Identification and characterization of myocardial metastases in neuroendocrine tumor patients using 68Ga-DOTATATE PET-CT
Identification and characterization of myocardial metastases in neuroendocrine tumor patients using 68Ga-DOTATATE PET-CT
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DOI：
10.1186/s40644-018-0168-2
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发表时间：
2018-09-20
期刊：
影响因子：
4.9
通讯作者：
Cyran, Clemens C.
中科院分区：
文献类型：
--
作者：
Kunz, Wolfgang G.;Eschbach, Ralf S.;Cyran, Clemens C.
背景：临床实践中观察到神经内分泌肿瘤（NET）患者心肌内的局灶性68 Ga-DOTATATE PET病变。我们确定的频率和特点的病变，是一致的心脏转移和评估病变的检出率的常规imaging.Methods：629例患者接受68镓DOTATATE PET-CT在一个超区域综合癌症中心的NET被列入一个连续的注册表。入选标准为：（1）在两次以上连续PET检查中心肌内的局灶性68 Ga-DOTATATE示踪剂摄取，和（2）对比增强CT。为了确定常规CT成像的诊断准确性，使用了比例为1：3的病例对照队列。PET和CT由两名设盲的阅片师独立分析。科恩的K进行了评估interreader协议描述性统计的频率和特点和组比较进行了分析，使用Fisher的精确test.Results：心肌转移的患病率相关的登记为2.4%（15 629 NET患者符合纳入标准），共检测到21个心肌68镓DOTATATE病灶。心肌病变最常位于左心室（43%）和室间隔（43%）。无患者出现心包积液。心肌转移患者在人口统计学、肿瘤分级、疾病分期或循环肿瘤标志物方面与总体登记相比没有差异（所有p > 0.05）。心肌转移患者的Ki 67指数较高（p = 0.049）。PET评估的阅片员间一致性极佳（Cohen K = 1.0）。CT阅读显示敏感性为19%（95%可信区间：6-43%），特异性为100%（95%可信区间：90- 100%hCLUSION：68 Ga-DOTATATE PET能够检测NET患者的心肌转移性病变。相比之下，标准形态CT成像提供非常有限的灵敏度。
Background: Focal 68Ga-DOTATATE PET lesions within the myocardium of neuroendocrine tumor (NET) patients are observed in clinical practice. We determined the frequency and characteristics of lesions that are consistent with cardiac metastasis and assessed the lesion detection rate of conventional imaging.Methods: 629 patients who underwent 68Ga-DOTATATE PET-CT at a supraregional comprehensive cancer center on NET were included from a consecutive registry. Inclusion criteria were: (1) focal 68Ga-DOTATATE tracer uptake within the myocardium in more than two sequential PET exams, and (2) contrast-enhanced CT. To determine the diagnostic accuracy of conventional CT imaging, a case-control cohort with a ratio of 1:3 was used. PET and CT were independently analyzed by two blinded readers. Cohen's K was assessed for interreader agreement Descriptive statistics were applied for frequencies and characteristics and group comparisons were analyzed using the Fisher's exact test.Results: The prevalence of myocardial metastases related to the registry was 2.4% (15 of 629 NET patients fulfilling the inclusion criteria), for a total of 21 myocardial 68Ga-DOTATATE foci detected. Myocardial lesions were most frequently located in the left ventricle (43%) and the septum (43%). No patient demonstrated a pericardial effusion. Patients with myocardial metastases did not differ in demographics, tumor grading, disease stage or circulating tumor markers compared to the overall registry (all p > 0.05). Higher Ki67-Indices were observed (p = 0.049) for patients with myocardial metastases. Interreader agreement for PET assessment was excellent (Cohen's K = 1.0). CT reading showed a sensitivity of 19% (95% confidence interval: 6-43%) at a specificity of 100% (95% confidence interval: 90-100%).Conclusions: 68Ga-DOTATATE PET enables detection of myocardial metastatic lesions in NET patients. In contrast, standard morphologic CT imaging provides very limited sensitivity.