18F-FDG PET/CT 用于检测免疫疗法诱发的肾上腺皮质功能减退症--一项病例对照研究。

IF 9.6 3区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Clinical Nuclear Medicine Pub Date : 2024-12-01 Epub Date: 2024-09-25 DOI:10.1097/RLU.0000000000005440
Alessa Fischer, Julia M Martínez-Gómez, Joanna Mangana, Reinhard Dummer, Zoran Erlic, Svenja Nölting, Felix Beuschlein, Alexander Maurer, Michael Messerli, Martin W Huellner, Stephan Skawran
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引用次数: 0

摘要

目的:在接受免疫检查点抑制剂(ICIs)治疗的患者中,多达 10% 的患者会出现垂体炎。核磁共振成像显示三分之一的患者垂体无异常。延迟诊断会增加肾上腺危象危及生命的风险,因此需要及早发现。本研究评估了 FDG PET/CT 在一组黑色素瘤患者中检测 ICI 诱导的肾上腺皮质功能减退症的诊断准确性:将在确诊前90天至确诊后10天接受FDG PET/CT检查的转移性黑色素瘤和ICI诱发的肾上腺皮质功能减退症患者与接受ICI治疗但无肾上腺皮质功能减退症症状的年龄和性别匹配的对照组患者进行比较。计算垂体的 SUVmax 与血池的 SUVmean 之比(靶-背景比 [TBR])。采用接收者操作特征曲线下面积分析法评估TBR的诊断准确性:结果:共纳入 28 名患者。大多数肾上腺皮质功能减退症患者接受了伊匹单抗/尼伐单抗治疗(9/14,64.3%)。对TBR分布的目测评估显示,诊断时间的缩短与TBR分布呈正相关。为评估诊断效果,仅纳入了诊断前50天至诊断后8天进行FDG PET/CT检查的患者(11/14)。与对照组相比,这些患者的 TBR 明显更高(中位数[四分位间范围]分别为 2.78 [2.41] vs 1.59 [0.70];P = 0.034)。当 TBR 临界值为 2.41 时,灵敏度为 72.7%,特异度为 90.9%(接收者操作特征曲线下面积 = 0.769):我们的研究结果表明,在接受 ICI 治疗的转移性黑色素瘤患者中,垂体 TBR 约为 2.4 可能预示着 ICI 即将诱发垂体功能减退症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
18 F-FDG PET/CT for Detection of Immunotherapy-Induced Hypophysitis-A Case-Control Study.

Purpose: Hypophysitis occurs in up to 10% of patients treated with immune-checkpoint inhibitors (ICIs). MRI shows no abnormalities of the pituitary gland in one third of patients. A delayed diagnosis increases the risk for life-threatening adrenal crisis, underscoring the need for early detection. This study evaluates the diagnostic accuracy FDG PET/CT in detecting ICI-induced hypophysitis in a cohort of melanoma patients.

Materials and methods: Patients with metastatic melanoma and ICI-induced hypophysitis, who underwent FDG PET/CT 90 days before to 10 days after diagnosis, were compared with an age- and sex-matched control group of patients undergoing ICI treatment without signs of hypophysitis. The ratio of SUV max of the pituitary gland to the SUV mean of the blood pool (target-to-background ratio [TBR]) was calculated. Diagnostic accuracy of the TBR was assessed using area under the receiver operating characteristics curve analysis.

Results: A total of 28 patients was included. The majority of patients with hypophysitis received ipilimumab/nivolumab (64.3%, 9/14). Visual assessment of the TBR distribution demonstrated a positive correlation with decreasing time to diagnosis. To evaluate diagnostic performance, only patients with FDG PET/CT 50 days before to 8 days after diagnosis (11/14) were included. TBR was significantly higher in these compared with the control group (median [interquartile range], 2.78 [2.41] vs 1.59 [0.70], respectively; P = 0.034). A sensitivity of 72.7% and a specificity of 90.9% were achieved at a TBR threshold of 2.41 (area under the receiver operating characteristics curve = 0.769).

Conclusions: Our findings suggest that, in patients undergoing ICI treatment for metastatic melanoma, a pituitary TBR of approximately 2.4 may indicate impending ICI-induced hypophysitis.

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来源期刊
Clinical Nuclear Medicine
Clinical Nuclear Medicine 医学-核医学
CiteScore
2.90
自引率
31.10%
发文量
1113
审稿时长
2 months
期刊介绍: Clinical Nuclear Medicine is a comprehensive and current resource for professionals in the field of nuclear medicine. It caters to both generalists and specialists, offering valuable insights on how to effectively apply nuclear medicine techniques in various clinical scenarios. With a focus on timely dissemination of information, this journal covers the latest developments that impact all aspects of the specialty. Geared towards practitioners, Clinical Nuclear Medicine is the ultimate practice-oriented publication in the field of nuclear imaging. Its informative articles are complemented by numerous illustrations that demonstrate how physicians can seamlessly integrate the knowledge gained into their everyday practice.
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