68Ga-DOTATATE、18F-FDG PET/CT双显像模式在胃肠胰神经内分泌肿瘤的分期及治疗中的价值

doi:10.12122/j.issn.1673-4254.2025.06.10

摘要/Abstract

摘要：

目的探讨⁶⁸Ga-DOTATATE与¹⁸F-FDG PET/CT显像在不同级别胃肠胰神经内分泌肿瘤（GEP-NEN）分期及治疗决策中的价值。方法回顾性分析2020年8月~2023年3月在南方医科大学南方医院行¹⁸F-FDG和⁶⁸Ga-DOTATATE PET/CT显像的GEP-NEN患者49例，包括初诊患者34例，治疗后复发、转移患者15例。按病理分型将GEP-NEN分为G1、G2、G3神经内分泌瘤（NET）及神经内分泌癌（NEC）。依据同一患者双示踪剂阳性肿瘤病灶检出效能分为4种模式：⁶⁸Ga-DOTATATE>¹⁸F-FDG（A）；⁶⁸Ga-DOTATATE=¹⁸F-FDG（B）；⁶⁸Ga-DOTATATE<¹⁸F-FDG（C）；互补（D）。分析评价双示踪联合显像在分期及治疗决策中的价值。结果 ⁶⁸Ga-DOTATATE PET/CT对全身肿瘤病灶检出优于¹⁸F-FDG PET/CT（P<0.001）；⁶⁸Ga-DOTATATE显像在原发灶/复发灶、淋巴结转移、肝转移及骨转移的检出率更高（P<0.05），而¹⁸F-FDG PET/CT在肺转移和腹膜转移的检出率更高（P<0.05）。49例患者双示踪剂检出模式的比例为：模式A占46.9%（23/49），模式B占38.8%（19/49），模式C占12.2%（6/49），模式D占2.0%（1/49）。不同级别GEP-NEN患者¹⁸F-FDG PET/CT对⁶⁸Ga-DOTATATE PET/CT的补充价值为：G1 NET患者为0%（0/13）、G2 NET患者为8.3%（2/24）、G3 NET患者为50%（3/6）及NEC患者为33.3%（2/6）。12.2%（6/49）患者因联合¹⁸F-FDG PET/CT显像额外发现病灶而确定或改变分期，从而确定或改变治疗方案。结论 GEP-NEN患者应首选⁶⁸Ga-DOTATATE PET/CT显像。对于G1 NET患者，联合¹⁸F-FDG PET/CT显像对分期及治疗决策无帮助，对G2、G3、NEC患者，联合¹⁸F-FDG PET/CT显像提高了部分患者分期及治疗决策精准度。

关键词: 神经内分泌肿瘤, 生长抑素受体, 奥曲肽, 镓放射性同位素Ga68, 氟脱氧葡萄糖F18, 正电子发射断层显像术, 体层摄影术, X线计算机

Abstract:

Objective To evaluate the value of ⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CT imaging in staging and treatment decision for gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN). Methods This retrospective analysis was conducted in 49 patients with GEP-NEN undergoing ¹⁸F-FDG and ⁶⁸Ga-DOTATATE PET/CT imaging at our hospital from August, 2020 to March, 2023, including 34 newly diagnosed patients and 15 patients with recurrence or metastasis after treatment. GEP-NEN were classified into G1, G2, and G3 neuroendocrine tumors (NET) and neuroendocrine carcinomas (NEC) based on pathological typing. The detection efficiency were classified into 4 patterns based on the number of positive tumor lesions detected by the two tracers: ⁶⁸Ga-DOTATATE>¹⁸F-FDG (A); ⁶⁸Ga-DOTATATE=¹⁸F-FDG (B); ⁶⁸Ga-DOTATATE<¹⁸F-FDG (C); and complementation (D). The value of dual-modality imaging in staging and treatment decision were evaluated by visual analysis. Results In the 49 patients with GEP-NEN, ⁶⁸Ga-DOTATATE PET/CT was superior to ¹⁸F-FDG PET/CT for detecting systemic tumor lesions (P<0.001) and more sensitive for detecting primary/recurrent lesions, lymph node metastasis, liver metastasis, and bone metastasis (P<0.05), while ¹⁸F-FDG PET/CT had higher detection rates for lung metastasis and peritoneal metastasis (P<0.05). In terms of the detection efficiency, Pattern A was found in 46.9% (23/49) patients, Pattern B in 38.8% (19/49), Pattern C in 12.2% (6/49), and Pattern D in 2.0% (1/49). The complementary value of ¹⁸F-FDG PET/CT to ⁶⁸Ga-DOTATATE PET/CT was 0% in G1 NET patients (0/13), 8.3% in G2 NET patients (2/24), 50% in G3 NET patients (3/6), and 33.3% in NEC patients (2/6). 12.2% (6/49) of the patients had their staging confirmed or changed due to additional lesions detected by ¹⁸F-FDG PET/CT imaging, resulting subsequently in establishment or adjustment of their treatment plans. Conclusion ⁶⁸Ga-DOTATATE PET/CT imaging should be the primary choice for GEP-NEN patients. Additional ¹⁸F-FDG PET/CT imaging can potentially improve precision of staging and treatment decision-making for G2, G3 and NEC patients but provides virtually no clinical benefits for G1 NET patients.

