68Ga—DOTATATEPET／CT在垂体腺瘤中的应用价值

Clinical value of 68Ga-DOTATATE PET/CT in pituitary adenoma： a pilot study

目的观察新型SSTR显像剂68Ga-DOTATATE在不同类型垂体腺瘤中的摄取情况，评估其对奥曲肽治疗生长激素腺瘤的疗效评价作用。方法选取34例（男15例，女19例）原发垂体腺瘤患者，其中22例为分泌型腺瘤（5例为促肾上腺皮质激素腺瘤，17例为生长激素腺瘤），12例为无功能腺瘤。有13例生长激素腺瘤术前行奥曲肽治疗，分别于治疗前后行68Ga—DOTATATEPET／CT显像，其余患者术前行显像。结合MRI判断腺瘤位置并使用PET／CT自带软件勾画ROI，获得肿瘤SUVmax、肿瘤体积和密度指数（DI）。显像后2周内所有患者均行经鼻垂体腺瘤切除术，并行病理和常规免疫组织化学检查。采用Mann—Whitneyu检验分析数据。结果分泌型腺瘤的DI大于无功能腺瘤的PI（7．16±4．52与1．08±1．40；u=48．5，P〈0．05），而前者的肿瘤体积小于后者[（2．92±1．60）cm2和（9．10±7．00）cm2；=43．0，P〈0．05]，但两者的SUVmax。差异无统计学意义（M=130．0，P〉0．05）。促肾上腺皮质激素腺瘤与生长激素腺瘤的DI差异无统计学意义（u=18．0，P〉0．05），且前者的肿瘤体积小于后者[（0．95±1．08）cm。和（3．49±3．01）cm2；M=16．5，P〈0．05]。奥曲肽治疗有效的8例生长激素腺瘤患者的DI高于治疗无效的5例腺瘤患者的DI（3．55±0．91与1．38±0．69；M=2．0，P〈0．05）。结论68Ga—DOTATATEPET／CT显像可以观察垂体腺瘤的体积变化，可用于垂体腺瘤疗效评估，且奥曲肽治疗前DI高者疗效优于DI低者。

Objective To investigate the correlation between the uptake of 6SGa_DOTATATE in pi- tuitary adenoma and clinical parameters such as hormonal hypersecretion, and to evaluate the curative effect with 6SGa-DOTATATE imaging after octreotide therapy in patients with growth hormone-secreting adenoma （ GH adenoma）. Methods A total of 34 patients （ 15 males, 19 females） with pituitary adenoma were re- cruited, including 5 adrenocorticotropic hormone-secreting adenoma （ACTH adenoma）, 17 GH adenoma, and 12 non-functioning adenoma （NF adenoma）. In the 17 patients with GH adenoma, there were 13 patients treated by octreotide intramuscular injection 3 times with a total dose of 60 mg for 3 months. The finial diagnosis was based on histology. 6SGa-DOTATATE imaging was performed, and SUV tumor volume and density index （DI） were recorded in all patients. The DI was the ratio of tumor SUV to tumor volume. The effective therapy was defined as more than 50% of hormonal suppression or more than 20% of tumor shrinkage. Non-parametric Mann-Whitney u test was used. Results NF adenoma showed greater tumor volume than secretory adenoma, （（9.10±7.00） cm3 vs （2.92±1.60） cm3, u=43.0, P〈0.05） , whereas DI of secretory adenoma was higher than that of NF adenoma （7.16±4.52 vs 1.08± 1.40, u = 48.5, P〈0.05）. Ad- ditionally, DI was significantly higher（3.55±0.91 vs 1.38±0.69, u = 2.0, P〈0.05） in patients （ n= 8） with effective treatment than that in patients without effective treatment （n= 5） may be a useful probe for PET imaging in patients with pituitary adenoma, ting the therapeutic effect of somatostatin analog treatment. Conclusion 6SGa_DOTATATE and may be valuable for predicring the therapeutic effect of somatostatin analog treatment.