Department of Nuclear Medicine, Galliera Hospital, Genoa, Italy
Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy.
J Nucl Med. 2020 Mar;61(3):367-374. doi: 10.2967/jnumed.119.232553. Epub 2019 Sep 20.
Our purpose was to evaluate the diagnostic role of F-3,4-dihydroxyphenylalanine (DOPA) PET/CT at the time of staging in children with neuroblastoma and to investigate its ability to assess treatment response. We also investigated the prognostic value of F-DOPA PET/CT at the same time points. We enrolled children with neuroblastoma at onset. Before and after induction chemotherapy, all patients underwent F-DOPA PET/CT and I-metaiodobenzylguanidine (MIBG) scanning plus SPECT/CT. F-DOPA PET/CT results were compared with those of I-MIBG whole-body scanning (WBS). For each modality, patient-based analysis and lesion-based analysis were performed and sensitivity was calculated. We applied scoring systems to I-MIBG scanning and F-DOPA PET/CT (i.e.,I-MIBG WBS score and whole-body metabolic burden [WBMB], respectively) and evaluated the association between these parameters, the principal neuroblastoma risk factors, and outcome. We enrolled 16 high-risk and 2 intermediate-risk neuroblastoma patients. On patient-based analysis, sensitivity in detecting primary tumors, soft-tissue metastases, and bone or bone-marrow metastases was 83%, 50%, and 92%, respectively, for I-MIBG WBS versus 94%, 92%, and 100%, respectively, for F-DOPA PET/CT. On lesion-based analysis, the sensitivity of F-DOPA PET/CT in detecting soft-tissue and bone or bone-marrow metastases was 86% and 99%, respectively-significantly higher than that of I-MIBG WBS, at 41% and 93%, respectively. After therapy, on patient-based analysis, the sensitivity in detecting primary tumors, soft-tissue metastases, and bone or bone-marrow metastases was 72%, 33%, and 38%, respectively, for I-MIBG WBS versus 83%, 75% and 54%, respectively, for F-DOPA PET/CT. On lesion-based analysis, the sensitivity of F-DOPA PET/CT in detecting soft-tissue and bone or bone-marrow metastases was 77% and 86%, respectively-significantly higher than that of I-MIBG WBS, at 28% and 69%, respectively. During follow-up, 8 cases of disease progression and 5 deaths occurred. On multivariate analysis, only posttherapeutic F-DOPA WBMB (>7.5) was associated with progression-free survival. F-DOPA PET/CT is more sensitive than I-MIBG WBS in staging neuroblastoma patients and evaluating disease persistence after chemotherapy. In a time-to-event analysis, posttherapeutic F-DOPA WBMB remained the only risk factor associated with disease progression.
我们的目的是评估氟代-3,4-二羟苯丙氨酸（DOPA）PET/CT 在神经母细胞瘤分期时的诊断作用，并研究其评估治疗反应的能力。我们还同时研究了 F-DOPA PET/CT 的预后价值。我们招募了初诊的神经母细胞瘤患儿。在诱导化疗前后，所有患者均进行了 F-DOPA PET/CT 和 I-间碘苄胍（MIBG）扫描加 SPECT/CT。F-DOPA PET/CT 结果与 I-MIBG 全身扫描（WBS）进行比较。对每种方法进行了基于患者和基于病变的分析，并计算了敏感性。我们应用评分系统对 I-MIBG 扫描和 F-DOPA PET/CT（即 I-MIBG WBS 评分和全身代谢负担[WBMB]）进行评估，并评估这些参数与主要神经母细胞瘤风险因素和结局之间的关系。我们招募了 16 例高危和 2 例中危神经母细胞瘤患者。基于患者的分析，I-MIBG WBS 检测原发肿瘤、软组织转移和骨或骨髓转移的敏感性分别为 83%、50%和 92%，而 F-DOPA PET/CT 的敏感性分别为 94%、92%和 100%。基于病变的分析，F-DOPA PET/CT 检测软组织和骨或骨髓转移的敏感性分别为 86%和 99%，显著高于 I-MIBG WBS 的 41%和 93%。治疗后，基于患者的分析，I-MIBG WBS 检测原发肿瘤、软组织转移和骨或骨髓转移的敏感性分别为 72%、33%和 38%，而 F-DOPA PET/CT 的敏感性分别为 83%、75%和 54%。基于病变的分析，F-DOPA PET/CT 检测软组织和骨或骨髓转移的敏感性分别为 77%和 86%，显著高于 I-MIBG WBS 的 28%和 69%。在随访期间，发生了 8 例疾病进展和 5 例死亡。多变量分析显示，仅治疗后 F-DOPA WBMB（>7.5）与无进展生存相关。F-DOPA PET/CT 在分期神经母细胞瘤患者和评估化疗后疾病持续存在方面比 I-MIBG WBS 更敏感。在时间事件分析中，治疗后 F-DOPA WBMB 仍然是唯一与疾病进展相关的风险因素。
