[F]AlF-NOTA-奥曲肽PET/CT在胃肠胰神经内分泌肿瘤患者分期及再分期中的临床应用：与[F]FDG PET/CT的比较
The clinical benefits of [F]AlF-NOTA-octreotide PET/CT in staging and restaging patients with gastroenteropancreatic neuroendocrine neoplasms: comparison of [F]FDG PET/CT.
作者信息
Chen Donghe, Liu Zhenfeng, Wang Guolin, Tu Mengjiao, Yang Fei, Jiang Chunting, Zhao Kui, Su Xinhui
机构信息
Department of Nuclear Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China.
出版信息
BMC Med Imaging. 2025 Jul 11;25(1):280. doi: 10.1186/s12880-025-01824-9.
BACKGROUND
Accurate clinical TNM staging is crucial for managing GEP-NENs according to the latest NCCN guidelines. [Ga] labeled somatostatin receptor (SSTR) PET/CT outperforms [F]FDG PET/CT in evaluating well and moderately differentiated NENs. However, few studies have investigated the performance of [F] labeled SSTRs in the exploration of GEP-NENs.
PURPOSE
This retrospective study compared the performance of [F]AlF-NOTA-octreotide ([F]OC) with [F]FDG PET/CT for precise staging and restaging GEP-NENs.
METHODS
Participants with clinically suspected or confirmed NENs were enrolled and underwent paired [F]OC and [F]FDG PET/CT between. Lesion findings and PET metabolic parameters, such as the maximum standardized uptake value (SUV) and tumor-to-background ratio (TBR), were compared between the two types of radiotracers. The results of histology or imaging follow-up served as the reference standard for the final diagnosis.
RESULTS
Thirty-seven patients and 209 suspicious lesions were included in the statistical analysis. In patients for initial staging (n = 19), [F]OC PET/CT led to upstaging of the clinical T stage in 13 (66.7%) patients and TNM stage in 10 (52.6%) patients compared with [F]FDG PET/CT. In posttreatment patients for restaging (n = 18), [F]OC PET/CT demonstrated superior performance in 9 (50%) patients and inferior performance in 3 (16.7%) patients compared with [F]FDG PET/CT. For the 176 confirmed NEN lesions, the SUV and TBR of [F]OC were greater than those of [F]FDG (median SUV, 11.3 vs. 2.1; P < 0.001; median TBR, 8.0 vs. 1.6; P < 0.001, respectively). For lesions < 0.5 cm, 0.5 ~ 1.0 cm and 1.0 ~ 2.0 cm in size, [F]OC PET/CT had a significantly higher sensitivity than [F]FDG PET/CT did (P = 0.041, < 0.001, 0.028, respectively), whereas for lesions between 2.0 ~ 4.0 cm and > 4.0 cm in size, the differences were not significant (P = 0.103 and 0.539).
CONCLUSIONS
[F]OC PET/CT outperformed [F]FDG PET/CT in detecting small well-differentiated GEP-NEN lesions and metastases less than 2.0 cm in size, even tiny lesions (≤ 0.5 cm), which helps improve GEP-NEN staging and restaging.
CLINICAL TRIAL NUMBER
Not applicable.
背景
根据最新的美国国立综合癌症网络（NCCN）指南，准确的临床TNM分期对于管理胃肠胰神经内分泌肿瘤（GEP-NENs）至关重要。[镓]标记的生长抑素受体（SSTR）PET/CT在评估高分化和中分化神经内分泌肿瘤方面优于[氟]氟代脱氧葡萄糖（[F]FDG）PET/CT。然而，很少有研究调查[氟]标记的SSTRs在GEP-NENs探查中的性能。
目的
这项回顾性研究比较了[F]AlF-NOTA-奥曲肽（[F]OC）与[F]FDG PET/CT在GEP-NENs精确分期及再分期方面的性能。
方法
纳入临床怀疑或确诊为神经内分泌肿瘤的参与者，并在其间接受[F]OC和[F]FDG PET/CT检查。比较两种放射性示踪剂之间的病变发现及PET代谢参数，如最大标准化摄取值（SUV）和肿瘤与本底比值（TBR）。组织学或影像学随访结果作为最终诊断的参考标准。
结果
37例患者及209个可疑病变纳入统计分析。在初始分期的患者中（n = 19），与[F]FDG PET/CT相比，[F]OC PET/CT使13例（66.7%）患者的临床T分期及10例（52.6%）患者的TNM分期上调。在接受治疗后进行再分期的患者中（n = 18），与[F]FDG PET/CT相比，[F]OC PET/CT在9例（50%）患者中表现更优，在3例（16.7%）患者中表现较差。对于176个确诊的神经内分泌肿瘤病变，[F]OC的SUV和TBR大于[F]FDG（SUV中位数，11.3对2.1；P < 0.001；TBR中位数，8.0对1.6；P < 0.001）。对于大小<0.5 cm、0.51.0 cm和1.02.0 cm的病变，[F]OC PET/CT的灵敏度显著高于[F]FDG PET/CT（P分别为0.041、<0.001、0.028），而对于大小在2.0~4.0 cm和>4.0 cm的病变，差异无统计学意义（P分别为0.103和0.539）。
结论
[F]OC PET/CT在检测大小<2.0 cm的高分化GEP-NEN小病变及转移灶甚至微小病变（≤0.5 cm）方面优于[F]FDG PET/CT，这有助于改善GEP-NEN的分期及再分期。
临床试验编号
不适用。
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