[124I]CLR1404 PET/CT in High-Grade Primary and Metastatic Brain Tumors
[124I]CLR1404 PET/CT in High-Grade Primary and Metastatic Brain Tumors
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DOI：
10.1007/s11307-019-01362-1
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发表时间：
2020-04-01
影响因子：
3.1
通讯作者：
Kuo, John S.
中科院分区：
文献类型：
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作者：
Hall, Lance T.;Titz, Benjamin;Kuo, John S.
目的 人们不断寻找对脑肿瘤具有高敏感性和特异性的成像技术。正电子发射断层扫描 (PET) 成像已显示出前景，但许多 PET 药物要么肿瘤特异性低，要么物理半衰期不切实际。 [I-124]CLR1404 是一种小分子烷基磷酸胆碱类似物，被认为与质膜脂筏结合，并且在之前针对脑肿瘤患者的初步研究中显示出较高的肿瘤背景比 (TBR)。本研究试图确定 [I-124]CLR1404 PET/CT（又名 CLR124）的临床价值。程序 对新发或疑似复发的高级别原发性或转移性脑肿瘤 (N = 27) 的成年患者注射 [I-124]CLR1404，然后在 6、24 和 48 小时进行 PET/CT。计算所有时间点的标准摄取值 (SUV) 和 TBR 值。与磁共振成像 (MRI) 相比，对 [I-124]CLR1404 的摄取进行了定性评估，并与临床结果相关。最终诊断（N = 25）是根据手术切除的组织或长期随访得出的。结果 除一名最终诊断为原发性/复发性脑肿瘤的患者外，所有患者均检测到高 TBR 的阳性摄取（12/13），并且只有不到一半的患者出现治疗相关变化（5/12）。 [I-124]CLR1404 摄取和 MRI 对比增强之间的一致性 < 40%，而 T-2 高信号和摄取之间没有一致性。摄取和不摄取 [I-124]CLR1404 的患者之间总体结果没有显着差异。结论 这些患者的摄取模式表明 [I-124]CLR1404 PET/CT 对诊断肿瘤组织具有非常高的敏感性；然而，肿瘤特异性需要进一步确定。与标准 MRI 特征相对缺乏一致性表明，与单独的 MRI 相比，[I-124]CLR1404 PET/CT 提供了有关脑肿瘤的更多信息，可能会改善临床决策。
Purpose There is a continuous search for imaging techniques with high sensitivity and specificity for brain tumors. Positron emission tomography (PET) imaging has shown promise, though many PET agents either have a low tumor specificity or impractical physical half-lives. [I-124]CLR1404 is a small molecule alkylphosphocholine analogue that is thought to bind to plasma membrane lipid rafts and has shown high tumor-to-background ratios (TBR) in a previous pilot study in brain tumor patients. This study attempts to define the clinical value of [I-124]CLR1404 PET/CT (aka CLR124). Procedures Adult patients with new or suspected recurrence of high-grade primary or metastatic brain tumors (N = 27) were injected with [I-124]CLR1404 followed by PET/CT at 6, 24, and 48 h. Standard uptake values (SUV) and TBR values were calculated for all time points. Uptake of [I-124]CLR1404 was qualitatively assessed, compared with magnetic resonance imaging (MRI), and correlated with clinical outcome. Final diagnosis (N = 25) was established based on surgically resected tissue or long-term follow-up. Results Positive uptake with high TBR was detected in all but one patient with a final diagnosis of primary/recurrent brain tumor (12/13) and in less than half of patients with treatment-related changes (5/12). Concordance between [I-124]CLR1404 uptake and contrast enhancement on MRI was seen in < 40 %, with no concordance between T-2-hyperintensities and uptake. No significant difference in overall outcome was found between patients with and without [I-124]CLR1404 uptake. Conclusions The uptake pattern in these patients suggests a very high sensitivity of [I-124]CLR1404 PET/CT for diagnosing tumor tissue; however, tumor specificity needs to be further defined. Relative lack of concordance with standard MRI characteristics suggests that [I-124]CLR1404 PET/CT provides additional information about brain tumors compared to MRI alone, potentially improving clinical decision-making.