Babazadeh Nasim T, Schlund Devan J, Cornelius Tyler, Singh Jagadeesh S, Tierney John F, Chen Meri, Keutgen Xavier M
Department of Surgery, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL, 60612, USA.
Department of Radiology, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL, 60612, USA.
World J Surg. 2020 Feb;44(2):604-611. doi: 10.1007/s00268-019-05216-3.
The only potential cure for neuroendocrine tumors (NETs) is operative resection, which may also offer a survival benefit for advanced disease. We aimed to assess the role of Ga-DOTATATE PET/CT in preoperative planning and compared its performance to CT with IV contrast and MRI with Eovist, for abdominal NETs.
Records of patients who underwent Ga-DOTATATE PET/CT in addition to MRI with Eovist and/or CT with IV contrast were retrospectively evaluated. The effect of imaging findings on surgical management and characteristics of detected lesions were analyzed. Descriptive statistics were used.
Of 21 patients who underwent Ga-DOTATATE PET/CT prior to surgical resection, five (24%) had a change in surgical management due to findings. In three patients, Ga-DOTATATE PET/CT identified the primary tumor. In two patients, Ga-DOTATATE PET/CT helped clarify equivocal hepatic lesions seen on MRI with Eovist. MRI with Eovist had the highest number of lesions found (median 13, versus 9 on CT and 9.5 on Ga-DOTATATE PET/CT). DOTATATE-avid lesions were on average larger than lesions seen only on MRI with Eovist (1.6 cm versus 0.6 cm, p = 0.0002). The optimal cutoff point for detection by Ga-DOTATATE PET/CT was a size of 0.95 cm, with a sensitivity of 56% and specificity of 98%.
Preoperative Ga-DOTATATE PET/CT is useful only in a subset of patients undergoing surgical resection for NETs. MRI with Eovist is superior at identifying liver metastases when compared to Ga-DOTATATE PET/CT and should therefore be used routinely before hepatic cytoreduction of NETs.
神经内分泌肿瘤（NETs）唯一可能的治愈方法是手术切除，这对晚期疾病也可能带来生存获益。我们旨在评估镓[⁶⁸Ga] DOTATATE PET/CT在术前规划中的作用，并将其表现与静脉注射造影剂增强CT及使用钆塞酸二钠的MRI用于腹部NETs的情况进行比较。
回顾性评估除使用钆塞酸二钠的MRI和/或静脉注射造影剂增强CT外还接受了镓[⁶⁸Ga] DOTATATE PET/CT检查的患者记录。分析影像结果对手术管理的影响以及所发现病变的特征。采用描述性统计方法。
在21例手术切除前接受镓[⁶⁸Ga] DOTATATE PET/CT检查的患者中，5例（24%）因检查结果而改变了手术管理方案。3例患者中，镓[⁶⁸Ga] DOTATATE PET/CT识别出了原发肿瘤。2例患者中，镓[⁶⁸Ga] DOTATATE PET/CT有助于明确在使用钆塞酸二钠的MRI上所见的肝脏可疑病变。使用钆塞酸二钠的MRI发现的病变数量最多（中位数为13个，而CT为9个，镓[⁶⁸Ga] DOTATATE PET/CT为9.5个）。镓[⁶⁸Ga] DOTATATE摄取阳性的病变平均大于仅在使用钆塞酸二钠的MRI上所见的病变（1.6厘米对0.6厘米，p = 0.0002）。镓[⁶⁸Ga] DOTATATE PET/CT检测的最佳截断点大小为0.95厘米，敏感性为56%，特异性为98%。
术前镓[⁶⁸Ga] DOTATATE PET/CT仅对部分接受NETs手术切除的患者有用。与镓[⁶⁸Ga] DOTATATE PET/CT相比，使用钆塞酸二钠的MRI在识别肝转移方面更具优势，因此在NETs肝减瘤术前应常规使用。
