Simultaneous 68Ga-DOTATOC PET/MRI in Patients With Gastroenteropancreatic Neuroendocrine Tumors Initial Results
Simultaneous 68Ga-DOTATOC PET/MRI in Patients With Gastroenteropancreatic Neuroendocrine Tumors Initial Results
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DOI：
10.1097/rli.0b013e3182871a7f
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发表时间：
2013-05-01
影响因子：
6.7
通讯作者：
Lauenstein, Thomas C.
中科院分区：
文献类型：
--
作者：
Beiderwellen, Karsten J.;Poeppel, Thorsten D.;Lauenstein, Thomas C.
目的：该初步研究的目的是证明同时获得的（68）-镓-DOTA-D-Phe 1-Tyr（3）-奥曲肽的潜力（Ga-68-DOTATOC）正电子发射断层扫描/磁共振成像（PET/MRI）与Ga-68-DOTATOC PET/计算机断层扫描（PET/CT）在患有已知胃肠胰腺神经内分泌肿瘤（NET）的患者中的比较。前瞻性入组经组织病理学证实的NET和计划Ga-68-DOTATOC PET/CT患者（4名女性和4名男性;平均[SD]年龄：54 [17]岁;中位数：55岁;范围：25岁至74岁），进行额外的PET/MRI综合扫描。正电子发射断层扫描/计算机断层扫描采用三相对比增强全剂量方案进行。正电子发射断层扫描/磁共振成像包括诊断性对比增强全身MRI方案。两名阅片人分别分析了PET/CT和PET/MRI数据集，包括其子扫描，按照随机顺序，在4分顺序量表（0，不可见; 1，良性; 2，不确定; 3，恶性）上进行病变定位、计数和表征。此外，在二进制量表上对每个病变进行一致评级（仅允许良性/恶性）。临床影像学、现有既往检查和组织病理学（如可用）作为参考标准。在PET阳性病变中，一致测量标准化摄取值（SUVmax）。进行了描述性的、以病例为导向的数据分析，包括确定恶性、良性和与其定位相关的不确定病变的检出频率和百分比。此外，还计算了单一模态（如PET、CT或MRI）检测的百分比。计算观察者间变异性（Cohen's kappa）。结果：根据参考标准，8例患者中有5例在检查时为恶性NET病变。PET/CT共正确识别了4例患者，PET和CT组件分别正确识别了3例患者。PET/MRI正确识别了所有5例NET疾病阳性患者，MRI子扫描识别了所有5例患者，PET子扫描识别了3例患者。所有在PET/CT中被视为恶性的病变均在PET/MRI中进行了同样的描述和考虑。由于弥散加权成像中的弥散限制，PET/CT中被评定为“不确定”的一个肝脏病变在PET/MRI中被确定为转移。在PET/CT表征的4个肺部病变中，仅1个在PET/MRI中被描绘。在PET/CT中描绘的3个淋巴结中，仅1个在PET/MRI中得到表征。PET/CT（kappa = 0.916）和PET/MRI（kappa = 1.0）的观察者间可靠性同样非常好。在PET/CT和PET/MRI中测量的SUVmax显示出很强的相关性（Pearson相关系数，0.996）。结论：该初步研究证明了Ga-68-DOTATOC PET/MRI在胃肠胰腺NET患者中的潜力，在腹部病变的表征方面具有特殊优势，但MRI固有的某些弱点，如肺转移和骨质增生性骨病变。
Objectives: The aim of this pilot study was to demonstrate the potential of simultaneously acquired (68)-Gallium-DOTA-D-Phe1-Tyr(3)-octreotide (Ga-68-DOTATOC) positron emission tomography/magnetic resonance imaging (PET/MRI) in comparison with Ga-68-DOTATOC PET/computed tomography (PET/CT) in patients with known gastroenteropancreatic neuroendocrine tumors (NETs).Materials and Methods: Eight patients (4 women and 4 men; mean [SD] age, 54 [17] years; median, 55 years; range 25Y74 years) with histopathologically confirmed NET and scheduled Ga-68-DOTATOC PET/CT were prospectively enrolled for an additional integrated PET/MRI scan. Positron emission tomography/computed tomography was performed using a triple-phase contrast-enhanced full-dose protocol. Positron emission tomography/magnetic resonance imaging encompassed a diagnostic, contrast-enhanced whole-body MRI protocol. Two readers separately analyzed the PET/CT and PET/MRI data sets including their subscans in random order regarding lesion localization, count, and characterization on a 4-point ordinal scale (0, not visible; 1, benign; 2, indeterminate; and 3, malignant). In addition, each lesion was rated in consensus on a binary scale (allowing for benign/malignant only). Clinical imaging, existing prior examinations, and histopathology (if available) served as the standard of reference. In PET-positive lesions, the standardized uptake value (SUVmax) was measured in consensus. Adescriptive, case-oriented data analysiswas performed, including determination of frequencies and percentages in detection of malignant, benign, and indeterminate lesions in connection to their localization. In addition, percentages in detection by a singular modality (such as PET, CT, or MRI) were calculated. Interobserver variability was calculated (Cohen's kappa). The SUVs in the lesions in PET/CT and PET/MRI were measured, and the correlation coefficient (Pearson, 2-tailed) was calculated.Results: According to the reference standard, 5 of the 8 patients had malignant NET lesions at the time of the examination. A total of 4 patients were correctly identified by PET/CT, with the PET and CT component correctly identifying 3 patients each. All 5 patients positive for NET disease were correctly identified by PET/MRI, with the MRI subscan identifying all 5 patients and the PET subscan identifying 3 patients. All lesions considered as malignant in PET/CT were equally depicted in and considered using PET/MRI. One liver lesion rated as "indetermined" in PET/CT was identified as metastasis in PET/MRI because of a diffusion restriction in diffusion-weighted imaging. Of the 4 lung lesions characterized in PET/CT, only 1 was depicted in PET/MRI. Of the 3 lymph nodes depicted in PET/CT, only 1 was characterized in PET/MRI. Interobserver reliability was equally very good in PET/CT (kappa = 0.916) and PET/MRI (kappa = 1.0). The SUVmax measured in PET/CT and in PET/MRI showed a strong correlation (Pearson correlation coefficient, 0.996).Conclusions: This pilot study demonstrates the potential of Ga-68-DOTATOC PET/MRI in patients with gastroenteropancreatic NET, with special advantages in the characterization of abdominal lesions yet certain weaknesses inherent to MRI, such as lung metastases and hypersclerotic bone lesions.