳定。然而，2016年1月记录到病情进展，患者参加了一项II期肽受体放射性核素治疗再治疗试验，该试验目前正在进行。
我们的研究强调，在鉴别显示F-CH摄取的成骨性骨转移的鉴别诊断中应考虑NET。也可以假设这种成像技术的预后作用。
