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^[68^Ga]Ga-DOTA-TOC PET/CT 对胰腺神经内分泌肿瘤特征分析的附加值:与大型研究队列中增强 CT 和/或 MRI 的对比。

Added value of [Ga]Ga-DOTA-TOC PET/CT for characterizing pancreatic neuroendocrine neoplasms: a comparison with contrast-enhanced CT and/or MRI in a large study cohort.

机构信息

Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, 110-744, Korea.

Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.

出版信息

Eur Radiol. 2021 Oct;31(10):7734-7745. doi: 10.1007/s00330-021-07859-0. Epub 2021 Mar 31.

Abstract

OBJECTIVES

To investigate an additional value of [Ga]Ga-DOTA-TOC PET/CT for characterizing suspected pancreatic neuroendocrine neoplasms (NENs) in a large study cohort.

METHODS

This retrospective study included 167 patients who underwent [Ga]Ga-DOTA-TOC PET/CT for suspected pancreatic NENs detected by contrast-enhanced CT (n = 153) and/or MRI (n = 85). Two board-certified radiologists independently reviewed CT and/or MRI as well as [Ga]Ga-DOTA-TOC PET/CT and scored the probability of NEN on a 5-point scale. Radiologists' diagnostic performances with and without [Ga]Ga-DOTA-TOC PET/CT were compared using pathologic findings as the standard of reference.

RESULTS

All 167 patients were pathologically diagnosed with NENs (n = 131) or non-NENs (n = 36) by surgery (n = 93) or biopsy (n = 74). The non-NEN group included focal pancreatitis (n = 7), gastrointestinal stromal tumor (n = 6), serous cystadenoma (n = 5), metastatic renal cell carcinoma (n = 4), intrapancreatic accessory spleen (n = 4), ductal adenocarcinoma (n = 3), solid pseudopapillary neoplasm (n = 2), intraductal papillary mucinous carcinoma (n = 1), adenosquamous carcinoma (n = 1), schwannoma (n = 1), paraganglioma (n = 1), and solitary fibrous tumor (n = 1). Radiologists' diagnostic performance significantly improved after the addition of [Ga]Ga-DOTA-TOC PET/CT (AUC of CT: 0.737 vs. 0.886 for reviewer 1 [p = 0.0004]; 0.709 vs. 0.859 for reviewer 2 [p = 0.0002], AUC of MRI: 0.748 vs. 0.872 for reviewer 1 [p = 0.023]; 0.670 vs. 0.854 for reviewer 2 [p = 0.001]). [Ga]Ga-DOTA-TOC PET/CT significantly improved sensitivity (CT: 87.4% vs. 96.6% for reviewer 1 [p = 0.001]; 74.8% vs. 92.5% for reviewer 2 [p = 0.0001], MRI: 86.9% vs. 98.4% for reviewer 1 [p = 0.016]; 70.5% vs. 91.8% for reviewer 2 [p = 0.002]).

CONCLUSIONS

[Ga]Ga-DOTA-TOC PET/CT provided an additional value over conventional CT or MRI for the characterization of suspected pancreatic NENs.

KEY POINTS

• [Ga]Ga-DOTA-TOC PET/CT could provide additional value over conventional CT and/or MRI for the exact characterization of suspected pancreatic NENs by increasing AUC values and sensitivity. • Diagnostic improvement was significant, especially in NENs showing an atypical enhancement pattern. • The inter-observer agreement was improved when [Ga]Ga-DOTA-TOC PET/CT was added to CT and/or MRI.

摘要

目的

在一项大型研究队列中,探究 [Ga]Ga-DOTA-TOC PET/CT 对疑似胰腺神经内分泌肿瘤(NENs)的附加价值。

方法

本回顾性研究纳入了 167 名因经对比增强 CT(n = 153)和/或 MRI(n = 85)检测到疑似胰腺 NENs 而接受 [Ga]Ga-DOTA-TOC PET/CT 的患者。两名经过认证的放射科医生独立对 CT 和/或 MRI 以及 [Ga]Ga-DOTA-TOC PET/CT 进行了评估,并使用 5 分制对 NENs 的可能性进行评分。使用病理结果作为参考标准,比较了有和没有 [Ga]Ga-DOTA-TOC PET/CT 时放射科医生的诊断性能。

结果

所有 167 名患者均通过手术(n = 93)或活检(n = 74)病理诊断为 NENs(n = 131)或非-NENs(n = 36)。非-NEN 组包括局灶性胰腺炎(n = 7)、胃肠道间质瘤(n = 6)、浆液性囊腺瘤(n = 5)、转移性肾细胞癌(n = 4)、胰内副脾(n = 4)、导管腺癌(n = 3)、实性假乳头状瘤(n = 2)、导管内乳头状黏液性癌(n = 1)、腺鳞癌(n = 1)、神经鞘瘤(n = 1)、副神经节瘤(n = 1)和孤立性纤维性肿瘤(n = 1)。添加 [Ga]Ga-DOTA-TOC PET/CT 后,放射科医生的诊断性能显著提高(CT 的 AUC:第一审稿人 0.737 与 0.886 [p = 0.0004];第二审稿人 0.709 与 0.859 [p = 0.0002]);MRI 的 AUC:第一审稿人 0.748 与 0.872 [p = 0.023];第二审稿人 0.670 与 0.854 [p = 0.001])。[Ga]Ga-DOTA-TOC PET/CT 显著提高了敏感性(CT:第一审稿人 87.4% 与 96.6% [p = 0.001];第二审稿人 74.8% 与 92.5% [p = 0.0001]);MRI:第一审稿人 86.9% 与 98.4% [p = 0.016];第二审稿人 70.5% 与 91.8% [p = 0.002])。

结论

与常规 CT 或 MRI 相比,[Ga]Ga-DOTA-TOC PET/CT 为疑似胰腺 NENs 的特征提供了附加价值。

关键点

  • [Ga]Ga-DOTA-TOC PET/CT 可通过增加 AUC 值和敏感性,为疑似胰腺 NENs 的准确特征提供比常规 CT 和/或 MRI 更高的附加价值。

  • 诊断改善显著,尤其是在显示非典型增强模式的 NENs 中。

  • 添加 [Ga]Ga-DOTA-TOC PET/CT 可提高观察者间的一致性。

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