Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Neuroendocrinology. 2024;114(8):775-785. doi: 10.1159/000539572. Epub 2024 Jun 5.
Aims of the study were to assess the differences in the diagnostic efficacy of 68Ga-somatostatin receptor analogs (68Ga-SSAs) and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for detecting bone metastases in neuroendocrine neoplasm (NEN) and to analyze the correlation between imaging features and clinical features of BMs.
We retrospectively analyzed the clinical and imaging data of 213 NEN patients who underwent 68Ga-SSA PET/CT and were finally diagnosed as BMs by pathology or follow-up. Of those, 103 patients underwent 18F-FDG PET/CT within 7 days after 68Ga-SSA PET/CT.
The BM detection rate of 68Ga-SSA PET/CT was higher than 18F-FDG PET/CT (86.4% vs. 66.0%, p = 0.02) in 103 patients with dual scanning. Meanwhile, the number of positive lesions in 68Ga-SSA PET/CT was significantly more than in 18F-FDG PET/CT (3.37 ± 1.95 vs. 2.23 ± 2.16, t = 4.137, p < 0.001). Most bone metastasis lesions presented as osteogenic change in CT (55.4%, 118/213). Concerning the primary tumor, the most frequent were of pancreatic origin (26.3%, 56/213), followed by rectal origin (22.5%, 48/213), thymic origin in 33 cases (15.5%), pulmonary origin in 29 cases (13.6%), paraganglioma in 20 cases (9.4%). The efficiency of 68Ga-SSA PET/CT to detect BMs was significantly correlated with the primary site (p = 0.02), with thymic carcinoid BMs being the most difficult to detect, and the positive rate was only 60.6% (20/33). However, 18F-FDG PET/CT positive rate was 76.92% (10/13) in thymic carcinoid BMs. In addition, the BMs of 7 patients in this study were detected by 68Ga-SSA PET earlier than CT for 4.57 months (range: 2-10 months).
68Ga-SSA PET/CT has higher sensitivity for detecting the BMs of NEN than 18F-FDG and detects the BM earlier than CT. Moreover, 18F-FDG PET/CT should be a complement for diagnosing the BMs of thymic carcinoids.
本研究旨在评估 68Ga-生长抑素受体类似物（68Ga-SSA）和 18F-氟脱氧葡萄糖（18F-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）在神经内分泌肿瘤（NEN）骨转移中的诊断效能差异，并分析骨转移的影像学特征与临床特征之间的相关性。
我们回顾性分析了 213 例接受 68Ga-SSA PET/CT 检查并最终经病理或随访诊断为骨转移的 NEN 患者的临床和影像学资料。其中，103 例患者在 68Ga-SSA PET/CT 后 7 天内接受了 18F-FDG PET/CT 检查。
在 103 例进行双重扫描的患者中，68Ga-SSA PET/CT 的骨转移检出率高于 18F-FDG PET/CT（86.4% vs. 66.0%，p=0.02）。同时，68Ga-SSA PET/CT 中阳性病变的数量明显多于 18F-FDG PET/CT（3.37±1.95 vs. 2.23±2.16，t=4.137，p＜0.001）。大多数骨转移病变在 CT 上表现为成骨改变（55.4%，118/213）。在原发肿瘤方面，最常见的是胰腺来源（26.3%，56/213），其次是直肠来源（22.5%，48/213），33 例为胸腺来源（15.5%），29 例为肺来源（13.6%），20 例为副神经节瘤来源（9.4%）。68Ga-SSA PET/CT 检测骨转移的效率与原发部位显著相关（p=0.02），胸腺类癌的骨转移最难检测，阳性率仅为 60.6%（20/33）。然而，18F-FDG PET/CT 在胸腺类癌骨转移中的阳性率为 76.92%（10/13）。此外，本研究中有 7 例患者的骨转移在 CT 前通过 68Ga-SSA PET 提前 4.57 个月（2-10 个月）检测到。
68Ga-SSA PET/CT 对 NEN 骨转移的检测灵敏度高于 18F-FDG，且比 CT 更早发现骨转移。此外，18F-FDG PET/CT 应作为诊断胸腺类癌骨转移的补充手段。
