镓- DOTATATE PET/CT对神经内分泌肿瘤的管理影响

Management Impact of Ga-DOTATATE PET/CT in Neuroendocrine Tumors.

作者信息

Anderson Redmond-Craig, Velez Erik M, Desai Bhushan, Jadvar Hossein

机构信息

Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, 2250 Alcazar St., CSC 102, Los Angeles, CA 90033 USA.

出版信息

Nucl Med Mol Imaging. 2021 Feb;55(1):31-37. doi: 10.1007/s13139-020-00677-0. Epub 2021 Jan 7.

DOI:10.1007/s13139-020-00677-0

PMID:33643487

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7881063/

Abstract

PURPOSE

The goal of our retrospective single tertiary academic medical center investigation was to examine the added diagnostic value and clinical impact of Ga-DOTATATE PET/CT in the therapeutic management of patients with neuroendocrine tumors (NETs).

METHODS

Imaging database was queried for all "PET-DOTATATE" examinations performed at our tertiary care academic institution using MONTAGE™. The patient's clinical history and recent prior imaging were reviewed. The additional diagnostic value and clinical management impact of Ga-DOTATATE were assessed through retrospective chart review.

RESULTS

A total of 81 Ga-DOTATATE PET/CT scans in 74 patients were found, and 11 patients were excluded from analysis as they had no prior imaging available for comparison, with resultant analysis cohort of 63 patients. Six patients had 2 or more Ga-DOTATATE PET/CT examinations. The most common primary diagnosis was undifferentiated NET (63.5%), followed by carcinoid (27.0%), paraganglioma (4.8%), insulinoma (3.2%), and pheochromocytoma (1.6%). The primary sites of disease from the most to the least common were the pancreas (36.5%), small bowel (22.2%), unknown primary (15.9%), lung (6.3%), large bowel (6.3%), and mesentery (4.8%), and other locations accounted for 7.9%. In patients who had prior imaging available for comparison, there were new lesions identified on Ga-DOTATATE PET/CT in 21 patients (33.3%) that were not identified on other prior imaging modalities. Of these patients, 5 underwent subsequent MRI and 1 had a repeat Ga-DOTATATE PET/CT to further characterize new lesions seen. Moreover, 15 patients (23.8%) had a change in treatment plan, including altering medical therapy in 9 patients, change in planned extent of surgical management in 5 patients, and cancelation of a planned primary tumor resection in 1 patient with metastatic disease.

CONCLUSION

Our retrospective cohort demonstrated that Ga-DOTATATE PET/CT improves lesion detection over conventional imaging in 33.3% and impacts the therapeutic management in 23.8% of patients with NET.

摘要

目的

我们这项回顾性单中心三级学术医疗中心研究的目的是，探讨镓[68Ga] DOTATATE正电子发射断层显像/X线计算机体层成像（PET/CT）在神经内分泌肿瘤（NET）患者治疗管理中的附加诊断价值及临床影响。

方法

利用MONTAGE™在我们的三级学术医疗中心查询所有“PET-DOTATATE”检查的影像数据库。回顾患者的临床病史及近期的既往影像资料。通过回顾性病历审查评估镓[68Ga] DOTATATE的附加诊断价值及对临床管理的影响。

结果

共发现74例患者的81次镓[68Ga] DOTATATE PET/CT扫描，11例患者因无既往影像资料可供比较而被排除在分析之外，最终分析队列有63例患者。6例患者进行了2次或更多次镓[68Ga] DOTATATE PET/CT检查。最常见的原发性诊断为未分化NET（63.5%），其次为类癌（27.0%）、副神经节瘤（4.8%）、胰岛素瘤（3.2%）和嗜铬细胞瘤（1.6%）。疾病的原发部位由最常见到最不常见依次为胰腺（36.5%）、小肠（22.2%）、原发灶不明（15.9%）、肺（6.3%）、大肠（6.3%）和肠系膜（4.8%），其他部位占7.9%。在有既往影像资料可供比较的患者中，镓[68Ga] DOTATATE PET/CT发现了21例（33.3%）其他既往影像检查未发现的新病灶。在这些患者中，5例接受了后续的磁共振成像（MRI）检查，1例进行了重复镓[68Ga] DOTATATE PET/CT检查以进一步明确所见新病灶的特征。此外，15例患者（23.8%）的治疗方案发生了改变，包括9例患者改变药物治疗、5例患者改变手术治疗计划范围、1例有转移疾病的患者取消了计划中的原发性肿瘤切除术。