Key words: neuroendocrine tumors, somatostatin receptor, octreotide, gallium radioisotope Ga68, fluorodeoxyglucose F18, positron emission tomography, tomography, X-ray computed

张骁翔, 田颖, 傅丽兰, 张胤, 董烨, 谢飞, 陈莉, 黄衍超, 吴湖炳, 谭建儿. ⁶⁸Ga-DOTATATE、¹⁸F-FDG PET/CT双显像模式在胃肠胰神经内分泌肿瘤的分期及治疗中的价值[J]. 南方医科大学学报, 2025, 45(6): 1212-1219.

Xiaoxiang ZHANG, Ying TIAN, Lilan FU, Yin ZHANG, Ye DONG, Fei XIE, Li CHEN, Yanchao HUANG, Hubing WU, Jianer TAN. ⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CT dual-modality imaging enhances precision of staging and treatment decision for gastroenteropancreatic neuroendocrine neoplasms[J]. Journal of Southern Medical University, 2025, 45(6): 1212-1219.

图/表 5

图1 18F-FDG和68Ga-DOTATATE PET/CT 对GEP-NEN病灶检出的模式分类图

Fig.1 Classification of detection patterns of GEP-NEN by 18F-FDG and 68Ga-DOTATATE PET/CT.

表1 49例GEP-NEN患者特征

Tab.1 Characteristics of 49 patients with GEP-NEN

Characteristics	Value	Ratio (%)
Gender (n)
Male	29	59.2
Female	20	40.8
Age [year, M(P₂₅,P₇₅)]	55 (45.5-60)	-
Diagnosis (n)
Newly diagnosed	34	69.4
Recurrence or metastasis after treatment	15	30.6
Primary tumor (n)
Gastric	6	12.2
Colorectal	18	36.7
Pancreatic	25	51.0
Histopathology (n)
G1 NET	13	26.5
G2 NET	24	49.0
G3 NET	6	12.2
NEC	6	12.2
Patient with metastasis (n)
Yes	30	61.2
No	19	38.8

表2 18F-FDG和68Ga-DOTATATE PET/CT对原发/复发灶及转移灶阳性检出的比较

Tab.2 Comparison of 18F-FDG and 68Ga-DOTATATE PET/CT for detection of primary/recurrent and metastatic lesion

Lesion	Number of patients (n)	Number of lesions (n)	¹⁸F-FDG positive lesion detection [n(%)]	⁶⁸Ga-DOTATATE positive lesion detection [n(%)]	P
Total	49	539	347 (64.4)	447 (82.9)	<0.001
Primary/recurrent	45	45	32 (71.1)	42 (93.3)	0.011
Lymph nodes	29	109	89 (81.7)	107 (98.2)	<0.001
Liver	1	277	193 (69.7)	220 (79.4)	0.011
Bone	9	65	11 (16.9)	62 (95.4)	<0.001
Lung	3	23	9 (39.1)	2 (8.7)	0.035
Peritoneum	2	6	6 (100)	1 (16.7)	0.015
Adrenal	2	3	3 (100)	3 (100)	>0.999
Brain	1	3	2 (66.7)	3 (100)	>0.999
Kidney	1	1	1 (100)	1 (100)	>0.999
Spleen	1	2	0 (0.0)	2 (100)	0.333
Pancreas	1	1	0 (0.0)	1 (100)	>0.999
Ovary	1	1	0 (0.0)	1 (100)	>0.999
Soft tissue	2	3	1 (33.3)	2 (66.7)	>0.999

表3 18F-FDG和68Ga-DOTATATE PET/CT对不同级别GEP-NEN的检出比较

Tab.3 Comparison of 18F-FDG and 68Ga-DOTATATE PET/CT for detecting different grades of GEP-NEN ［n（%）］

Grades	Patterns A	Patterns B	Patterns C	Patterns D
Total	23 (46.9)	19 (38.8)	6 (12.2)	1 (2.0)
G1 NET	6 (12.2)	7 (14.3)	0 (0.0)	0 (0.0)
G2 NET	14 (28.6)	8 (16.3)	2 (4.1)	0 (0.0)
G3 NET	2 (4.1)	1 (2.0)	2 (4.1)	1 (2.0)
NEC	1 (2.0)	3 (6.1)	2 (4.1)	0 (0.0)

图2 G2 NET患者行双示踪剂联合显像, 因联合18F-FDG PET/CT显像额外发现多发肝脏转移灶而改变分期

Fig.2 A G2 NET patient underwent dual tracer PET/CT scans, and the staging was changed due to additional detection of multiple liver metastases by 18F-FDG PET/CT imaging. The 66-year-old male patient was diagnosed with pancreatic neuroendocrine tumor (G2 NET) with multiple liver metastases. 68Ga-DOTATATE PET/CT showed a high uptake lesion in the tail of the pancreas (A, B, red arrows, SUVmax: 35.2), while 18F-FDG PET/CT showed a mild hypermetabolic lesion in the tail of the pancreas (D, E, red arrows, SUVmax: 4.2). 18F-FDG PET/CT displayed multiple hypermetabolic lesions in the liver (D, F, red arrows, SUVmax: 4.0 and 3.6, respectively), while 68Ga-DOTATATE PET/CT did not show abnormal uptake at the corresponding site (C, blue arrows).

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⁶⁸Ga-DOTATATE、¹⁸F-FDG PET/CT双显像模式在胃肠胰神经内分泌肿瘤的分期及治疗中的价值

⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CT dual-modality imaging enhances precision of staging and treatment decision for gastroenteropancreatic neuroendocrine neoplasms

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