Kroiss A S, Uprimny C, Shulkin B L, Gruber L, Frech A, Jazbec T, Girod P P, Url C, Thomé C, Riechelmann H, Sprinzl G M, Fraedrich G, Virgolini I J
Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria.
Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria.
Rev Esp Med Nucl Imagen Mol (Engl Ed). 2019 Mar-Apr;38(2):94-99. doi: 10.1016/j.remn.2018.09.004. Epub 2019 Jan 7.
F-Fluoro-L-dihydroxyphenylalanine (F-DOPA) PET offers high sensitivity and specificity in the imaging of non-malignant extra-adrenal paraganglioma (PGL) and pheochromocytoma (PHEO) but lower sensitivity in metastatic disease. These tumours are of neuroendocrine origin and can be detected by Ga-DOTA-Tyr3-octreotide (Ga-DOTA-TOC) PET. Therefore, we compared Ga-DOTA-TOC and F-DOPA as radiolabels for PET/CT imaging for the diagnosis of metastatic extra-adrenal PGL and PHEO. Combined cross-sectional imaging was the reference standard.
A total of 6 men and 4 women (age range 22-72 years) with anatomical and/or histologically proven metastatic PGL and PHEO were included in this study. Of these patients, 2 male patients suffered from PHEO, while the remaining 8 patients were diagnosed as metastatic extra-adrenal PGL disease. Comparative evaluation included morphological imaging with CT and functional imaging with Ga-DOTA-TOC and F-DOPA PET. The imaging results were analyzed on a per-lesion basis. The maximum standardized uptake value (SUV) of each functional imaging modality in concordant tumour lesions was measured.
Compared with anatomical imaging, the per-lesion detection rate of Ga-DOTA-TOC was 100% (McNemar, P<0.01), and that of F-DOPA PET was 82.3% (McNemar, P<0.8) in metastatic extra-adrenal PGL and PHEO. Overall, Ga-DOTA-TOC PET identified 67 lesions; anatomical imaging identified 62 lesions, and F-DOPA PET identified 56 lesions. The SUV (mean±SD) of all concordant lesions was 29.3±19.9 for Ga-DOTA-TOC PET and 12.3±9.1 for F-DOPA PET (Mann-Whitney U test, P<0.0001).
Ga-DOTA-TOC PET offers the highest detection rate in metastatic extra-adrenal PGL and PHEO compared to F-DOPA PET and even to diagnostic CT, particularly in bone lesions. Combined functional/anatomical imaging (Ga-DOTA-TOC PET/CT) enables exact tumour extension to be detected in these rare tumour entities, especially in the case of unclear anatomical correlation.
F - 氟 - L - 二羟基苯丙氨酸（F - DOPA）PET在非恶性肾上腺外副神经节瘤（PGL）和嗜铬细胞瘤（PHEO）成像中具有高灵敏度和特异性，但在转移性疾病中灵敏度较低。这些肿瘤起源于神经内分泌，可通过镓 - DOTA - 酪胺酸3 - 奥曲肽（Ga - DOTA - TOC）PET检测。因此，我们比较了Ga - DOTA - TOC和F - DOPA作为PET/CT成像的放射性示踪剂用于诊断转移性肾上腺外PGL和PHEO。联合横断面成像作为参考标准。
本研究纳入了6名男性和4名女性（年龄范围22 - 72岁），其具有解剖学和/或组织学证实的转移性PGL和PHEO。在这些患者中，2名男性患者患有PHEO，其余8名患者被诊断为转移性肾上腺外PGL疾病。比较评估包括CT形态学成像以及Ga - DOTA - TOC和F - DOPA PET功能成像。对每个病灶的成像结果进行分析。测量了每个功能成像模态在一致肿瘤病灶中的最大标准化摄取值（SUV）。
与解剖学成像相比，在转移性肾上腺外PGL和PHEO中，Ga - DOTA - TOC的病灶检出率为100%（McNemar检验，P < 0.01），F - DOPA PET的病灶检出率为82.3%（McNemar检验，P < 0.8）。总体而言，Ga - DOTA - TOC PET识别出67个病灶；解剖学成像识别出62个病灶，F - DOPA PET识别出56个病灶。Ga - DOTA - TOC PET所有一致病灶的SUV（均值±标准差）为29.3±19.9，F - DOPA PET为12.3±9.1（Mann - Whitney U检验，P < 0.0001）。
与F - DOPA PET甚至诊断性CT相比，Ga - DOTA - TOC PET在转移性肾上腺外PGL和PHEO中的检出率最高，尤其是在骨病灶中。功能/解剖学联合成像（Ga - DOTA - TOC PET/CT）能够在这些罕见肿瘤实体中检测到准确的肿瘤范围，特别是在解剖学关联不明确的情况下。
