神经内分泌肿瘤骨转移生长抑素受体PET/CT显像特征分析

The feature analysis of ^(68)Ga-somatostatin analogue PET/CT for bone metastasis of neuroendocrine neoplasm

目的:探讨生长抑素受体正电子发射体层成像(positron emission tomography,PET)/计算机体层成像(computed tomography,CT)在神经内分泌肿瘤(neuroendocrine neoplasm,NEN)骨转移诊断中的价值及其图像特征。方法:回顾并分析2019年8月—2021年12月于复旦大学附属肿瘤医院接受^(68)Ga标记的生长抑素类似物(^(68)Ga-somatostatin analogue,^(68)Ga-SSA)PET/CT的NEN骨转移患者的临床及影像学资料。阳性骨病灶定义为显像剂摄取高于正常骨的局限性病灶,测量其最大标准摄取值(maximum standard uptake value,SUV_(max))。根据显像剂种类、肿瘤起源、病理学分级及骨密度改变等进行分析,分别用非独立样本t检验及方差分析比较不同组间SUV_(max)的差异。结果:1041例接受^(68)Ga-SSA PET/CT显像的NEN患者中,105例(10.1%)最终诊断为NEN骨转移,其中36例行^(68)Ga-DOTATATE PET/CT,69例行^(68)GaDOTANOC PET/CT,显像阳性探测率分别为88.9%和76.8%(P=0.191)。原发肿瘤为胰腺NEN的占26.7%(28/105),为直肠NEN的占20.0%(21/105)。大部分发生骨转移的NEN为NET G2,以成骨性转移为主。^(68)Ga-DOTATATE与^(68)GaDOTANOC显像骨阳性病灶的SUV_(max)差异无统计学意义(17.0±19.6 vs 24.6±31.4,P=0.216)。根据肿瘤原发部位分为胃肠胰NEN组、纵隔/肺NEN组和嗜铬细胞瘤/副神经节瘤组,3组骨转移灶的SUV_(max)分别为18.72±17.44、15.81±21.17和45.87±66.88,3组间差异有统计学意义(F=3.867,P=0.025)。结论:生长抑素受体显像是诊断NEN骨转移的灵敏方法,^(68)Ga-DOTATATE和^(68)Ga-DOTANOC PET/CT对骨转移的诊断效能差异无统计学意义。NEN骨转移最常见于胃肠胰NET G2,以成骨性转移多见,嗜铬细胞瘤/副神经节瘤骨转移灶显像剂摄取最高。

Objective:To discuss the diagnostic efficiency and imaging features of somatostatin receptor positron emission tomography(PET)/computed tomography(CT)for bone metastasis of neuroendocrine neoplasm(NEN).Methods:Clinical characteristics and PET/CT features of NEN patients with bone metastasis in Fudan University Shanghai Cancer Center were retrospectively analyzed.Positive lesions on PET/CT were defined as focal significant uptake which was higher than background of normal bone.Maximum standard uptake value(SUV_(max))of positive lesions was measured.The difference of SUV_(max) was compared by independent sample t test and One-Way ANOVA grouped by tracer species,primary tumor,pathological grade and bone change.Results:105 cases(10.1%)were finally diagnosed as bone metastasis of NEN in 1041 patients with NEN who underwent ^(68)Ga-SSA PET/CT.In this study,36 cases underwent ^(68)Ga-DOTATATE PET/CT,69 cases underwent ^(68)Ga-DOTANOC PET/CT.The detective rates were 88.9%and 76.8%for ^(68)Ga-DOTATATE and ^(68)Ga-DOTANOC(P=0.191).The most common primary tumor of bone metastasis is pancreatic NEN(28/105,26.7%)and secondly rectal NEN(21/105,20.0%).Bone metastasis mostly originated from NET G2 and presented as osteoblastic changes.There was no significant difference of SUV_(max) of bone metastasis on ^(68)Ga-DOTATATE and ^(68)Ga-DOTANOC PET/CT(17.0±19.6 vs 24.6±31.4,P=0.216).SUV_(max) of bone metastasis showed significant difference among gastroenterpancreatic NEN,thymic/pulmonary NEN and phaochromocytoma/paraganglioma 18.72±17.44,15.81±21.17 and 45.87±66.88(F=3.867,P=0.025).Conclusion:Somatostatin receptor PET/CT shows high sensitivity of detecting bone metastasis of NEN.^(68)Ga-DOTATATE and ^(68)Ga-DOTANOC PET/CT presents similar diagnostic efficiency.Bone metastasis mostly originated from gastroenterpancreatic NEN and commonly manifested as osteoblastic changes.Highest radioactivity of ^(68)Ga-SSA was observed in bone metastasis from phaochromocytoma/paraganglioma.