~(99m)Tc-HYNIC-TOC SPECT/CT显像中胰头高摄取的判读:生理性摄取或胰腺神经内分泌瘤?
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摘要
目的:本研究旨在探讨如何准确判断~(99m)Tc-HYNIC-TOC SPECT/CT显像中胰头高摄取灶的性质。方法:回顾性分析125例~(99m)Tc-HYNIC-TOC SPECT/CT检查患者,包括可疑胰腺神经内分泌瘤(pancreatic neuroendocrine tumor,p NET)或远处转移性NET寻找原发灶或明确NET行临床分期或随访者。根据视觉判断评价SPECT/CT图像上是否存在胰头高摄取,若存在高摄取,测量病灶部位、胰腺本底、肝脏本底及同层面竖脊肌本底的放射性计数,并计算得到病灶/胰腺本底比(L/P)、病灶/肝脏本底比(L/H)和病灶/肌肉本底比(L/M)。通过影像学随访或病理证实获取最终诊断结果。结果:125例患者中,20例(16.0%)手术或穿刺病理证实为p NET,22例(17.6%)长期随访局部未见病灶,考虑为生理性摄取。p NET与胰头生理性摄取的L/P差异无统计学意义(P=0.118),前者的L/H和L/M明显高于后者(P=0.001和0.013)。受试者工作特征(receiver operating characteristic,ROC)曲线分析显示,L/H和L/M判别p NET还是胰头生理性摄取的曲线下面积(area under curve,AUC)为0.789和0.725,此时L/H阈值为1.4。结论:通过L/H测定,有助于判断~(99m)TcHYNIC-TOC SPECT/CT显像中胰头高摄取灶为胰腺生理性摄取还是p NET。
Objective: To discuss how to determine the property of high uptake of pancreatic head identified by ~(99m)Tc-HYNIC-TOC SPECT/CT. Methods: We retrospectively analyzed 125 patients who underwent ~(99m)Tc-HYNIC-TOC SPECT/CT for suspecious pancreatic neuroendocrine tumor(p NET) or staging and restaging of NET or detecting primary tumor for metastatic NET. High uptake of pancreatic head in the image of SPECT/CT was defined by visual assessment. If it existed, the radioactive counts of high-uptake lesion, normal pancreas, normal hepatic tissue and normal muscle were measured and the ratios of lesion-to-pancreas(L/P), lesion-to-hepatic tissue(L/H) and lesion-to-muscle(L/M) were calculated. The final results were achieved by imaging follow-up or pathological confirmation. Results: Twenty(16.0%) patients were confirmed as p NET by surgery or biopsy. Twenty-two(17.6%) patients were considered as physiological uptake because of lack of abnormal masses located in the pancreatic head. There was no significant difference in L/P between p NET and physiological uptake(P=0.118). However, L/H and L/M of p NET were significantly higher than those of physiological uptake(P=0.001 and 0.013). The areas under curve by receiver operating characteristic(ROC) curve analysis of L/H and L/M for distinguishing p NET from physiological uptake were 0.789 and 0.725, respectively. Conclusion: It is a useful way to differentiate p NET from physiological uptake in ~(99m)Tc-HYNIC-TOC SPECT/CT by measuring the ratio of L/H.
Objective: To discuss how to determine the property of high uptake of pancreatic head identified by ~(99m)Tc-HYNIC-TOC SPECT/CT. Methods: We retrospectively analyzed 125 patients who underwent ~(99m)Tc-HYNIC-TOC SPECT/CT for suspecious pancreatic neuroendocrine tumor(p NET) or staging and restaging of NET or detecting primary tumor for metastatic NET. High uptake of pancreatic head in the image of SPECT/CT was defined by visual assessment. If it existed, the radioactive counts of high-uptake lesion, normal pancreas, normal hepatic tissue and normal muscle were measured and the ratios of lesion-to-pancreas(L/P), lesion-to-hepatic tissue(L/H) and lesion-to-muscle(L/M) were calculated. The final results were achieved by imaging follow-up or pathological confirmation. Results: Twenty(16.0%) patients were confirmed as p NET by surgery or biopsy. Twenty-two(17.6%) patients were considered as physiological uptake because of lack of abnormal masses located in the pancreatic head. There was no significant difference in L/P between p NET and physiological uptake(P=0.118). However, L/H and L/M of p NET were significantly higher than those of physiological uptake(P=0.001 and 0.013). The areas under curve by receiver operating characteristic(ROC) curve analysis of L/H and L/M for distinguishing p NET from physiological uptake were 0.789 and 0.725, respectively. Conclusion: It is a useful way to differentiate p NET from physiological uptake in ~(99m)Tc-HYNIC-TOC SPECT/CT by measuring the ratio of L/H.
引文
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[15]KUYUMCU S,?ZKAN Z G,SANLI Y,et al.Physiological and tumoral uptake of 68Ga-DOTATATE:standardized uptake values and challenges in interpretation[J].Ann Nucl Med,2013,27(6):538-545.
[16]ALBERS M B,MAURER E,KL?PPEL G,et al.Pancreatic polypeptide-rich islets in the posterior portion of the pancreatic head-a tumor mimic in somatostatin receptor scintigraphy[J].Pancreas,2014,43(4):648-650.
[17]YAMAGA L Y,NETO G C,DA CUNHA M L,et al.99mTcHYNIC-TOC increased uptake can mimic malignancy in the pancreas uncinate process at somatostatin receptor SPECT/CT[J].Radiol Med,2016,121(3):225-228.
