目的:68镓(68Ga)标记的生长抑素类似物(SSA)PET显像已广泛应用于神经内分泌肿瘤(NENs)的临床实践。与68Ga相比,18F具有伟大的实际和经济优势。尽管一些研究显示了健康志愿者和小型NEN患者组中[18F]AlF-NOTA-奥曲肽([18F]-OC)的特征,其临床价值有待进一步研究。在这里,这项回顾性研究旨在评估[18F]-OCPET/CT检测NENs的诊断准确性,以及将其与对比增强CT/MRI进行比较。
方法:我们回顾性分析了93例接受过[18F]-OCPET/CT和CT或MRI扫描的患者的资料。在这些病人中,有45例疑似NENs的患者进行诊断评估,48例经病理证实的NENs可检测转移或复发。[18F]-OCPET/CT图像通过测量肿瘤的最大标准化摄取值(SUVmax)进行视觉和半定量评估,肿瘤背景SUVmax比(TBR),和垂体的SUVmax(SUVhowphyssis)。在这93例患者中发现了276个可疑的NEN病变。组织病理学或影像学随访结果作为最终诊断的参考标准。
结果:45例疑似NENs患者通过切除或活检的组织病理学检查得到证实。[18F]-OCPET/CT在G1-G3NENs病变中显示高放射性示踪剂摄取。[18F]-OCPET/CT表现出优越的性能,灵敏度为96.3%,77.8%的特异性,与CT/MRI相比,诊断NENs的准确率为88.9%。当SUVmax截止时,TBR,和SUVhypophysis分别为8.3、3.1和15.4,[18F]-OCPET/CT在区分NEN和非NEN病变的敏感性和特异性之间具有最佳平衡。总共276个疑似NEN病变,灵敏度,特异性,[18F]-OCPET/CT诊断NENs的准确率为90.5%,82.1%,和88.8%,分别,高于CT和MRI。G1和G2NEN比G3具有更高的TBR和更低的CT增强强度。SUVmax和TBR与G2的CT增强强度呈正相关,而不是G1或G3。
结论:[18F]-OCPET/CT是一种用于NENs的初步诊断和检测转移或术后复发的有前途的成像方式。
Gallium-68 (68Ga)-labeled somatostatin analog (SSA) PET imaging has been widely used in clinical practice of neuroendocrine neoplasms (NENs). Compared with 68Ga, 18F has a great practical and economic advantage. Although a few studies have shown the characteristics of [18F] AlF-NOTA-octreotide ([18F]-OC) in healthy volunteers and small NEN patient groups, its clinical value needs further investigation. Herein, this retrospective study aimed to evaluate the diagnostic accuracy of [18F]-OC PET/CT in detecting NENs, as well as to compare it with contrast-enhanced CT/MRI.
We retrospectively reviewed the data of 93 patients who had undergone [18F]-OC PET/CT and CT or MRI scans. Of these patients, there were 45 patients with suspected NENs for diagnostic evaluation, and 48 patients with pathologically confirmed NENs for detecting metastasis or recurrence. [18F]-OC PET/CT images were evaluated visually and semi-quantitatively by measuring maximum standardized uptake value of tumor (SUVmax), tumor-to-background SUVmax ratio (TBR), and SUVmax of hypophysis (SUVhypophysis). A total of 276 suspected NEN lesions were found in these 93 patients. The results of histopathology or radiographic follow-up served as the reference standard for the final diagnosis.
Forty-five patients with suspected NENs were confirmed by histopathological examination via resection or biopsy. [18F]-OC PET/CT showed high radiotracer uptake in the lesions of G1-G3 NENs. [18F]-OC PET/CT showed superior performance with 96.3% of sensitivity, 77.8% of specificity, and 88.9% of accuracy in diagnosing NENs compared to CT/MRI. When cutoffs of SUVmax, TBR, and SUVhypophysis were 8.3, 3.1, and 15.4, [18F]-OC PET/CT had the best equilibrium between sensitivity and specificity for differentiating NEN from non-NEN lesions. For a total of 276 suspected NEN lesions, the sensitivity, specificity, and accuracy of [18F]-OC PET/CT for diagnosis of NENs were 90.5%, 82.1%, and 88.8%, respectively, and were higher than those of CT and MRI. G1 and G2 NENs had higher TBR and lower CT enhancement intensity than G3. The SUVmax and TBR had a positive correlation with CT enhancement intensity in G2 rather than in G1 or G3.
[18F]-OC PET/CT is a promising imaging modality for initial diagnosis and detecting metastasis or postoperative recurrence in NENs.