Araz Mine, Soydal Çiğdem, Demir Özgür, Gökcan Mustafa Kürşat, Küçük Nuriye Özlem
Ankara University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey
Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
Mol Imaging Radionucl Ther. 2023 Feb 23;32(1):1-7. doi: 10.4274/mirt.galenos.2022.81904.
To evaluate the diagnostic performance of F-dihydroxyphenylalanine (FDOPA) positron emission tomography/computed tomography (PET/CT) in the detection of medullary thyroid carcinoma (MTC) recurrence in patients with elevated calcitonin levels.
The patients who had undergone F-FDOPA PET/CT imaging for elevated calcitonin levels after primary surgery of MTC were included in the study. addition, if available F-fluorodeoxyglucose (FDG) PET/CT and Gallium-68 (Ga)- DOTATATE PET/CT images of the patients were evaluated retrospectively. The sensitivity and diagnostic performance of F-DOPA PET/CT were investigated.
A total of 14 patients (9 F and 5 M; median age: 45) were included in the analysis. Three patients had MEN IIA syndrome and 1 patient had MEN IIB syndrome, 10 patients had a diagnosis of sporadic MTC. Median calcitonin levels of the patients were calculated as 757.5 (min-max: 28.5-7911) pg/mL. Nine patients and 5 patients had undergone ultrasound and contrast-enhanced computed tomography (ceCT) of the neck, respectively, before F-FDOPA PET/CT imaging. F-FDOPA PET/CT revealed pathological uptake in the thyroid bed, lymph nodes, and distant organs in three, five and two patients, respectively. Median maximum standardized uptake value for the recurrent or metastatic lesions were calculated as 6.4 (min-max: 1.9-18.4). The sensitivity of F-FDOPA PET/CT in the detection of recurrent disease was calculated as 64%. Eight patients had Ga-DOTATATE PET/CT and 7 of them had F-FDG PET/CT within 3 months period before F-FDOPA PET/CT. F-FDOPA PET/CT revealed recurrent disease in 4 of 5 and 2 of the 5 patients who had negative F-FDG PET/CT and negative Ga- DOTATATE PET/CT, respectively.
F-FDOPA PET/CT can detect recurrence in about two- thirds of patients with elevated calcitonin levels after primary surgery for MTC. Due to variable differentiation degree, different receptor status, and clinical behavior of MTC, all three radiopharmaceuticals can be beneficial and are complementary to each other in patient management.
评估F - 二羟基苯丙氨酸（FDOPA）正电子发射断层扫描/计算机断层扫描（PET/CT）在检测降钙素水平升高的甲状腺髓样癌（MTC）患者复发情况中的诊断性能。
本研究纳入了在MTC初次手术后因降钙素水平升高而接受F - FDOPA PET/CT成像的患者。此外，若有患者的F - 氟脱氧葡萄糖（FDG）PET/CT和镓 - 68（Ga） - DOTATATE PET/CT图像，则进行回顾性评估。研究F - DOPA PET/CT的敏感性和诊断性能。
共有14例患者（9例女性和5例男性；中位年龄：45岁）纳入分析。3例患者患有MEN IIA综合征，1例患者患有MEN IIB综合征，10例患者诊断为散发性MTC。患者的降钙素水平中位数计算为757.5（最小值 - 最大值：28.5 - 7911）pg/mL。在进行F - FDOPA PET/CT成像前，分别有9例和5例患者接受了颈部超声和增强计算机断层扫描（ceCT）检查。F - FDOPA PET/CT分别在3例、5例和2例患者的甲状腺床、淋巴结和远处器官发现了病理性摄取。复发或转移病灶的最大标准化摄取值中位数计算为6.4（最小值 - 最大值：1.9 - 18.4）。F - FDOPA PET/CT检测复发性疾病的敏感性计算为64%。8例患者进行了Ga - DOTATATE PET/CT检查，其中7例在F - FDOPA PET/CT检查前3个月内进行了F - FDG PET/CT检查。F - FDOPA PET/CT分别在F - FDG PET/CT和Ga - DOTATATE PET/CT检查结果为阴性的5例患者中的4例和5例患者中的2例中发现了复发性疾病。
F - FDOPA PET/CT可在约三分之二的MTC初次手术后降钙素水平升高的患者中检测到复发。由于MTC的分化程度、受体状态和临床行为各不相同，这三种放射性药物在患者管理中都可能有益且相互补充。
