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在对导致儿茶酚胺分泌过度的肿瘤进行定位诊断时,6-[18F]氟- l-二羟基苯丙氨酸正电子发射计算机断层扫描优于传统的123I-间碘苄胍闪烁扫描、计算机断层扫描及磁共振成像 |
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6-[F-18]Fluoro-l-Dihydroxyphenylalanine Positron Emission Tomography Is Superior to Conventional Imaging with 123I-Metaiodobenzylguanidine Scintigraphy, Computer Tomography, and Magnetic Resonance Imaging in Localizing Tumors Causing Catecholamine Excess |
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Fiebrich H-B, Brouwers AH, Kerstens MN 2010/6/22 11:48:26 |
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J Clin Endocrinol Metab, 2009, |
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View at Publisher |
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Context:
Catecholamine excess is rare, but symptoms may be life threatening.
Objective:
The objective of the study was to investigate the sensitivity of 6-[F-18]fluoro-l-dihydroxyphenylalanine positron emission tomography (18F-DOPAPET), compared with 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy and computer tomography (CT)/magnetic resonance imaging (MRI) for tumor localization in patients with catecholamine excess.
Design and Setting:
All consecutive patients with catecholamine excess visiting the University Medical Center Groningen, Groningen, The Netherlands, between March 2003 and January 2008 were eligible.
Patients:
Forty-eight patients were included. The final diagnosis was pheochromocytoma in 40, adrenal hyperplasia in two, paraganglioma in two, ganglioneuroma in one, and unknown in three.
Main Outcome Measures:
Sensitivities and discordancy between 18F-DOPA PET, 123I-MIBG, and CT or MRI were analyzed for individual patients and lesions. Metanephrines and 3-methoxytyramine in plasma and urine and uptake of 18F-DOPAwith PET were measured to determine the whole-body metabolic burden and correlated with biochemical tumor activity. The gold standard was a composite reference standard.
Results:
18F-DOPA PET showed lesions in 43 patients, 123I-MIBG in 31, and CT/MRI in 32. Patient-based sensitivity for 18F-DOPA PET, 123I-MIBG, and CT/MRI was 90, 65, and 67% (P<0.01 for 18F-DOPA PET vs. both 123I-MIBG and CT/MRI, P=1.0 123I-MIBG vs. CT/MRI). Lesion-based sensitivities were 73, 48, and 44% (P=0.001 for sup 18F-DOPA PET vs. both 123I-MIBG and CT/MRI, P=0.51 123I-MIBG vs. CT/MRI). The combination of 18F-DOPA PET with CT/MRI was superior to 123I-MIBG with CT/MRI (93 vs. 76%, P<0.001). Whole-body metabolic burden measured with 18F-DOPA PET correlated with plasma normetanephrine (r=0.82), urinary normetanephrine (r=0.84), and metanephrine (r=0.57).
Conclusion:
To localize tumors causing catecholamine excess, 18F-DOPA PET is superior to 123I-MIBG scintigraphy and CT/MRI. |
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疾病资源中心
病例分析 [栏目介绍]
王燕燕 王曙
上海交通大学附属瑞金医院内分泌科
患者,女,69岁。2009年1月无明显诱因下出现乏力,当时程度较轻,未予以重视。2009年3月患者乏力症状加重,尿色逐渐加深,大便习惯改变,颜色变淡。4月18日入我院感染科治疗,诉轻度头晕、心慌,体重减轻10kg。无肝区疼痛,无发热,无腹痛、腹泻、腹胀、里急后重,无恶性、呕吐等。入院半月前于外院就诊,查肝功能:ALT 601IU/L,AST 785IU/L,TBIL 97.7umol/L,白蛋白 41g/L,甲状腺功能:游离T3 30.6pmol/L,游离T4 51.9pmol/L,心电图示快速房颤。
医学数据库
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