The Role of Delayed 18F-FDG PET Imaging in the Follow-up of Patients with Alveolar Echinococcosis
The Role of Delayed 18F-FDG PET Imaging in the Follow-up of Patients with Alveolar Echinococcosis
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DOI：
10.2967/jnumed.112.109942
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发表时间：
2013-03-01
影响因子：
9.3
通讯作者：
Blagosklonov, Oleg
中科院分区：
文献类型：
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作者：
Caoduro, Cecile;Porot, Clemence;Blagosklonov, Oleg
F-18-FDG PET已被证明在泡状棘球绦虫病(AE)患者的随访中是有用的，并已被建议作为苯并咪唑中断结构化治疗的治疗决策的替代标记物。然而，标准的PET采集(F-18-FDG注射后1小时)缺乏敏感性，即使F-18-FDG周围摄取消失，寄生虫仍可能存活。我们研究的目的是评估延迟的F-18-FDG PET在治疗AE患者中的有效性。方法：在6年的时间里，使用F-18-FDG对70例接受苯并咪唑治疗的AE患者进行120次正电子发射计算机断层扫描，不作选择。所有患者在注射F-18-FDG(4MBq/kg)后1h在PET/CT设备上进行全身成像，并在注射后3h进行肝脏采集。同时对血清学检测结果进行分析。结果：在标准获取时被认为是阴性的57次扫描中，13次(22.8%)在延迟获取时明显阳性，6次(10.5%)在延迟获取时变得不确定。此外，在22个在标准采集时被解释为不确定的扫描中，有20个被认为是阳性的，因为在延迟采集时，病灶周围明显地摄取了F-18-FDG。因此，延迟收购在32.5%的案例中改变了解释。此外，在接受苯并咪唑治疗的44例患者中，11例(25%)在延迟采集时出现病理性F-18-FDG摄取，但未达到标准摄取。在这些患者中，尽管标准的F-18-FDG PET结果为阴性，且血清学检查结果为阴性，但仍继续进行治疗。另一方面，7例延迟性F-18-FDG PET阴性、血清学阴性的患者在8-37个月(平均23个月)内安全地中断了治疗，没有发现复发的证据。结论：我们的研究清楚地表明，延迟的F-18-FDG PET极大地促进了AE患者活动性和非活动性肝脏病变的鉴别。此外，我们的结果强烈表明，结合延迟的F-18-FDG PET和特定的血清学将防止仅基于标准F-18-FDG PET的治疗过早中断后观察到的大多数复发。
F-18-FDG PET has already proved its usefulness in the follow-up of patients with alveolar echinococcosis (AE) and has been proposed as a surrogate marker for therapeutic decisions on structured treatment interruption by benzimidazoles. However, standard PET acquisition (1 h after F-18-FDG injection) lacks sensitivity, and the parasite may stay viable even if F-18-FDG perilesional uptake has disappeared. The aim of our study was to evaluate the usefulness of delayed F-18-FDG PET in the management of AE patients. Methods: During a 6-y period, 120 PET scans using F-18-FDG were obtained for 70 AE patients treated by benzimidazoles, without selection. All patients underwent whole-body imaging on a PET/CT device 1 h after F-18-FDG injection (4 MBq/kg), as well as an acquisition focused on the liver 3 h after the injection. We also analyzed the results of serologic tests. Results: Of the 57 scans considered negative at the standard acquisition, 13 (22.8%) became clearly positive at the delayed acquisition, and 6 (10.5%) became indeterminate at the delayed acquisition. Furthermore, 20 of 22 scans interpreted as indeterminate at the standard acquisition were considered positive because of clear perilesional F-18-FDG uptake at the delayed acquisition. Thus, delayed acquisition changed the interpretation in 32.5% of cases. Moreover, of 44 patients treated by benzimidazoles and followed for more than 2 y by regular F-18-FDG PET scans and specific AE serology, 11 (25%) presented pathologic F-18-FDG uptake at the delayed acquisition but not at the standard one. In these patients, the treatment was continued despite negative results on standard F-18-FDG PET and negative serologic findings. On the other hand, in 7 patients with negative delayed F-18-FDG PET and negative serology, the treatment was safely interrupted with no evidence of disease recurrence during 8-37 mo (mean, 23 mo). Conclusion: Our study clearly demonstrated that delayed F-18-FDG PET greatly facilitated the differentiation between active and inactive liver lesions in AE patients. Also, our results strongly suggested that the combination of delayed F-18-FDG PET and specific serology would prevent most of the recurrences observed after premature interruption of the treatment based only on standard F-18-FDG PET.