PDF(Pubmed)
Abstract：
OBJECTIVE: Simultaneous positron emission tomography/magnetic resonance imaging (PET-MRI) combines the high sensitivity of PET with the high specificity of MRI and is a tool for the assessment of gastroenteropancreatic neuroendocrine neoplasms (G-NENs). However, it remains poorly evaluated with no clear recommendations in current guidelines. Thus, we evaluated the prognostic impact of PET-MRI in G-NEN patients.
METHODS: From June 2017 to December 2021, 71 G-NEN patients underwent whole-body PET-MRI for staging and/or follow-up purposes. A whole-body emission scan with 18F-6-fluoro-L-dihydroxyphenylalanine (18FDOPA, n = 30), 18F-fluoro-2-deoxy-D-glucose (18FDG, n = 21), or 68Ga-(DOTA(0)-Phe(1)-Tyr(3))-octreotide (68Ga-DOTATOC, n = 20) with the simultaneous acquisition of a T1-Dixon sequence and diffusion-weighed imaging (DWI), followed by a dedicated step of MRI sequences with a Gadolinium contrast was performed. The patients underwent PET-MRI every 6-12 months during the follow-up period until death. Over this period, 50 patients with two or more PET-MRI were evaluated.
RESULTS: The mean age was 61 [extremes, 31-92] years. At the baseline, PET-MRI provided new information in 12 cases (17%) as compared to conventional imaging: there were more metastases in eight, an undescribed location (myocardia) in two, and an unknown primary location in two cases. G grading at the baseline influenced overall survival. During the follow-up (7-381 months, mean 194), clinical and therapy managements were influenced by PET-MRI in three (6%) patients due to new metastases findings when neither overall, nor disease-free survivals in these two subgroups (n = 12 vs. n = 59), were different.
CONCLUSIONS: Our study suggests that using PET/MRI with the appropriate radiotracer improves the diagnostic performance with no benefit on survival. Further studies are warranted to evaluate the cost-effectiveness of this procedure.
METHODS: From June 2017 to December 2021, 71 G-NEN patients underwent whole-body PET-MRI for staging and/or follow-up purposes. A whole-body emission scan with 18F-6-fluoro-L-dihydroxyphenylalanine (18FDOPA, n = 30), 18F-fluoro-2-deoxy-D-glucose (18FDG, n = 21), or 68Ga-(DOTA(0)-Phe(1)-Tyr(3))-octreotide (68Ga-DOTATOC, n = 20) with the simultaneous acquisition of a T1-Dixon sequence and diffusion-weighed imaging (DWI), followed by a dedicated step of MRI sequences with a Gadolinium contrast was performed. The patients underwent PET-MRI every 6-12 months during the follow-up period until death. Over this period, 50 patients with two or more PET-MRI were evaluated.
RESULTS: The mean age was 61 [extremes, 31-92] years. At the baseline, PET-MRI provided new information in 12 cases (17%) as compared to conventional imaging: there were more metastases in eight, an undescribed location (myocardia) in two, and an unknown primary location in two cases. G grading at the baseline influenced overall survival. During the follow-up (7-381 months, mean 194), clinical and therapy managements were influenced by PET-MRI in three (6%) patients due to new metastases findings when neither overall, nor disease-free survivals in these two subgroups (n = 12 vs. n = 59), were different.
CONCLUSIONS: Our study suggests that using PET/MRI with the appropriate radiotracer improves the diagnostic performance with no benefit on survival. Further studies are warranted to evaluate the cost-effectiveness of this procedure.
摘要：
目的：同步正电子发射断层扫描/磁共振成像（PET-MRI）结合了PET的高灵敏度和MRI的高特异性，是评估胃肠胰腺神经内分泌肿瘤（G-NENs）的工具。然而,目前的指南中没有明确的建议,对其评估仍然不佳.因此，我们评估了PET-MRI对G-NEN患者预后的影响.
方法：从2017年6月至2021年12月，71例G-NEN患者接受了全身PET-MRI分期和/或随访。用18F-6-氟-L-二羟基苯丙氨酸（18FDOPA，n=30),18F-氟-2-脱氧-D-葡萄糖（18FDG，n=21),或68Ga-(DOTA(0)-Phe(1)-Tyr(3))-奥曲肽(68Ga-DOTATOC,n=20）同时采集T1-Dixon序列和扩散加权成像（DWI），随后进行了带有钆对比剂的MRI序列的专用步骤.患者在随访期间每6-12个月进行一次PET-MRI检查直至死亡。在此期间,对50例患者进行了两次或两次以上的PET-MRI评估。
结果：平均年龄为61[极端，31-92年。在基线，与常规成像相比，PET-MRI在12例（17％）中提供了新的信息：8例转移灶更多，一个没有描述的位置(心肌)一分为二,和未知的主要位置在两种情况下。基线的G分级影响总体生存率。在随访期间（7-381个月，平均194），3例（6%）患者的临床和治疗管理受到PET-MRI的影响，原因是新的转移发现，这两个亚组的无病生存率(n=12vs.n=59)，是不同的。
结论：我们的研究表明，使用PET/MRI和适当的放射性示踪剂可以提高诊断性能，而对生存没有益处。需要进一步的研究来评估该程序的成本效益。
方法：从2017年6月至2021年12月，71例G-NEN患者接受了全身PET-MRI分期和/或随访。用18F-6-氟-L-二羟基苯丙氨酸（18FDOPA，n=30),18F-氟-2-脱氧-D-葡萄糖（18FDG，n=21),或68Ga-(DOTA(0)-Phe(1)-Tyr(3))-奥曲肽(68Ga-DOTATOC,n=20）同时采集T1-Dixon序列和扩散加权成像（DWI），随后进行了带有钆对比剂的MRI序列的专用步骤.患者在随访期间每6-12个月进行一次PET-MRI检查直至死亡。在此期间,对50例患者进行了两次或两次以上的PET-MRI评估。
结果：平均年龄为61[极端，31-92年。在基线，与常规成像相比，PET-MRI在12例（17％）中提供了新的信息：8例转移灶更多，一个没有描述的位置(心肌)一分为二,和未知的主要位置在两种情况下。基线的G分级影响总体生存率。在随访期间（7-381个月，平均194），3例（6%）患者的临床和治疗管理受到PET-MRI的影响，原因是新的转移发现，这两个亚组的无病生存率(n=12vs.n=59)，是不同的。
结论：我们的研究表明，使用PET/MRI和适当的放射性示踪剂可以提高诊断性能，而对生存没有益处。需要进一步的研究来评估该程序的成本效益。
