Is there a place for FET PET in the initial evaluation of brain lesions with unknown significance?
Is there a place for FET PET in the initial evaluation of brain lesions with unknown significance?
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DOI：
10.1007/s00259-010-1457-6
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发表时间：
2010-04
影响因子：
9.1
通讯作者：
R. Pichler;A. Dunzinger;G. Wurm;J. Pichler;S. Weis;K. Nussbaumer;R. Topakian;R. Aigner
中科院分区：
文献类型：
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作者：
R. Pichler;A. Dunzinger;G. Wurm;J. Pichler;S. Weis;K. Nussbaumer;R. Topakian;R. Aigner
目的评价神经内科门诊使用o -（2-[18F]氟乙基）-l-酪氨酸（FET）正电子发射断层扫描(PET)/计算机断层扫描（CT）评估磁共振成像（MRI）新诊断的脑病变的临床价值。方法对2006 ~ 2008年连续接受MRI检查的脑内肿块或病变患者88例（男44例，女44例）进行评估，平均年龄50±19岁。由于神经系统临床症状，住院治疗是必要的。静脉注射185mbq场效应晶体管30min后PET/CT成像。HERMES工作站与MRI共配。结果60例患者fet摄取高于皮质水平。60例患者行神经外科手术（51例为fet阳性影像）；36例高级别肿瘤和19例低级别肿瘤经组织学证实。在这种情况下，FET PET对高级别肿瘤（WHO III-IV）的敏感性为94%。在低级别脑肿瘤（WHO I-II）中，19例中有13例FET阳性，这表明敏感性为68%。5 / 10（50%）的星形细胞瘤I和II不能通过FET显像。88例患者中有28例未提供组织学资料，因此诊断方法基于纵向观察。在中位7个月后进行放射学和/或临床对照。三名患者（均为FET阳性）在检查后几个月死亡，因为恶性脑肿瘤进展迅速。其余25例可排除恶性肿瘤。考虑整个队列88例患者，可识别恶性肿瘤43例，包括高级别胶质瘤、脑内淋巴瘤（n= 1）和转移（n= 3）。FET PET检测恶性肿瘤实体的灵敏度为93%。我们观察到两例假阳性的脑缺血后病变。值得注意的是，这两例脑胶质瘤病患者在FET PET成像上呈假阴性。恶性肿瘤的阴性预测值为89%。结论FET PET对有神经系统症状和近期MRI观察到脑病变的患者检测高级别胶质瘤具有较高的灵敏度。在通过FET PET评估未知意义的新脑病变的情况下，阴性图像可以鼓励采取观望策略-当然要根据临床图片和形态学成像。
PurposeThe aim of this study was to evaluate the clinical value of the use ofO-(2-[18F]fluoroethyl)-l-tyrosine (FET) positron emission tomography (PET)/computed tomography (CT) in patients of a neurological clinic for evaluation of brain lesions newly diagnosed by magnetic resonance imaging (MRI).MethodsWe evaluated 88 patients (44 women and 44 men) with a mean age of 50 ± 19 years who were sent consecutively for evaluation of an intracerebral mass or lesion observed by MRI from 2006 to 2008. Hospitalization was necessary due to neurological clinical symptoms. Images were obtained by PET/CT 30 min after i.v. injection of 185 MBq FET. Coregistration with MRI was done by HERMES workstation.ResultsFET uptake above the cortical level was observed in 60 patients. Neurosurgery was performed in 60 patients (51 with FET-positive imaging); 36 high-grade and 19 low-grade tumours were verified histologically. The sensitivity of FET PET for high-grade tumours (WHO III–IV) was 94% in this setting. Among the low-grade brain tumours (WHO I–II) 13 of 19 were FET positive, which indicates a sensitivity of 68%. Five of ten (50%) astrocytomas I and II could not be visualized by FET. Histological data were not provided for 28 of 88 patients, so the diagnostic approach is based upon longitudinal observation. Radiological and/or clinical control was done at a median of 7 months later. Three patients (all FET positive) died a few months after the examination because of rapid progression of the malignant brain tumour. A malignant entity could be excluded in the other 25 patients. Considering the whole cohort of 88 patients, 43 patients with malignant tumour could be identified, including high-grade glioma, intracerebral lymphoma (n= 1) and metastasis (n= 3). The sensitivity of FET PET for detecting a malignant tumour entity was 93%. We observed two false-positive cases with postischaemic lesions. Remarkably, the two patients with cerebral gliomatosis were false-negative on FET PET imaging. The negative predictive value for a malignant entity was calculated to be 89%.ConclusionOur results indicate a high sensitivity of FET PET for detecting high-grade glioma in patients with neurological symptoms and recently observed brain lesions by MRI. In the setting of evaluating new brain lesions of unknown significance via FET PET a negative image can encourage a wait and see strategy—of course in accordance with the clinical picture and morphological imaging.