[F]-OC PET/CT 与对比增强 CT/MRI 检测和评估神经内分泌肿瘤的比较。
Comparison of [F]-OC PET/CT and contrast-enhanced CT/MRI in the detection and evaluation of neuroendocrine neoplasms.
机构信息
Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, People's Republic of China.
Pharmacy Intravenous Admixture Services (PIVAS), The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People's Republic of China.
出版信息
Eur J Nucl Med Mol Imaging. 2023 Jul;50(8):2420-2431. doi: 10.1007/s00259-023-06200-9. Epub 2023 Mar 27.
OBJECTIVES
Gallium-68 (Ga)-labeled somatostatin analog (SSA) PET imaging has been widely used in clinical practice of neuroendocrine neoplasms (NENs). Compared with Ga, F has a great practical and economic advantage. Although a few studies have shown the characteristics of [F] AlF-NOTA-octreotide ([F]-OC) in healthy volunteers and small NEN patient groups, its clinical value needs further investigation. Herein, this retrospective study aimed to evaluate the diagnostic accuracy of [F]-OC PET/CT in detecting NENs, as well as to compare it with contrast-enhanced CT/MRI.
METHODS
We retrospectively reviewed the data of 93 patients who had undergone [F]-OC PET/CT and CT or MRI scans. Of these patients, there were 45 patients with suspected NENs for diagnostic evaluation, and 48 patients with pathologically confirmed NENs for detecting metastasis or recurrence. [F]-OC PET/CT images were evaluated visually and semi-quantitatively by measuring maximum standardized uptake value of tumor (SUV), tumor-to-background SUV ratio (TBR), and SUV of hypophysis (SUV). A total of 276 suspected NEN lesions were found in these 93 patients. The results of histopathology or radiographic follow-up served as the reference standard for the final diagnosis.
RESULTS
Forty-five patients with suspected NENs were confirmed by histopathological examination via resection or biopsy. [F]-OC PET/CT showed high radiotracer uptake in the lesions of G1-G3 NENs. [F]-OC PET/CT showed superior performance with 96.3% of sensitivity, 77.8% of specificity, and 88.9% of accuracy in diagnosing NENs compared to CT/MRI. When cutoffs of SUV, TBR, and SUV were 8.3, 3.1, and 15.4, [F]-OC PET/CT had the best equilibrium between sensitivity and specificity for differentiating NEN from non-NEN lesions. For a total of 276 suspected NEN lesions, the sensitivity, specificity, and accuracy of [F]-OC PET/CT for diagnosis of NENs were 90.5%, 82.1%, and 88.8%, respectively, and were higher than those of CT and MRI. G1 and G2 NENs had higher TBR and lower CT enhancement intensity than G3. The SUV and TBR had a positive correlation with CT enhancement intensity in G2 rather than in G1 or G3.
CONCLUSIONS
[F]-OC PET/CT is a promising imaging modality for initial diagnosis and detecting metastasis or postoperative recurrence in NENs.
目的
镓-68（Ga）标记的生长抑素类似物（SSA）正电子发射断层扫描（PET）成像已广泛应用于神经内分泌肿瘤（NENs）的临床实践。与 Ga 相比，F 具有巨大的实际和经济优势。尽管一些研究已经显示了[F]AlF-NOTA-奥曲肽（[F]-OC）在健康志愿者和小 NEN 患者群体中的特征，但它的临床价值需要进一步研究。在此，本回顾性研究旨在评估[F]-OC PET/CT 检测 NENs 的诊断准确性，并将其与对比增强 CT/MRI 进行比较。
方法
我们回顾性分析了 93 例接受[F]-OC PET/CT 和 CT 或 MRI 扫描的患者的数据。其中，45 例患者因疑似 NEN 进行诊断评估，48 例患者因病理证实的 NEN 进行转移或复发检测。通过测量肿瘤最大标准化摄取值（SUV）、肿瘤与背景 SUV 比值（TBR）和垂体 SUV（SUV），对[F]-OC PET/CT 图像进行视觉和半定量评估。93 例患者中共发现 276 个疑似 NEN 病变。组织病理学或影像学随访结果作为最终诊断的参考标准。
结果
45 例疑似 NEN 患者经手术切除或活检证实。[F]-OC PET/CT 显示 G1-G3 NEN 病变摄取放射性示踪剂较高。与 CT/MRI 相比，[F]-OC PET/CT 对 NEN 的诊断具有 96.3%的灵敏度、77.8%的特异性和 88.9%的准确性，表现出更高的性能。当 SUV、TBR 和 SUV 的截断值分别为 8.3、3.1 和 15.4 时，[F]-OC PET/CT 在区分 NEN 与非 NEN 病变的灵敏度和特异性之间具有最佳平衡。对于 276 个疑似 NEN 病变，[F]-OC PET/CT 对 NEN 诊断的灵敏度、特异性和准确性分别为 90.5%、82.1%和 88.8%，高于 CT 和 MRI。G1 和 G2 NEN 的 TBR 较高，CT 增强强度较低。G2 而非 G1 或 G3 的 SUV 和 TBR 与 CT 增强强度呈正相关。
结论
[F]-OC PET/CT 是一种有前途的成像方式，可用于 NEN 的初始诊断和检测转移或术后复发。
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