诊断:评估68Ga-生长抑素受体类似物(68Ga-SSA)和18F-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)诊断神经内分泌肿瘤(NEN)骨转移的诊断效能差异,并分析BMs的影像学特征和临床特征之间的相关性。其中,103例患者在68Ga-SSAPET/CT后7天内接受18F-FDGPET/CT。
结果:68Ga-SSAPET/CT的BM检出率高于18F-FDGPET/CT(86.4%vs.66.0%,103例双扫描患者p=0.02)。同时,68Ga-SSAPET/CT阳性病灶数明显多于18F-FDGPET/CT(3.37±1.95vs.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)。关于原发性肿瘤,最常见的是胰腺起源(26.3%,56/213),其次是直肠起源(22.5%,48/213),胸腺起源33例(15.5%),肺源性29例(13.6%),副神经节瘤20例(9.4%)。68Ga-SSAPET/CT检测BMs的效率与原发部位显著相关(p=0.02),胸腺类癌是最难检测的,阳性率仅为60.6%(20/33)。然而,胸腺类癌组织18F-FDGPET/CT阳性率为76.92%(10/13)。本研究中7例患者通过68Ga-SSAPET比CT早4.57个月(范围:2-10个月)检测到BMs.
结论:68Ga-SSAPET/CT比18F-FDG对NEN的BM检测具有更高的灵敏度,并且比CT更早地检测到BM。此外,18F-FDGPET/CT可作为胸腺类癌BMs诊断的补充。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.