联合 [F]FDG 和 [Ga]-DOTA-肽 PET/CT 在原发性肺类癌中的诊断和预后作用：一项多中心经验。
The diagnostic and prognostic role of combined [F]FDG and [Ga]-DOTA-peptides PET/CT in primary pulmonary carcinoids: a multicentric experience.
机构信息
Nuclear Medicine, ASST Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; Nuclear Medicine, University of Brescia, Brescia, Italy.
出版信息
Eur Radiol. 2023 Jun;33(6):4167-4177. doi: 10.1007/s00330-022-09326-w. Epub 2022 Dec 8.
OBJECTIVES
In the present retrospective multicentric study, we combined [Ga]-DOTA-peptides and [F]FDG-PET/CT findings aiming to investigate their capability to differentiate typical (TC) and atypical pulmonary carcinoids (AC) and their prognostic role.
METHODS
From three centers, 61 patients were retrospectively included. Based on a dual tracer combination we classified PET scans as score 1, [F]FDG- and [Ga]-DOTA-peptides negative; score 2, [68Ga]-DOTA-peptides positive and [F]FDG-negative; score 3, [Ga]-DOTA-peptides negative and [F]FDG-positive; score 4, both tracers positive. Moreover, for each patient, the ratios of SUVmax on [Ga]-DOTA-PET to that on [F]FDG-PET were calculated (SUVr).
RESULTS
Thirty-five patients had a final diagnosis of TC. Twenty-two TC (57%) had positive [Ga]-DOTA-peptides PET; instead, 21/26 (81%) AC had positive [F]FDG-PET/CT. On dual-tracer analysis, scores 1, 2, 3 and 4 were 13%, 20%, 43% and 24% for all populations; 17%, 26%, 20% and 37% for TC; 8%, 11%, 73% and 8% for AC. Median SUVr was significantly higher in TC than AC (6.4 vs. 0.4, p = 0.011). The best value of SUVr to predict the final diagnosis was 1.05 (AUC 0.889). Relapse or progression of disease happened in 17 patients (11 affected by AC) and death in 10 cases (7 AC). AC diagnosis, positive [F]FDG-PET, negative DOTA-PET and dual tracer score were significantly correlated with PFS (p = 0.013, p = 0.033, p = 0.029 and p = 0.019), while only AC diagnosis with OS (p = 0.022).
CONCLUSION
PET/CT findings had also a prognostic role in predicting PFS. Dual-tracer PET behavior may be used to predict the nature of pulmonary carcinoids and select the most appropriate management.
KEY POINTS
• Combination of [18F]FDG and [68Ga]-DOTA-peptides PET/CT results may help to differentiate between atypical and typical lung carcinoids. • The SUVmax ratio between [18F]FDG and [68Ga]-DOTA-peptides PET may help to differentiate between atypical and typical lung carcinoids. • Histotype and PET/CT features have a prognostic impact on PFS.
目的
在本回顾性多中心研究中，我们结合 [Ga]-DOTA-肽和 [F]FDG-PET/CT 结果，旨在研究它们区分典型（TC）和非典型肺类癌（AC）的能力及其预后作用。
方法
从三个中心中，回顾性纳入 61 名患者。基于双示踪剂组合，我们将 PET 扫描分类为评分 1：[F]FDG 和 [Ga]-DOTA-肽均阴性；评分 2：[68Ga]-DOTA-肽阳性且 [F]FDG 阴性；评分 3：[Ga]-DOTA-肽阴性且 [F]FDG 阳性；评分 4：两种示踪剂均阳性。此外，对于每位患者，计算了 [Ga]-DOTA-PET 上的 SUVmax 与 [F]FDG-PET 上的 SUVmax 的比值（SUVr）。
结果
35 名患者最终诊断为 TC。22 例 TC（57%）的 [Ga]-DOTA-肽 PET 阳性；而 26 例 AC（81%）的 [F]FDG-PET/CT 阳性。在双示踪剂分析中，所有人群的评分 1、2、3 和 4 分别为 13%、20%、43%和 24%；TC 为 17%、26%、20%和 37%；AC 为 8%、11%、73%和 8%。TC 的中位 SUVr 显著高于 AC（6.4 比 0.4，p=0.011）。预测最终诊断的 SUVr 的最佳值为 1.05（AUC 0.889）。17 名患者（11 名受 AC 影响）出现疾病复发或进展，10 名患者（7 名受 AC 影响）死亡。AC 诊断、[F]FDG-PET 阳性、DOTA-PET 阴性和双示踪剂评分与 PFS 显著相关（p=0.013、p=0.033、p=0.029 和 p=0.019），而仅 AC 诊断与 OS 相关（p=0.022）。
结论
PET/CT 结果对预测 PFS 也具有预后作用。双示踪剂 PET 行为可用于预测肺类癌的性质，并选择最合适的治疗方案。
关键点
[18F]FDG 和 [68Ga]-DOTA-肽 PET/CT 结果的组合可帮助区分非典型和典型肺类癌。
[18F]FDG 和 [68Ga]-DOTA-肽 PET 之间的 SUVmax 比值可帮助区分非典型和典型肺类癌。
组织类型和 PET/CT 特征对 PFS 具有预后影响。
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