~(68)Ga-DOTA-TATE正电子发射断层显像/计算机断层显像对~(99m)Tc-HYNIC-TOC单光子发射断层显像阴性瘤源性骨软化症致病肿瘤的定位价值
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摘要
目的分析~(99m)Tc-HYNIC-TOC单光子发射计算机断层显像(SPECT)结果阴性的瘤源性骨软化症(TIO)致病肿瘤的~(68)Ga-DOTA-TATE正电子发射断层显像/计算机断层显像(PET/CT)的图像特征,探讨其对致病肿瘤准确定位的指导价值。方法纳入37例经临床及病理确诊的~(99m)Tc-HYNIC-TOC SPECT显像结果阴性的TIO患者,回顾性分析致病肿瘤的~(68)Ga-DOTA-TATE PET/CT图像特点。结果 37例TIO患者致病肿瘤均为单发,术后病理包括35例磷酸盐尿性间叶组织肿瘤和2例梭形细胞瘤。所有TIO致病肿瘤~(68)Ga-DOTA-TATE PET/CT上均表现为放射性浓聚灶,标准化摄取最大值和标准化摄取平均值分别为7. 2±4. 3和4. 3±2. 4,平均最大径为(1. 9±0. 7) cm。37例TIO致病肿瘤,最常见发病部位为下肢(19/37),其次为躯干(11/37)、上/下颌骨(5/37)及上肢(2/37)。24例位于骨组织病灶,最常位于下肢长骨(13/24),多呈偏心性生长(8/13),3例累及骨皮质,同机CT以局限性溶骨性骨质破坏多见(14/24),部分呈骨质硬化型改变(9/24),较少累及周围软组织。13例位于软组织病灶,多呈边界清楚等或低密度结节(10/13),1例位于胸膜病灶伴钙化。结论 ~(68)Ga-DOTA-TATE PET/CT能够检出~(99m)Tc-HYNIC-TOC SPECT漏诊的TIO病例。若生长抑素受体高度表达病灶局部见溶骨性或硬化型骨质改变、软组织内等或低密度结节,更倾向于TIO的诊断。
Objective To analyze ~(68)Ga-DOTA-TATE positron emission tomography/computed tomography( PET/CT) imaging features of tumor-indud osteomalacia( TIO) patients with negative ~(99m)Tc-HYNIC-TOC single photo emission computed tomography( SPECT) findings and to investigate the value of ~(68)Ga-DOTA-TATE PET/CT in accurate localization of culprit tumors. Methods We retrospectively analyzed ~(68)Ga-DOTA-TATE PET/CT imaging features including location,size,density,the maximum and mean standardized uptake value in 37 TIO patients with negative ~(99m)Tc-HYNIC-TOC SPECT findings. Results Totally 37 solitary TIO tumors,including 35 phosphaturic mesenchymal tumors and 2 spindle cell tumors confirmed by pathological examinations,were detected via ~(68)Ga-DOTA-TATE PET/CT scans in the included 37 cases. These 37 TIO tumors showed obviously increased activities,with an maximum standardized uptake value of 7. 2 ± 4. 3 and mean standardized uptake value of 4. 3 ± 2. 4. The average maximum diameter was( 1. 9 ± 0. 7) cm. The majority of the tumors occurred in the lower extremities( 19/37),followed by the trunk( 11/37),maxillary/mandibular bone( 5/37),and upper extremities( 2/37). In addition,24 bone lesions were located in long bones of lower extremities( 13/24), most of which demonstrated eccentric growth( 8/13). Osteolytic changes( 14/24) were observed mainly in the lesions via the corresponding CT imaging; meanwhile,sclerotic changes presented in nine cases. Of the 13 soft-tissue lesions,the majority( 10/13) showed well-circumscribed isodense or hypodense nodules on the CT images,with spot calcification in one lesion located in the pleura. Conclusions ~(68)Ga-DOTA-TATE PET/CT scans can detect the TIO culprit tumors miss-diagnosed by ~(99m)Tc-HYNIC-TOC SPECT. Somatostatin-receptors highly expressed lesions with focal osteolytic or osteosclerotic change in bone and isodense or hypodense nodules in soft tissue will favor the diagnosis of TIO tumors.
