Department of Nuclear Medicine, Medical University Innsbruck, Austria.
Department of Nuclear Medicine, Medical University Innsbruck, Austria.
Nucl Med Biol. 2019 Apr;71:47-53. doi: 10.1016/j.nucmedbio.2019.04.003. Epub 2019 Apr 29.
F-Fluoro-L-dihydroxyphenylalanine (F-DOPA) PET offers high sensitivity and specificity in the imaging of non-malignant head and neck paraganglioma (HNPGL) but lower sensitivity in metastatic disease of these neuroendocrine tumours (NET). In contrast to the radiotracer F-DOPA, both I-meta-iodo-benzylguanidine (I-MIBG) and Ga-DOTA-Tyr3-octreotide (Ga-DOTA-TOC) offer valuable clinical information on norepinephrine and somatostatin (SST) receptor status for planning I-MIBG and radionuclide peptide therapy (PRRT), respectively. Therefore, we compared Ga-DOTA-TOC and F-DOPA PET/CT with I-MIBG planar and SPECT/CT imaging, for the detection of HNPGL. Combined cross-sectional imaging was the reference standard.
A total of 3 men and 7 women (age range 22 to 73 years) with anatomical and/or histologically proven HNPGL were included in this study. Of these patients, 3 patients had metastatic HNPGL. Comparative evaluation included morphological imaging with CT and functional imaging with Ga-DOTA-TOC and F-DOPA PET, including I-MIBG imaging. The imaging results were analysed on a per-patient and per-lesion basis.
On a per-patient analysis, the detection rate of both Ga-DOTA-TOC PET/CT and F-DOPA PET/CT was 100%, that of planar I-MIBG imaging 10.0% and that of SPECT/CT 20.0%. On a per-lesion basis and in reference to diagnostic CT, the sensitivity of Ga-DOTA-TOC PET/CT was 100% (McNemar, P < 0.5), that of F-DOPA PET/CT was 66.7% (McNemar, P < 0.01), that of planar I-MIBG imaging was 3.7% (McNemar, P < 0.0001), and that of SPECT/CT was 7.4% (McNemar, P < 0.0001) in HNPGL. Overall, Ga-DOTA-TOC PET identified 29 lesions and anatomical imaging identified 27 lesions. F-DOPA PET identified 18 lesions, whereas planar I-MIBG imaging identified 1 lesion and SPECT/CT 2 lesions.
Ga-DOTA-TOC PET/CT is superior for imaging, non-malignant and metastatic HNPGL compared to F-DOPA PET/CT and planar I-MIBG imaging, including SPECT/CT, particularly in bone lesions. Combined functional/anatomical imaging (Ga-DOTA-TOC PET/CT) enables excellent delineation of tumour extent in these rare tumour entities. Compared to I-MIBG scintigraphy, Ga-DOTA-TOC PET appears far more useful for planning radionuclide therapy in patients with surgically inoperable tumours or metastatic disease.
氟代 L-二羟苯丙氨酸（F-DOPA）PET 在非恶性头颈部副神经节瘤（HNPGL）的成像中具有高灵敏度和特异性，但在这些神经内分泌肿瘤（NET）的转移性疾病中的灵敏度较低。与放射性示踪剂 F-DOPA 相比，碘代苄胍（I-MIBG）和 Ga-DOTA-酪氨酸 3-奥曲肽（Ga-DOTA-TOC）都能为 I-MIBG 和放射性核素肽治疗（PRRT）的去甲肾上腺素和生长抑素（SST）受体状态提供有价值的临床信息。因此，我们比较了 Ga-DOTA-TOC 和 F-DOPA PET/CT 与 I-MIBG 平面和 SPECT/CT 成像，以检测 HNPGL。联合横断面成像为参考标准。
本研究共纳入 3 名男性和 7 名女性（年龄 22 至 73 岁），经解剖学和/或组织学证实患有 HNPGL。这些患者中有 3 名患有转移性 HNPGL。比较评估包括 CT 形态学成像和 Ga-DOTA-TOC 和 F-DOPA PET 功能成像，包括 I-MIBG 成像。对每位患者和每个病变的成像结果进行分析。
在每位患者的分析中，Ga-DOTA-TOC PET/CT 和 F-DOPA PET/CT 的检测率均为 100%，平面 I-MIBG 成像的检测率为 10.0%，SPECT/CT 的检测率为 20.0%。基于每个病变并参照诊断 CT，Ga-DOTA-TOC PET/CT 的灵敏度为 100%（McNemar，P<0.5），F-DOPA PET/CT 的灵敏度为 66.7%（McNemar，P<0.01），平面 I-MIBG 成像的灵敏度为 3.7%（McNemar，P<0.0001），SPECT/CT 的灵敏度为 7.4%（McNemar，P<0.0001）。总体而言，Ga-DOTA-TOC PET 发现了 29 个病变，解剖成像发现了 27 个病变。F-DOPA PET 发现了 18 个病变，而平面 I-MIBG 成像发现了 1 个病变，SPECT/CT 发现了 2 个病变。
与 F-DOPA PET/CT 和平面 I-MIBG 成像相比，包括 SPECT/CT 在内，Ga-DOTA-TOC PET/CT 对非恶性和转移性 HNPGL 的成像优于 F-DOPA PET/CT，特别是在骨病变中。功能/解剖联合成像（Ga-DOTA-TOC PET/CT）能够极好地描绘这些罕见肿瘤实体的肿瘤范围。与 I-MIBG 闪烁扫描相比，Ga-DOTA-TOC PET 似乎对计划无法手术或转移性疾病患者的放射性核素治疗更有用。
