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氟代乙基-L-酪氨酸 PET 与 MRI 同机融合显像在泌乳素瘤术后残余灶定位中的临床应用。

Clinical use of [F]fluoro-ethyl-L-tyrosine PET co-registered with MRI for localizing prolactinoma remnants.

机构信息

Dept. of Medicine, Division of Endocrinology, Center for Endocrine Tumors Leiden, Leiden University Medical Center, Leiden, the Netherlands.

Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands.

出版信息

Pituitary. 2024 Oct;27(5):614-624. doi: 10.1007/s11102-024-01430-y. Epub 2024 Jul 23.

DOI:10.1007/s11102-024-01430-y
PMID:39042164
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11513721/
Abstract

PURPOSE

To assess the utility of [F]fluoroethyl-L-tyrosine PET co-registered with magnetic resonance imaging ([F]FET-PET/MRI) in patients with difficult-to-localize prolactinoma to inform clinical decision-making and (surgical) treatment planning.

METHODS

Retrospective cohort study of 17 consecutive patients with prolactinoma undergoing [F]FET-PET/MRI between October 2020 and September 2022 for either (1) additional information in case of difficult-to-visualize remnants after prior transsphenoidal surgery (TSS), or pharmacological treatment, or (2) radiological diagnosis in absence of a (clear) adenoma on diagnostic/post-treatment conventional MRI.

RESULTS

[F]FET-PET/MRI identified a lesion in 14/17 patients, yet failed to identify active lesions in 2 patients with negative conventional MRI despite prolactin > 7.5 times upper limit of normal. [F]FET-PET/MRI results were inconclusive in 1 patient due to diffuse tracer uptake 10 weeks post-surgery. [F]FET-PET/MRI was completely concordant with a suspected lesion on conventional MRI in 10/17 patients, and partially concordant in 3/17 patients. New foci were identified in 4/17 patients. The [F]FET-PET/MRI conclusions influenced clinical shared decision-making in 15/17 patients, of whom 7 patients underwent TSS and 8 refrained from TSS. One patient underwent TSS despite negative [F]FET-PET/MRI, and one patient underwent additional imaging. Intraoperative findings corresponded with [F]FET-PET/MRI in 5/8 patients, and immunohistochemistry was positive in 5/8 patients. The treatment goal was achieved in 7/8 patients, and remission was achieved in 5/7 patients in whom total resection was considered feasible.

CONCLUSION

[F]FET-PET/MRI can be of added value in the preoperative decision-making process for selected patients with difficult-to-localize prolactinoma (remnants), or patients lacking a substrate on conventional MRI.

摘要

目的

评估氟乙基-L-酪氨酸正电子发射断层扫描与磁共振成像（[F]FET-PET/MRI）联合应用于定位困难的泌乳素瘤患者的价值，以辅助临床决策和（手术）治疗计划。

方法

这是一项回顾性队列研究，纳入了 2020 年 10 月至 2022 年 9 月间 17 例连续接受 [F]FET-PET/MRI 检查的泌乳素瘤患者，这些患者接受检查的原因包括：（1）既往经蝶窦手术（TSS）或药物治疗后，残留组织难以可视化时，提供额外信息；（2）诊断性/治疗后常规 MRI 未见（明确）腺瘤时，进行影像学诊断。

结果

在 17 例患者中，[F]FET-PET/MRI 识别出 14 例患者存在病灶，但在 2 例常规 MRI 结果为阴性且泌乳素>正常上限 7.5 倍的患者中，未能识别出活性病灶。1 例患者术后 10 周时出现弥漫性示踪剂摄取，[F]FET-PET/MRI 结果不确定。在 10/17 例患者中，[F]FET-PET/MRI 结果与常规 MRI 怀疑的病灶完全一致，在 3/17 例患者中部分一致。在 4/17 例患者中发现新病灶。在 15/17 例患者中，[F]FET-PET/MRI 结论影响了临床共同决策，其中 7 例患者接受了 TSS，8 例患者未接受 TSS。1 例患者尽管 [F]FET-PET/MRI 结果为阴性，但仍接受了 TSS，另 1 例患者接受了额外的影像学检查。在 8/8 例患者中，术中发现与 [F]FET-PET/MRI 结果一致，在 8/8 例患者中，免疫组织化学检测为阳性。在 8/8 例患者中达到了治疗目标，在考虑可行全切的 7/7 例患者中达到了缓解。

结论

在定位困难的泌乳素瘤（残留）或常规 MRI 未见病灶的患者中，[F]FET-PET/MRI 可在术前决策过程中提供附加价值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/098c/11513721/abdab8c8121f/11102_2024_1430_Figc_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/098c/11513721/ada077d899c2/11102_2024_1430_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/098c/11513721/04720408c019/11102_2024_1430_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/098c/11513721/abdab8c8121f/11102_2024_1430_Figc_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/098c/11513721/ada077d899c2/11102_2024_1430_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/098c/11513721/04720408c019/11102_2024_1430_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/098c/11513721/abdab8c8121f/11102_2024_1430_Figc_HTML.jpg

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