[18]PRASAD V,BAUM R P.Biodistribution of the Ga-68labeled somatostatin analogue DOTA-NOC in patients with neuroendocrine tumors:characterization of uptake in normal organs and tumor lesions[J].Q J Nucl Med Mol Imaging,2010,54(1):61-7.
[19]KROISS A,PUTZER D,DECRISTOFORO C,et al.68Ga-DOTA-TOC uptake in neuroendocrine tumour and healthy tissue:differentiation of physiological uptake and pathological processes in PET/CT[J].Eur J Nucl Med Mol Imaging,2013,40(4):514-523.
[20]WANG X,ZIELINSKI M C,MISAWA R,et al.Quantitative analysis of pancreatic polypeptide cell distribution in the human pancreas[J].PLo S One,2013,8(1):55501.
[2]张洪印.胃肠胰神经内分泌肿瘤分类方法及分子治疗研究新进展[J].癌症进展,2017,15(6):609-610,617.
[3]REUBI J C,WASER B,SCHAER J C,et al.Somatostatin receptor SST1-SST5 expression in normal and neoplastic human tissues using receptor autoradiography with subtypeselective ligands[J].Eur J Nucl Med,2001,28(7):836-846.
[4]ARTIKO V,AFGAN A,PETROVI?J,et al.Evaluation of neuroendocrine tumors with 99mTc-EDDA/HYNIC TOC[J].Nucl Med Rev Cent East Eur,2016,19(2):99-103.
[5]ARTIKO V,SOBIC-SARANOVIC D,PAVLOVIC S,et al.The clinical value of scintigraphy of neuroendocrine tumors using 99mTc-HYNIC-TOC[J].J BUON,2012,17(3):537-542.
[6]QIAO Z,ZHANG J,JIN X,et al.99mTc-HYNIC-TOC imaging in the evaluation of pancreatic masses which are potential neuroendocrine tumors[J].Clin Nucl Med,2015,40(5):397-400.
[7]AIT BOUDAOUD A,VERGES B,PETIT J M,et al.Uptake in the pancreatic uncinate process on the 111Inoctreotide scintigraphy:How to distinguish physiological from pathological uptake?[J].Nucl Med Commun,2017,38(9):737-743.
[8]AL-IBRAHEEM A,BUNDSCHUH R A,NOTNI J,et al.Focal uptake of 68Ga-DOTATOC in the pancreas:pathological or physiological correlate in patients with neuroendocrine tumours?[J].Eur J Nucl Med Mol Imaging,2011,38(11):2005-2013.
[9]BRABANDER T,TEUNISSEN J,KWEKKEBOOM D.Physiological uptake in the pancreatic head on somatostatin receptor scintigraphy using[111In-DTPA]octreotide:incidence and mechanism[J].Clin Nucl Med,2017,42(1):15-19.
[10]DE LA CUEVA L,LLORO P,SANGRóS M J,et al.Physiological expression of pancreatic somatostatin receptors in 99mTc-HYNIC-TOC scintigraphy[J].Clin Transl Oncol,2017,19(7):915-920.
[11]DECRISTOFORO C,MELENDEZ-ALAFORT L,SOSABOWS K I J K,et al.99 mTc-H Y N I C-[Ty r 3]-octreotide for imaging somatostatin-receptor-positive tumors:preclinical evaluation and comparison with 111Inoctreotide[J].J Nucl Med,2000,41(6):1114-1119.
[12]KIM J Y,HONG S M,RO J Y.Recent updates on grading and classification of neuroendocrine tumors[J].Ann Diagn Pathol,2017,29:11-16.
[13]JACOBSSON H,LARSSON P,JONSSON C,et al.Normal uptake of 68Ga-DOTA-TOC by the pancreas uncinate process mimicking malignancy at somatostatin receptor PET[J].Clin Nucl Med,2012,37(4):362-365.
[14]MAPELLI P,TAM H H,SHARMA R,et al.Frequency and significance of physiological versus pathological uptake of 68Ga-DOTATATE in the pancreas:validation with morphological imaging[J].Nucl Med Commun,2014,35(6):613-619.
[15]KUYUMCU S,?ZKAN Z G,SANLI Y,et al.Physiological and tumoral uptake of 68Ga-DOTATATE:standardized uptake values and challenges in interpretation[J].Ann Nucl Med,2013,27(6):538-545.
[16]ALBERS M B,MAURER E,KL?PPEL G,et al.Pancreatic polypeptide-rich islets in the posterior portion of the pancreatic head-a tumor mimic in somatostatin receptor scintigraphy[J].Pancreas,2014,43(4):648-650.
[17]YAMAGA L Y,NETO G C,DA CUNHA M L,et al.99mTcHYNIC-TOC increased uptake can mimic malignancy in the pancreas uncinate process at somatostatin receptor SPECT/CT[J].Radiol Med,2016,121(3):225-228.
[18]PRASAD V,BAUM R P.Biodistribution of the Ga-68labeled somatostatin analogue DOTA-NOC in patients with neuroendocrine tumors:characterization of uptake in normal organs and tumor lesions[J].Q J Nucl Med Mol Imaging,2010,54(1):61-7.
[19]KROISS A,PUTZER D,DECRISTOFORO C,et al.68Ga-DOTA-TOC uptake in neuroendocrine tumour and healthy tissue:differentiation of physiological uptake and pathological processes in PET/CT[J].Eur J Nucl Med Mol Imaging,2013,40(4):514-523.
[20]WANG X,ZIELINSKI M C,MISAWA R,et al.Quantitative analysis of pancreatic polypeptide cell distribution in the human pancreas[J].PLo S One,2013,8(1):55501.