68Ga-DOTATATE PET/CT显像联合MRI在肿瘤性骨软化症诊断中的应用

Application of 68Ga-DOTATATE PET/CT imaging combined with MRI in the diagnosis of tumor-induced osteomalacia

目的评价68Ga-1,4,7,10-四氮杂环十二烷-1,4,7,10-四乙酸-D-苯丙氨酸1-酪氨酸3-苏氨酸8-奥曲肽(DOTATATE)PET/CT显像及其联合MRI在提高肿瘤性骨软化症(TIO)诊断效能中的价值。方法回顾性分析2012年3月至2018年10月同时行99Tc^m-联肼尼克酰胺-酪氨酸3-奥曲肽(HYNIC-TOC)SPECT显像及68Ga-DOTATATE PET/CT显像的159例(男89例、女70例,年龄17~59岁)临床疑诊TIO的患者资料,将全身任何部位出现异常放射性浓聚且除外骨折或炎性反应所致非特异性摄取的病灶诊为TIO致病肿瘤。其中80例根据68Ga-DOTATATE PET/CT显像结果另行相应部位MRI,分析其图像特征,将呈结节或团块状占位的病灶诊为TIO致病肿瘤。对照手术病理及随访结果,分别统计99Tc^m-HYNIC-TOC SPECT显像、68Ga-DOTATATE PET/CT显像及68Ga-DOTATATE PET/CT显像联合MRI对TIO的诊断效能。结果159例患者中,TIO患者135例,非TIO患者24例。99Tcm-HYNIC-TOC SPECT显像正确诊断92例TIO患者和22例非TIO患者,诊断灵敏度、特异性和准确性分别为68.1%(92/135)、91.7%(22/24)和71.7%(114/159)。68Ga-DOTATATE PET/CT显像正确诊断134例TIO患者和19例非TIO患者,诊断灵敏度、特异性和准确性分别为99.3%(134/135)、79.2%(19/24)和96.2%(153/159)。在80例行MRI的患者中,68Ga-DOTATATE PET/CT显像联合MRI正确诊断74例TIO患者和5例非TIO患者,诊断灵敏度、特异性和准确性分别为98.7%(74/75)、5/5和98.8%(79/80)。结论68Ga-DOTATATE PET/CT显像诊断TIO的灵敏度高于99Tc^m-HYNIC-TOC SPECT显像,且其联合MRI能提高诊断的特异性和准确性。

Objective To evaluate the effect of 68Ga-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid-D-Phe1-Tyr3-Thr8-octreotide(DOTATATE)PET/CT imaging combined with MRI on improving the diagnostic efficiency for tumor-induced osteomalacia(TIO).Methods From March 2012 to October 2018,159 patients(89 males,70 females;age 17-59 years)who were suspected with TIO and underwent both 99Tcm-hydrazinonicotinamide-Tyr3-octreotide(HYNIC-TOC)SPECT imaging and 68Ga-DOTATATE PET/CT imaging were recruited into this retrospective study.Lesions presenting abnormal increased focal uptake in any part of the body were suspected of culprit tumors,excluding those induced by fractures and inflammation.Based on the suspicious culprit lesions detected by 68Ga-DOTATATE PET/CT imaging,80 patients underwent corresponding MRI.The lesion presenting as the space-occupying nodule or mass with abnormal signal on MR image was diagnosed as the TIO culprit lesion.Compared with the results of pathological examination and clinical follow-up,the diagnostic efficiency of 99Tc^m-HYNIC-TOC SPECT imaging and 68Ga-DOTATATE PET/CT imaging and the combination of 68Ga-DOTATATE PET/CT imaging and MRI for TIO were analyzed.Results Of 159 patients,135 were confirmed with TIO and 24 were with non-TIO.99Tc^m-HYNIC-TOC SPECT imaging accurately diagnosed 92 TIO patients and 22 non-TIO patients,with the sensitivity,specificity and accuracy of 68.1%(92/135),91.7%(22/24)and 71.7%(114/159)respectively.68Ga-DOTATATE PET/CT imaging accurately diagnosed 134 TIO patients and 19 non-TIO patients,with the sensitivity,specificity and accuracy of 99.3%(134/135),79.2%(19/24)and 96.2%(153/159)respectively.A total of 74 TIO and 5 non-TIO patients were accurately diagnosed by 68Ga-DOTATATE PET/CT imaging combined with MRI,with the sensitivity,specificity and accuracy of 98.7%(74/75),5/5 and 98.8%(79/80).Conclusion 68Ga-DOTATATE PET/CT imaging shows higher sensitivity than 99Tc^m-HYNIC-TOC SPECT imaging in diagnosing TIO,and the combination of 68Ga-DOTATATE PET/CT imaging and MRI can improve the specificity and accuracy.