Objective To analyze ~(68)Ga-DOTA-TATE positron emission tomography/computed tomography( PET/CT) imaging features of tumor-indud osteomalacia( TIO) patients with negative ~(99m)Tc-HYNIC-TOC single photo emission computed tomography( SPECT) findings and to investigate the value of ~(68)Ga-DOTA-TATE PET/CT in accurate localization of culprit tumors. Methods We retrospectively analyzed ~(68)Ga-DOTA-TATE PET/CT imaging features including location,size,density,the maximum and mean standardized uptake value in 37 TIO patients with negative ~(99m)Tc-HYNIC-TOC SPECT findings. Results Totally 37 solitary TIO tumors,including 35 phosphaturic mesenchymal tumors and 2 spindle cell tumors confirmed by pathological examinations,were detected via ~(68)Ga-DOTA-TATE PET/CT scans in the included 37 cases. These 37 TIO tumors showed obviously increased activities,with an maximum standardized uptake value of 7. 2 ± 4. 3 and mean standardized uptake value of 4. 3 ± 2. 4. The average maximum diameter was( 1. 9 ± 0. 7) cm. The majority of the tumors occurred in the lower extremities( 19/37),followed by the trunk( 11/37),maxillary/mandibular bone( 5/37),and upper extremities( 2/37). In addition,24 bone lesions were located in long bones of lower extremities( 13/24), most of which demonstrated eccentric growth( 8/13). Osteolytic changes( 14/24) were observed mainly in the lesions via the corresponding CT imaging; meanwhile,sclerotic changes presented in nine cases. Of the 13 soft-tissue lesions,the majority( 10/13) showed well-circumscribed isodense or hypodense nodules on the CT images,with spot calcification in one lesion located in the pleura. Conclusions ~(68)Ga-DOTA-TATE PET/CT scans can detect the TIO culprit tumors miss-diagnosed by ~(99m)Tc-HYNIC-TOC SPECT. Somatostatin-receptors highly expressed lesions with focal osteolytic or osteosclerotic change in bone and isodense or hypodense nodules in soft tissue will favor the diagnosis of TIO tumors.
引文
[1] Hesse E,Moessinger E,Rosenthal H,et al. Oncogenic osteomalacia:exact tumor localization by co-registration of positron emission and computed tomography[J]. J Bone Miner Res,2007,22(1):158-162. DOI:10. 1359/jbmr. 060909.
[2] Seufert J,Ebert K,Muller J,et al. Octreotide therapy for tumor-induced osteomalacia[J]. N Engl J Med,2001,345(26):1883-1888. DOI:10. 1056/NEJMoa. 010839.
[3] Jing H,Li F,Zhuang H,et al. Effective detection of the tumors causing osteomalacia using[Tc-99m]-HYNIC-octreotide(99mTc-HYNIC-TOC)whole body scan[J]. Eur J Radiol,2013,82(11):2028-2034. DOI:10. 1016/j. ejrad.2013. 04. 006.
[4] Zhang J,Zhu Z,Zhong D,et al. 68Ga DOTATATE PET/CT is an accurate imaging modality in the detection of culprit tumors causing osteomalacia[J]. Clin Nucl Med,2015,40(8):642-646. DOI:10. 1097/RLU. 0000000000000854.
[5] Feng J,Jiang Y,Wang O,et al. The diagnostic dilemma of tumor induced osteomalacia:a retrospective analysis of 144cases[J]. Endocr J,2017,64(7):675-683. DOI:10.1507/endocrj. EJ16-0587.
[6] Jiang Y,Xia WB,Xing XP,et al. Tumor-induced osteomalacia:an important cause of adult-onset hypophosphatemic osteomalacia in China:report of 39 cases and review of the literature[J]. J Bone Miner Res,2012,27(9):1967-1975.DOI:10. 1002/jbmr. 1642.
[7] Mak MP,da Costa e Silva VT,Martin RM,et al. Advanced prostate cancer as a cause of oncogenic osteomalacia:an underdiagnosed condition[J]. Support Care Cancer,2012,20(9):2195-2197. DOI:10. 1007/s00520-012-1474-z.
[8] Elderman JH,Wabbijn M,de Jongh F,et al. Hypophosphataemia due to FGF-23 producing B cell non-Hodgkin’s lymphoma[J]. BMJ Case Rep,2016,2016. DOI:10. 1136/bcr-2015-213954.
[9] Harish S,Jurriaans E,Jan E,et al. Giant cell tumour of soft tissue causing oncogenic osteomalacia:report demonstrating the use of octreotide scintigraphy in tumour localization[J]. Clin Radiol,2008,63(1):101-107. DOI:10. 1016/j.crad. 2007. 05. 017.
[10] Yamada Y,Kinoshita I,Kenichi K,et al. Histopathological and genetic review of phosphaturic mesenchymal tumours,mixed connective tissue variant[J]. Histopathology,2018,72(3):460-471. DOI:10. 1111/his. 13377.
[11] Reubi JC,Waser B,Laissue JA,et al. Somatostatin and vasoactive intestinal peptide receptors in human mesenchymal tumors:in vitro identification[J]. Cancer Res,1996,56(8):1922-1931.
[12] Chong WH,Andreopoulou P,Chen CC,et al. Tumor localization and biochemical response to cure in tumor-induced osteomalacia[J]. J Bone Miner Res,2013,28(6):1386-1398. DOI:10. 1002/jbmr. 1881.
