神经内分泌肿瘤转移灶PET/CT生长抑素受体显像特点分析

摘要

Objective To investigate the characteristics of NEN metastasis with SSTR PET/CT and to correlate the results with FDG-PET and pathology.Methods From November 2011 to August 2016, a total of 43 patients with NEN (18 males, 25 females;age range: 26-74 years) were recruited into this retrospective study;they underwent 68Ga-DOTA-TATE PET/CT (TATE-PET) imaging 40-60 min after 44.4-229.4 MBq 68Ga-DOTA-TATE administration.Metastases in 31 patients were confirmed by histopathology and in 12 patients by follow-up and other imaging modalities.Twenty-eight of 43 patients finished routine FDG-PET in a week after TATE-PET.PET/CT results were considered positive when the metastatic lesions were tracer-avid.ROI was drawn over each lesion for size and SUV measurement.χ2 test and Pearson correlation analysis were used for statistical analysis.Results (1) Of 43 patients, TATE-PET detection rates of metastasis in the liver, lymph nodes, bones and lungs were 85.7%(30/35), 12/13, 7/7, 2/3, respectively, with their corresponding SUVmax of 18.1(11.3-23.3), 10.8(5.4-15.6), 7.7(4.2-9.9) and 1.8(1.3-2.3), respectively.Statistical correlation between size and SUVmax was found in metastatic bone lesions(r=0.233, P<0.05).(2) In 31 patients with histopathologically proven metastasis, TATE-PET detected 23/24(95.8%) G2, 1/2 G1 and 5/5 G3 metastases.G1 metastases were only found in the liver.(3)Among 28 patients underwent both TATE-PET and FDG-PET, there was no significant difference between the detecting rate of metastasis: 89.2%(25/28) vs 71.4%(20/28);χ2=2.389, P>0.05.Compared with FDG-PET, TATE-PET was superior in demonstrating metastasis in the liver and bones (70.0%(14/20) vs 65.0%(13/20), 3/3 vs 2/3), equal in detecting lung metastasis (both 2/3) but inferior in demonstrating metastasis in lymph nodes(9/10 vs 10/10).Conclusions The capability of TATE-PET in revealing NEN metastasis varies depending on lesion localization and histologic grade.TATE-PET and FDG-PET are complementary to each other in detection of NEN metastasis, but without obvious relationship to histologic grade.%目的 探讨NEN转移灶68Ga-DOTA-TATE PET/CT(TATE-PET)显像特点及其与病理和18F-FDG PET/CT(FDG-PET)显像关系.方法 回顾性分析2011年11月至2016年8月间43例NEN患者(男18例,女25例;年龄26~74岁)资料.患者静脉注射68Ga-DOTA-TATE 44.4~229.4 MBq后40~60 min显像,28例在1周内按常规方法行FDG-PET.31例患者的转移灶经病理证实,余为临床诊断.病灶显像剂摄取高于本底为阳性,用ROI法测量病灶直径、SUVmax和SUVmean.采用χ2检验和Pearson相关分析处理数据.结果 (1)TATE-PET对43例患者的肝、淋巴结、骨及肺转移灶总检出率分别为85.7%(30/35)、12/13、7/7及2/3,SUVmax分别为18.1(11.3~23.3)、10.8(5.4~15.6)、7.7(4.2~9.9)和1.8(1.3~2.3).骨转移灶SUVmax与直径存在相关性(r=0.233,P<0.05).(2)31例转移灶有病理结果的患者中,TATE-PET对G1、G2、G3的检出率分别为1/2、23/24(95.8%)和5/5.转移灶为G1的NEN仅发现于肝脏.(3)28例患者行2种显像,TATE-PET与FDG-PET对转移灶总检出率分别为89.2%(25/28)和71.4%(20/28),差异无统计学意义(χ2=2.389,P>0.05).TATE-PET对肝、骨转移灶检出率高于FDG-PET[70.0%(14/20)与65.0%(13/20),3/3与2/3],而FDG-PET对淋巴结转移检出效果好(10/10与9/10),两者对肺转移灶检出能力相当(均为2/3).结论 TATE-PET对不同脏器及不同病理分级的NEN转移灶检出效果不同,TATE-PET与FDG-PET显像结果互补,但与病理分级无明显关系.