Department of Nuclear Medicine, University Hospital Münster, Münster, Germany;
West German Cancer Centre, Münster, Germany.
J Nucl Med. 2024 Feb 1;65(2):192-198. doi: 10.2967/jnumed.123.266513.
[F]tetrafluoroborate ([F]TFB) is an emerging PET tracer with excellent properties for human sodium iodide symporter (NIS)-based imaging in patients with differentiated thyroid cancer (DTC). The aim of this study was to compare [F]TFB PET with high-activity posttherapeutic [I]iodine whole-body scintigraphy and SPECT/CT in recurrent DTC and with [F]FDG PET/CT in suspected dedifferentiation. Twenty-six patients treated with high-activity radioactive [I]iodine therapy (range, 5.00-10.23 GBq) between May 2020 and November 2022 were retrospectively included. Thyroid-stimulating hormone was stimulated by 2 injections of recombinant thyroid-stimulating hormone (0.9 mg) 48 and 24 h before therapy. Before treatment, all patients underwent [F]TFB PET/CT 40 min after injection of a median of 321 MBq of [F]TFB. To study tracer kinetics in DTC lesions, 23 patients received an additional scan at 90 min. [I]iodine therapeutic whole-body scintigraphy and SPECT/CT were performed at a median of 3.8 d after treatment. Twenty-five patients underwent additional [F]FDG PET. Two experienced nuclear medicine physicians evaluated all imaging modalities in consensus. A total of 62 suspected lesions were identified; of these, 30 lesions were [I]iodine positive, 32 lesions were [F]TFB positive, and 52 were [F]FDG positive. Three of the 30 [I]iodine-positive lesions were retrospectively rated as false-positive iodide uptake. Tumor-to-background ratio measurements at the 40- and 90-min time points were closely correlated (e.g., for the tumor-to-background ratio for muscle, the Pearson correlation coefficient was 0.91; < 0.001; = 49). We found a significant negative correlation between [F]TFB uptake and [F]FDG uptake as a potential marker for dedifferentiation (Pearson correlation coefficient, -0.26; = 0.041; = 62). Pretherapeutic [F]TFB PET/CT may help to predict the positivity of recurrent DTC lesions on [I]iodine scans. Therefore, it may help in the selection of patients for [I]iodine therapy. Future prospective trials for iodine therapy guidance are warranted. Lesion [F]TFB uptake seems to be inversely correlated with [F]FDG uptake and therefore might serve as a dedifferentiation marker in DTC.
[F]四氟硼酸根（[F]TFB）是一种新兴的正电子发射断层扫描（PET）示踪剂，具有优异的性能，可用于基于人钠碘同向转运体（NIS）的分化型甲状腺癌（DTC）患者成像。本研究旨在比较[F]TFB PET 与高活度放射性碘治疗后全身扫描和 SPECT/CT 在复发性 DTC 中的应用，并与[F]FDG PET/CT 在疑似去分化中的应用进行比较。 2020 年 5 月至 2022 年 11 月期间，回顾性纳入 26 例接受高活度放射性碘治疗（范围为 5.00-10.23GBq）的患者。在治疗前 48 和 24 小时，用 2 次重组促甲状腺激素（0.9mg）刺激甲状腺刺激激素。在治疗前，所有患者均在注射中位数为 321MBq [F]TFB 后 40 分钟接受 [F]TFB PET/CT 检查。为了研究 DTC 病变中的示踪剂动力学，23 例患者在 90 分钟时接受了额外的扫描。在治疗后中位数 3.8 天进行放射性碘治疗全身闪烁扫描和 SPECT/CT。25 例患者进行了额外的[F]FDG PET。两名经验丰富的核医学医师以共识的方式评估了所有成像方式。 共发现 62 个可疑病变；其中，30 个病变碘阳性，32 个病变[F]TFB 阳性，52 个病变[F]FDG 阳性。30 个碘阳性病变中有 3 个被回顾性评定为假阳性碘摄取。40 分钟和 90 分钟时的肿瘤与背景比测量值密切相关（例如，对于肿瘤与肌肉的背景比，皮尔逊相关系数为 0.91；<0.001；n=49）。我们发现[F]TFB 摄取与[F]FDG 摄取之间存在显著的负相关，这可能是分化不良的潜在标志物（皮尔逊相关系数为-0.26；<0.001；n=62）。 治疗前[F]TFB PET/CT 可能有助于预测碘扫描中复发性 DTC 病变的阳性率。因此，它可能有助于选择碘治疗的患者。未来需要进行前瞻性碘治疗指导试验。病变[F]TFB 摄取似乎与[F]FDG 摄取呈负相关，因此可能是 DTC 的分化标志物。
