From the Departments of Radiology and Nuclear Medicine.
Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht.
Clin Nucl Med. 2023 Sep 1;48(9):757-762. doi: 10.1097/RLU.0000000000004776. Epub 2023 Jul 22.
A high SUV max tumor-to-liver ratio (TLR) of 68 Ga-DOTATATE can be used to select patients with neuroendocrine tumors (NETs) for peptide receptor radionuclide therapy (PRRT). In addition, an SUV max TLR ≥ 8.1 is associated with increased progression-free survival in NET patients treated with somatostatin analogs (SSAs). To avoid a theoretical interaction, several guidelines recommend performing PET/CT just before the monthly administration of long-acting SSAs. We aimed to investigate the effect of SSA on the SUV max of 68 Ga-DOTATATE in patients with NET and to identify independent predictors for high SUV max TLR.
For this retrospective study, 192 68 Ga-DOTATATE PET/CT scans of 165 patients without (n = 115) and with (n = 77) SSA (octreotide or lanreotide) in the 3 months before PET/CT were collected and reviewed. The effect of SSA on SUV max values was analyzed by a maximum likelihood mixed model.
Patients with SSA had a significantly higher median SUV max TLR than patients without SSA (4.7 [IQR], 3.1-7.7) versus 3.2 [IQR, 2.0-5.4]; P < 0.001). Multivariable logistic regression analysis showed that SSA use was an independent predictor for SUV max TLR ≥ 8.1 (odds ratio, 2.91; 95% confidence interval, 1.26-6.72; P = 0.012).
Our data suggest that higher SSA concentrations do not have a negative effect on 68 Ga-DOTATATE uptake in tumor lesions. In addition, we found that only SSA use was associated with SUV max TLR ≥ 8.1. Our results are consistent with previously conducted studies and in line with the recently published guideline that suggests that the relatively recent use of SSA does not necessitate any delay in 68 Ga-DOTATATE PET/CT imaging.
68Ga-DOTATATE 的肿瘤与肝脏最大标准摄取值比（TLR）高（SUVmax TLR）达 68 可以用于选择神经内分泌肿瘤（NET）患者进行肽受体放射性核素治疗（PRRT）。此外，在接受生长抑素类似物（SSA）治疗的 NET 患者中，SUVmax TLR≥8.1 与无进展生存期增加相关。为避免理论上的相互作用，一些指南建议在每月给予长效 SSA 治疗前进行 PET/CT。我们旨在研究 SSA 对 NET 患者 68Ga-DOTATATE SUVmax 的影响，并确定 SUVmax TLR 高的独立预测因素。
这项回顾性研究共纳入了 165 名患者的 192 次 68Ga-DOTATATE PET/CT 扫描，这些患者在 PET/CT 检查前 3 个月内无（n=115）和有（n=77）SSA（奥曲肽或兰瑞肽）。采用最大似然混合模型分析 SSA 对 SUVmax 值的影响。
有 SSA 的患者 SUVmax TLR 的中位数显著高于无 SSA 的患者（4.7[IQR]，3.1-7.7 比 3.2[IQR]，2.0-5.4；P＜0.001）。多变量逻辑回归分析显示，SSA 的使用是 SUVmax TLR≥8.1 的独立预测因素（优势比，2.91；95%置信区间，1.26-6.72；P=0.012）。
我们的数据表明，较高的 SSA 浓度不会对肿瘤病变中的 68Ga-DOTATATE 摄取产生负面影响。此外，我们发现只有 SSA 的使用与 SUVmax TLR≥8.1 相关。我们的结果与之前的研究一致，也符合最近发表的指南，该指南表明，相对较近的 SSA 使用不需要延迟 68Ga-DOTATATE PET/CT 成像。