[13] Antunes P,Ginj M,Zhang H,et al. Are radiogallium-labelled DOTA-conjugated somatostatin analogues superior to those labelled with other radiometals?[J]. Eur J Nucl Med Mol Imaging,2007,34(7):982-993. DOI:10. 1007/s00259-006-0317-x.
[14]于江媛,李洁,李囡,等.胃肠胰神经内分泌肿瘤患者99Tcm-HYNIC-TOC SPECT与68Ga-DOTA-TATE PET/CT显像的对比研究[J].中华核医学与分子影像杂志,2015,35(4):289-292. DOI:10. 3760/cma. j. issn. 2095-2848.2015. 04. 013.
[15] Hofman MS,Kong G,Neels OC,et al. High management impact of Ga-68 DOTATATE(GaTate)PET/CT for imaging neuroendocrine and other somatostatin expressing tumours[J].J Med Imaging Radiat Oncol,2012,56(1):40-47. DOI:10.1111/j. 1754-9485. 2011. 02327. x.
[16] Reubi JC,Schar JC,Waser B,et al. Affinity profiles for human somatostatin receptor subtypes SST1-SST5 of somatostatin radiotracers selected for scintigraphic and radiotherapeutic use[J]. Eur J Nucl Med,2000,27(3):273-282.
[17] Satyaraddi A,Cherian KE,Shetty S,et al. Musculoskeletal oncogenic osteomalacia-an experience from a single centre in South India[J]. J Orthop,2017,14(1):184-188. DOI:10.1016/j. jor. 2016. 12. 010.
[18]徐加利,余卫,王华,等.肿瘤源性骨软化症责任肿瘤的CT和MRI表现[J].临床放射学杂志,2017,36(8):1165-1169. DOI:10. 13437/j. cnki. jcr. 2017. 08. 030.
[19] Higley M,Beckett B,Schmahmann S,et al. Locally aggressive and multifocal phosphaturic mesenchymal tumors:two unusual cases of tumor-induced osteomalacia[J]. Skeletal Radiol,2015,44(12):1825-1831. DOI:10. 1007/s00256-015-2246-x.
[20] Nakamura K,Ohishi M,Matsunobu T,et al. Tumor-induced osteomalacia caused by a massive phosphaturic mesenchymal tumor of the acetabulum:a case report[J]. Mod Rheumatol,2018,28(5):906-910. DOI:10. 3109/14397595. 2016. 1173322.
[21] Minisola S,Peacock M,Fukumoto S,et al. Tumour-induced osteomalacia[J]. Nat Rev Dis Primers,2017,3:17044.DOI:10. 1038/nrdp. 2017. 44.
[22] Paquet M,Gauthe M,Zhang Yin J,et al. Diagnostic performance and impact on patient management of(68)GaDOTA-TOC PET/CT for detecting osteomalacia-associated tumours[J]. Eur J Nucl Med Mol Imaging,2018,45(10):1710-1720. DOI:10. 1007/s00259-018-3971-x.
[23] Zuo QY,Wang H,Li W,et al. Treatment and outcomes of tumor-induced osteomalacia associated with phosphaturic mesenchymal tumors:retrospective review of 12 patients[J]. BMC Musculoskelet Disord,2017,18(1):403. DOI:10. 1186/s12891-017-1756-1.
[2] Seufert J,Ebert K,Muller J,et al. Octreotide therapy for tumor-induced osteomalacia[J]. N Engl J Med,2001,345(26):1883-1888. DOI:10. 1056/NEJMoa. 010839.
[3] Jing H,Li F,Zhuang H,et al. Effective detection of the tumors causing osteomalacia using[Tc-99m]-HYNIC-octreotide(99mTc-HYNIC-TOC)whole body scan[J]. Eur J Radiol,2013,82(11):2028-2034. DOI:10. 1016/j. ejrad.2013. 04. 006.
[4] Zhang J,Zhu Z,Zhong D,et al. 68Ga DOTATATE PET/CT is an accurate imaging modality in the detection of culprit tumors causing osteomalacia[J]. Clin Nucl Med,2015,40(8):642-646. DOI:10. 1097/RLU. 0000000000000854.
[5] Feng J,Jiang Y,Wang O,et al. The diagnostic dilemma of tumor induced osteomalacia:a retrospective analysis of 144cases[J]. Endocr J,2017,64(7):675-683. DOI:10.1507/endocrj. EJ16-0587.
[6] Jiang Y,Xia WB,Xing XP,et al. Tumor-induced osteomalacia:an important cause of adult-onset hypophosphatemic osteomalacia in China:report of 39 cases and review of the literature[J]. J Bone Miner Res,2012,27(9):1967-1975.DOI:10. 1002/jbmr. 1642.
