18F-FDOPA PET/CT显像在嗜铬细胞瘤/副神经节瘤诊断中的临床应用  

Clinical application of 18F-FDOPA PET/CT imaging in the diagnosis of pheochromocytoma/paraganglioma

作　　者：关志伟[1] 麻广宇[1] 张晓军[1] 付华平[1] 臧丽[2] 张锦明[1] 徐白萱[1] Guan Zhiwei;Ma Guangyu;Zhang Xiaojun;Fu Huaping;Zang Li;Zhang Jinming;Xu Baixuan(Department of Nuclear Medicine,PLA General Hospital,Beijing 100853,China;Department of Endocrinology,PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院核医学科,北京100853 [2]解放军总医院内分泌科,北京100853

出　　处：《中华核医学与分子影像杂志》2019年第8期468-472,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的分析18F-L-6-氟-3,4-二羟基苯丙氨酸(18F-FDOPA)PET/CT显像在嗜铬细胞瘤/副神经节瘤(PPGLs)诊断中的应用价值。方法前瞻性纳入2018年1月至2018年9月间因肾上腺区及腹膜后占位并疑诊PPGLs而行18F-FDOPA PET/CT显像的26例患者(男15例、女11例,年龄13~76岁),收集其临床、实验室及影像学资料。在PET/CT图像的肝及病变部位勾画感兴趣区(ROI),测定肝平均标准摄取值(SUVmean)、病变部位最大标准摄取值(SUVmax),并据其计算肿瘤/肝比值(T/L)。以病理结果为"金标准",计算18F-FDOPA PET/CT显像对PPGLs的诊断效能,并与CT、MR结果进行比较。另外对T/L行受试者工作特征(ROC)曲线分析。结果共25例患者有明确诊断,其中PPGLs 12例、非PPGLs 13例。18F-FDOPA PET/CT显像诊断PPGLs的灵敏度、特异性、准确性、阳性预测值与阴性预测值分别为11/12、12/13、92.00%(23/25)、11/12和12/13。T/L的ROC曲线下面积为0.978(阈值1.55)。在PPGLs患者中,18F-FDOPA PET/CT显像共发现阳性病灶29个,其中嗜铬细胞瘤病灶12个、副神经节瘤(PGL)病灶17个;CT及MR仅发现了11个18F-FDOPA PET/CT显像阳性的PGL病灶,漏诊了4例患者中的6个直径小于1 cm的PGL病灶。结论18F-FDOPA PET/CT显像诊断PPGLs较CT/MR能发现更多的PGL小病灶,可用于PPGLs的定位及定性诊断。Objective To explore the efficiency of 6-18F-fluoro-L-3,4-dihydroxyphenylalanine(18F-FDOPA)PET/CT imaging in the diagnosis of pheochromocytoma/paraganglioma(PPGLs).Methods Twenty-six patients(15 males,11 females;age:13-76 years)who were suspected of PPGLs with adrenal or retroperitoneal mass were enrolled into this prospective study.All patients underwent 18F-FDOPA PET/CT imaging.The clinical data,laboratory data and imaging results were collected.Region of interest(ROI)was drawn on the liver and lesions,and the mean standardized uptake value(SUVmean)of the liver and the maximum standardized uptake value(SUVmax)of lesions were calculated,as well as the ratio of tumor/lesion ratio(T/L).Based on the pathological results considered as the gold standard,the diagnostic efficiency of 18F-FDOPA PET/CT imaging in PPGLs was calculated and compared with that of CT/MR.Besides,receiver operating characteristic(ROC)curve analysis of T/L was used.Results Twenty-five patients were pathologically confirmed,including 12 patients with PPGLs and 13 patients with non-PPGLs.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of 18F-FDOPA PET/CT imaging was 11/12,12/13,92.00%(23/25),11/12 and 12/13,respectively.The area under the ROC curve of T/L was 0.978,with the cut-off value of 1.55.18F-FDOPA PET/CT imaging totally detected 29 positive foci,including 12 of pheochromocytoma(PCC)and 17 of paraganglioma(PGL).Among those 18F-FDOPA positive PGL foci,11 were detected by CT/MR,while 6 with diameter less than 1 cm were missed.Conclusion 18F-FDOPA PET/CT imaging can detect more small PGL lesions than CT/MR,suggesting that it may be a proper imaging modality of PPGLs.

关 键 词：嗜铬细胞瘤 副神经节瘤 左旋多巴 氟放射性同位素 正电子发射断层显像术 体层摄影术 X线计算机 

分 类 号：R73[医药卫生—肿瘤]