前瞻性比较 (4S)-4-(3-F-氟丙基)-L-谷氨酸与 F-氟脱氧葡萄糖 PET/CT 检测胰腺导管腺癌转移：一项概念验证研究。
Prospective comparison of (4S)-4-(3-F-fluoropropyl)-L-glutamate versus F-fluorodeoxyglucose PET/CT for detecting metastases from pancreatic ductal adenocarcinoma: a proof-of-concept study.
机构信息
Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Rd., Taipei, 10002, Taiwan, Republic of China.
出版信息
Eur J Nucl Med Mol Imaging. 2019 Apr;46(4):810-820. doi: 10.1007/s00259-018-4251-5. Epub 2019 Jan 11.
PURPOSE
(4S)-4-(3-F-Fluoropropyl)-L-glutamate (FSPG) positron emission tomography (PET) reflects system x transporter (xCT) expression. FSPG PET has been used to detect brain, lung, breast and liver cancer with only modest success. There is no report on the use of FSPG PET in pancreatic ductal adenocarcinoma (PDAC), presumably because of normal xCT expression in the pancreas. Nonetheless, the tissue-specific expression of xCT in the pancreas suggests that FSPG PET may be ideal for identifying metastasized PDAC.
METHODS
The performance of FSPG in detecting PDAC metastases was compared with that of F-fluorodeoxyglucose (FDG) in small-animal PET studies in seven PDAC tumour-bearing mice and in prospective PET/computed tomography (CT) studies in 23 patients with tissue-confirmed PDAC of stage III or stage IV. All PET/CT results were correlated with the results of histopathology or contrast-enhanced CT (ceCT) performed 3 and 6 months later.
RESULTS
In the rodent model, FSPG PET consistently found more PDAC metastases earlier than FDG PET. FSPG PET showed a trend for a higher sensitivity, specificity and diagnostic accuracy than FDG PET in detecting PDAC metastases in a patient-based analysis: 95.0%, 100.0% and 95.7%, and 90.0%, 66.7% and 90.0%, respectively. In a lesion-based analysis, FSPG PET identified significantly more PDAC metastases, especially in the liver, than FDG PET (109 vs. 95; P = 0.0001, 95% CI 4.9-14.6). The tumour-to-background ratios for FSPG and FDG uptake on positive scans were similar (FSPG 4.2 ± 4.3, FDG 3.6 ± 3.0; P = 0.44, 95% CI -1.11 to 0.48), despite a lower tumour maximum standardized uptake value in FSPG-avid lesions (FSPG 4.2 + 2.3, FDG 7.7 + 5.7; P = 0.002, 95% CI 0.70-4.10). Because of the lower physiological activity of FSPG in the liver, FSPG PET images of the liver are more easy to interpret than FDG PET images, and therefore the use of FSPG improves the detection of liver metastasis.
CONCLUSION
FSPG PET is superior to FDG PET in detecting metastasized PDAC, especially in the liver.
目的
（4S）-4-（3-氟丙基）-L-谷氨酸（FSPG）正电子发射断层扫描（PET）反映系统 x 转运体（xCT）的表达。FSPG PET 已被用于检测脑、肺、乳腺和肝癌，但成功率仅为中等。目前尚无 FSPG PET 用于胰腺导管腺癌（PDAC）的报道，据推测是因为胰腺中 xCT 的正常表达。然而，xCT 在胰腺中的组织特异性表达表明，FSPG PET 可能是识别转移性 PDAC 的理想方法。
方法
在 7 只 PDAC 荷瘤小鼠的小动物 PET 研究和 23 例组织证实的 III 期或 IV 期 PDAC 患者的前瞻性 PET/CT（CT）研究中，比较了 FSPG 在检测 PDAC 转移中的性能与 F-氟脱氧葡萄糖（FDG）的性能。所有 PET/CT 结果均与 3 个月和 6 个月后进行的组织学或对比增强 CT（ceCT）结果相关。
结果
在啮齿动物模型中，FSPG PET 始终比 FDG PET 更早地发现更多的 PDAC 转移。在基于患者的分析中，FSPG PET 在检测 PDAC 转移方面显示出更高的灵敏度、特异性和诊断准确性的趋势：95.0%、100.0%和 95.7%，90.0%、66.7%和 90.0%。在基于病变的分析中，FSPG PET 比 FDG PET 发现更多的 PDAC 转移，尤其是在肝脏中（109 比 95；P = 0.0001，95%CI 4.9-14.6）。阳性扫描中 FSPG 和 FDG 摄取的肿瘤与背景比值相似（FSPG 4.2 ± 4.3，FDG 3.6 ± 3.0；P = 0.44，95%CI -1.11 至 0.48），尽管 FSPG 摄取病变的肿瘤最大标准化摄取值较低（FSPG 4.2 + 2.3，FDG 7.7 + 5.7；P = 0.002，95%CI 0.70-4.10）。由于 FSPG 在肝脏中的生理活性较低，因此 FSPG PET 图像比 FDG PET 图像更容易解释，因此使用 FSPG 提高了对肝转移的检测。
结论
FSPG PET 在检测转移性 PDAC 方面优于 FDG PET，尤其是在肝脏中。
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