[7] Mak MP,da Costa e Silva VT,Martin RM,et al. Advanced prostate cancer as a cause of oncogenic osteomalacia:an underdiagnosed condition[J]. Support Care Cancer,2012,20(9):2195-2197. DOI:10. 1007/s00520-012-1474-z.
[8] Elderman JH,Wabbijn M,de Jongh F,et al. Hypophosphataemia due to FGF-23 producing B cell non-Hodgkin’s lymphoma[J]. BMJ Case Rep,2016,2016. DOI:10. 1136/bcr-2015-213954.
[9] Harish S,Jurriaans E,Jan E,et al. Giant cell tumour of soft tissue causing oncogenic osteomalacia:report demonstrating the use of octreotide scintigraphy in tumour localization[J]. Clin Radiol,2008,63(1):101-107. DOI:10. 1016/j.crad. 2007. 05. 017.
[10] Yamada Y,Kinoshita I,Kenichi K,et al. Histopathological and genetic review of phosphaturic mesenchymal tumours,mixed connective tissue variant[J]. Histopathology,2018,72(3):460-471. DOI:10. 1111/his. 13377.
[11] Reubi JC,Waser B,Laissue JA,et al. Somatostatin and vasoactive intestinal peptide receptors in human mesenchymal tumors:in vitro identification[J]. Cancer Res,1996,56(8):1922-1931.
[12] Chong WH,Andreopoulou P,Chen CC,et al. Tumor localization and biochemical response to cure in tumor-induced osteomalacia[J]. J Bone Miner Res,2013,28(6):1386-1398. DOI:10. 1002/jbmr. 1881.
[13] Antunes P,Ginj M,Zhang H,et al. Are radiogallium-labelled DOTA-conjugated somatostatin analogues superior to those labelled with other radiometals?[J]. Eur J Nucl Med Mol Imaging,2007,34(7):982-993. DOI:10. 1007/s00259-006-0317-x.
[14]于江媛,李洁,李囡,等.胃肠胰神经内分泌肿瘤患者99Tcm-HYNIC-TOC SPECT与68Ga-DOTA-TATE PET/CT显像的对比研究[J].中华核医学与分子影像杂志,2015,35(4):289-292. DOI:10. 3760/cma. j. issn. 2095-2848.2015. 04. 013.
[15] Hofman MS,Kong G,Neels OC,et al. High management impact of Ga-68 DOTATATE(GaTate)PET/CT for imaging neuroendocrine and other somatostatin expressing tumours[J].J Med Imaging Radiat Oncol,2012,56(1):40-47. DOI:10.1111/j. 1754-9485. 2011. 02327. x.
[16] Reubi JC,Schar JC,Waser B,et al. Affinity profiles for human somatostatin receptor subtypes SST1-SST5 of somatostatin radiotracers selected for scintigraphic and radiotherapeutic use[J]. Eur J Nucl Med,2000,27(3):273-282.
[17] Satyaraddi A,Cherian KE,Shetty S,et al. Musculoskeletal oncogenic osteomalacia-an experience from a single centre in South India[J]. J Orthop,2017,14(1):184-188. DOI:10.1016/j. jor. 2016. 12. 010.
[18]徐加利,余卫,王华,等.肿瘤源性骨软化症责任肿瘤的CT和MRI表现[J].临床放射学杂志,2017,36(8):1165-1169. DOI:10. 13437/j. cnki. jcr. 2017. 08. 030.
[19] Higley M,Beckett B,Schmahmann S,et al. Locally aggressive and multifocal phosphaturic mesenchymal tumors:two unusual cases of tumor-induced osteomalacia[J]. Skeletal Radiol,2015,44(12):1825-1831. DOI:10. 1007/s00256-015-2246-x.
[20] Nakamura K,Ohishi M,Matsunobu T,et al. Tumor-induced osteomalacia caused by a massive phosphaturic mesenchymal tumor of the acetabulum:a case report[J]. Mod Rheumatol,2018,28(5):906-910. DOI:10. 3109/14397595. 2016. 1173322.
[21] Minisola S,Peacock M,Fukumoto S,et al. Tumour-induced osteomalacia[J]. Nat Rev Dis Primers,2017,3:17044.DOI:10. 1038/nrdp. 2017. 44.
[22] Paquet M,Gauthe M,Zhang Yin J,et al. Diagnostic performance and impact on patient management of(68)GaDOTA-TOC PET/CT for detecting osteomalacia-associated tumours[J]. Eur J Nucl Med Mol Imaging,2018,45(10):1710-1720. DOI:10. 1007/s00259-018-3971-x.
[23] Zuo QY,Wang H,Li W,et al. Treatment and outcomes of tumor-induced osteomalacia associated with phosphaturic mesenchymal tumors:retrospective review of 12 patients[J]. BMC Musculoskelet Disord,2017,18(1):403. DOI:10. 1186/s12891-017-1756-1.
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