(18)F-FLT PET/CT Adds Value to (18)F-FDG PET/CT for Diagnosing Relapse After Definitive Radiotherapy in Patients with Lung Cancer: Results of a Prospective Clinical Trial.
(18)F-FLT PET/CT Adds Value to (18)F-FDG PET/CT for Diagnosing Relapse After Definitive Radiotherapy in Patients with Lung Cancer: Results of a Prospective Clinical Trial.
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DOI：
10.2967/jnumed.120.247742
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发表时间：
2021-05-10
期刊：
影响因子：
--
通讯作者：
Fischer BM
中科院分区：
文献类型：
--
作者：
Christensen TN;Langer SW;Persson G;Larsen KR;Loft A;Amtoft AG;Berthelsen AK;Johannesen HH;Keller SH;Kjaer A;Fischer BM
诊断肺癌放疗后复发具有挑战性。由于辐射诱导的变化，CT和2-脱氧-2-[18 F]氟-D-葡萄糖（FDG）-PET/CT的特异性较低。3 '-脱氧-3'-[18F]氟胸苷（FLT）-PET先前已证明对恶性肿瘤的特异性高于FDG-PET。我们探讨了FLT-PET/CT在肺癌放疗后复发诊断中的价值。纳入了确定性放疗（常规分割放疗（cRT）或立体定向放疗（SBRT））后疑似肺癌复发的患者。在辐照高剂量体积（HDV）和基于患者的范围内分析灵敏度和特异性。对边际差异和观察者间一致性进行了评估。纳入了63例在70例HDV（34例cRT; 36例SBRT）中接受放疗的患者。FLT-PET/CT的特异性高于FDG-PET/CT（HDV：96% [87-100] vs. 71% [57-83]; p=0.0039;基于患者（90%[73-98] vs. 55% [36-74]; p=0.0020））。与SBRT相比，cRT后FLT-PET/CT和FDG-PET/CT的特异性差异更大。FLT-PET/CT的灵敏度低于FDG-PET/CT（HDV：69% [41-89] vs. 94% [70-100]; p=0.1250;基于患者：70% [51-84] vs. 94% [80-99]; p=0.0078）。与仅使用FDG-PET/CT相比，当FDG-PET/CT呈阳性或不确定时添加FLT-PET/CT可提高诊断价值。在cRT-HDV中，恶性肿瘤的概率从单独FDG-PET/CT的67%增加到两个PET均阳性时的100%。FLT-PET/CT在疑似复发患者中增加了FDG-PET/CT的诊断价值。FLT-PET/CT的诊断影响在cRT后最高。我们建议当FDG-PET/CT在先前照射体积内不确定或阳性时增加FLT-PET/CT，以提高组织学确认不容易获得的患者的诊断价值。
Diagnosing relapse after radiotherapy for lung cancer is challenging. The specificity of both CT and 2-deoxy-2-[18F]fluoro-D-glucose (FDG)-PET/CT is low due to radiation-induced changes. 3’-deoxy-3’-[18F]fluorothymidine (FLT)-PET has previously demonstrated higher specificity for malignancy than FDG-PET. We investigated the value of FLT-PET/CT for diagnosing relapse in irradiated lung cancer. Patients suspected for relapse of lung cancer after definitive radiotherapy (conventional fractionated radiotherapy (cRT) or stereotactic radiotherapy (SBRT)) were included. Sensitivity and specificity were analysed within the irradiated high-dose volume (HDV) and patient-based. Marginal differences and inter-observer agreement were assessed. Sixty-three patients who had received radiotherapy in 70 HDVs (34 cRT; 36 SBRT) were included. The specificity of FLT-PET/CT was higher than FDG-PET/CT (HDV: 96% [87-100] vs. 71% [57-83]; p=0.0039; patient-based (90 % [73-98] vs. 55% [36-74]; p=0.0020)). The difference between specificity of FLT-PET/CT and FDG-PET/CT was higher after cRT compared with SBRT. Sensitivity of FLT-PET/CT was lower than FDG-PET/CT (HDV: 69% [41-89] vs. 94% [70-100]; p=0.1250; patient-based: 70% [51-84] vs. 94% [80-99]; p=0.0078). Adding FLT-PET/CT when FDG-PET/CT was positive or inconclusive improved diagnostic value compared with FDG-PET/CT only. In cRT-HDVs, the probability of malignancy increased from 67% for FDG-PET/CT alone to 100% when both PETs were positive. FLT-PET/CT adds diagnostic value to FDG-PET/CT in patients with suspected relapse. The diagnostic impact of FLT-PET/CT was highest after cRT. We suggest adding FLT-PET/CT when FDG-PET/CT is inconclusive or positive within the previously irradiated volume to improve diagnostic value in patients where histological confirmation is not easily obtained.
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影响因子：
9.6
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