Zhang Shu, Wang Ling, Wang Tong, Xing Hai Qun, Huo Li, Li Fang
Department of Nuclear Medicine, ,Beijing 100730,China.
Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2018 Dec 20;40(6):757-764. doi: 10.3881/j.issn.1000-503X.10693.
Objective To analyze Ga-DOTA-TATE positron emission tomography/computed tomography (PET/CT) imaging features of tumor-indud osteomalacia (TIO) patients with negative Tc-HYNIC-TOC single photo emission computed tomography (SPECT) findings and to investigate the value of Ga-DOTA-TATE PET/CT in accurate localization of culprit tumors.Methods We retrospectively analyzed Ga-DOTA-TATE PET/CT imaging features including location,size,density,the maximum and mean standardized uptake value in 37 TIO patients with negative Tc-HYNIC-TOC SPECT findings.Results Totally 37 solitary TIO tumors,including 35 phosphaturic mesenchymal tumors and 2 spindle cell tumors confirmed by pathological examinations,were detected via Ga-DOTA-TATE PET/CT scans in the included 37 cases. These 37 TIO tumors showed obviously increased activities,with an maximum standardized uptake value of 7.2±4.3 and mean standardized uptake value of 4.3±2.4. The average maximum diameter was (1.9±0.7) cm. The majority of the tumors occurred in the lower extremities (19/37),followed by the trunk (11/37),maxillary/mandibular bone (5/37),and upper extremities (2/37). In addition,24 bone lesions were located in long bones of lower extremities (13/24),most of which demonstrated eccentric growth (8/13). Osteolytic changes (14/24) were observed mainly in the lesions via the corresponding CT imaging;meanwhile,sclerotic changes presented in nine cases. Of the 13 soft-tissue lesions,the majority (10/13) showed well-circumscribed isodense or hypodense nodules on the CT images,with spot calcification in one lesion located in the pleura.Conclusions Ga-DOTA-TATE PET/CT scans can detect the TIO culprit tumors miss-diagnosed by Tc-HYNIC-TOC SPECT. Somatostatin-receptors highly expressed lesions with focal osteolytic or osteosclerotic change in bone and isodense or hypodense nodules in soft tissue will favor the diagnosis of TIO tumors.
目的 分析锝[99mTc]泮替膦酸盐（Tc-HYNIC-TOC）单光子发射计算机断层扫描（SPECT）结果为阴性的肿瘤诱导性骨软化症（TIO）患者的镓[68Ga] DOTATATE正电子发射断层扫描/计算机断层扫描（PET/CT）影像特征，探讨Ga-DOTA-TATE PET/CT在TIO致病肿瘤精确定位中的价值。方法 回顾性分析37例Tc-HYNIC-TOC SPECT结果为阴性的TIO患者的Ga-DOTA-TATE PET/CT影像特征，包括位置、大小、密度、最大标准摄取值及平均标准摄取值。结果 37例患者经Ga-DOTA-TATE PET/CT扫描共检测到37个孤立性TIO肿瘤，其中35个为磷酸尿性间叶肿瘤，2个为梭形细胞瘤，经病理检查确诊。这37个TIO肿瘤均表现为放射性摄取明显增高，最大标准摄取值为7.2±4.3，平均标准摄取值为4.3±2.4。平均最大直径为（1.9±0.7）cm。多数肿瘤发生于下肢（19/37），其次为躯干（11/37）、上颌骨/下颌骨（5/37）和上肢（2/37）。此外，24处骨病变位于下肢长骨（13/24），其中大部分呈偏心性生长（8/13）。通过相应CT影像观察，病变主要表现为溶骨性改变（14/24），9例出现硬化性改变。13处软组织病变中，多数（10/13）在CT图像上表现为边界清晰的等密度或低密度结节，1处位于胸膜的病变有斑点状钙化。结论 Ga-DOTA-TATE PET/CT扫描可检测出被Tc-HYNIC-TOC SPECT漏诊的TIO致病肿瘤。骨内有局灶性溶骨或骨硬化改变、软组织内有等密度或低密度结节且生长抑素受体高表达的病变有助于TIO肿瘤的诊断。
