Küçük Hücreli Akciğer Kanserinin Beyin Metastazlarının 18F-FDG PET/CT'deki Görünümleri

Yıl 2022, Cilt: 32 Sayı: 3, 272 - 275, 01.08.2022

Hasan Önner Farise Yılmaz Halil Özer Abdussamet Batur Gonca Kara Gedik

https://doi.org/10.54005/geneltip.1073349

Öz

Amaç: Çalışmamızda, küçük hücreli akciğer kanserinin (KHAK) beyin manyetik rezonans görüntüleme (MRG) ile tespit edilen beyin metastazlarının (BM'ler) 18Fluor-Florodeoksiglukoz (18F-FDG) pozitron emisyon tomografisi/bilgisayarlı tomografisindeki (PET/BT) görünümlerini değerlendirdik.
Hastalar ve yöntem: Çalışmaya ilk evreleme amacıyla 30 gün içinde 18F-FDG PET/CT taraması ve beyin MRG'si olan SCLC hastaları dahil edildi. Beyin metastazlarını saptamak için MRG kullanıldı. BM'lerin 18F-FDG PET/BT üzerindeki görüntüleme bulguları değerlendirildi. 18F-FDG PET/BT çalışmasında BM'ler; saptanamayan, hipometabolik, hipermetabolik veya karışık (hem hipermetabolik hem de hipometabolik kısımları olan lezyonlar) paternler olarak sınıflandırıldı.
Bulgular: Çalışmaya yaş ortalaması 62.57 ± 9.64 olan 48'i (%94.1) erkek, 3'ü (%5.9) kadın; toplam 51 hasta dahil edildi. Hastaların 15'i (%29,4) sınırlı evredeyken, 36'sı (%69,6) yaygın evredeydi. 11 kişide, beyin MRG 28 BM gösterdi. 18F-FDG PET/BT'de 28 metastazın 13'ü görüldü. 18F-FDG PET/BT'deki BM görünümleri şunlardı: hipometabolik (n: 4), hipermetabolik (n: 6) ve karışık (n: 3). 18F-FDG PET/BT'de saptanan BM'lerin ortalama çapı 16mm iken; saptanamayanların ortalama çapı 4,3 mm idi.
Sonuç: 18F-FDG PET/BT'de BM'ler hipometabolik, hipermetabolik ve karışık paternler dahil olmak üzere çeşitli görünümlere sahip olabilir. Öte yandan, 18F-FDG PET/BT ile milimetrik boyutlu BM'lerin saptanamaması evrelemenin düzgün yapılmasını engellemektedir.

Anahtar Kelimeler

küçük hücreli akciğer kanseri, pozitron emisyon tomografisi, beyin metastazı

The Appearances of Brain Metastases of Small Cell Lung Cancer on 18F-FDG PET/CT

Öz

Purpose: We evaluate the appearances of the brain metastases (BMs) detected by brain magnetic resonance imaging (MRI) of small cell lung cancer (SCLC) on 18Fluor-Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT).
Patients and methods: SCLC patients who had an 18F-FDG PET/CT scan and a brain MRI within 30 days for initial staging were included. MRI was used to detect BMs. The imaging results of BMs on 18F-FDG PET/CT were assessed. On the 18F-FDG PET/CT study, the BMs were classified as undetectable, hypometabolic, hypermetabolic, or mixed patterns (lesions with both hypermetabolic and hypometabolic parts).
Results: A total of 51 patients [48 (94.1%) of whom were male and 3 (5.9%) female, with an average age of 62.57 ± 9.64] were included in this study. Fifteen patients (29.4%) were in the limited stage, whereas 36 patients (69.6%) were in the extensive stage. In 11 individuals, MRI indicated 28 BMs. On 18F-FDG PET/CT, 13 of the 28 metastases were visible. The following were the BMs appearances on 18F-FDG PET/CT: hypometabolic (n: 4), hypermetabolic (n: 6), and mixed (n: 3). While the mean diameter of BMs detected in 18F-FDG PET/CT was 16mm; the mean diameter of undetected ones was 4.3 mm.
Conclusion: On 18F-FDG PET/CT, BMs can have a variety of appearances, including hypometabolic, hypermetabolic, and mixed patterns. On the other hand, failure to detect millimetric size BMs in 18F-FDG PET/CT prevents proper staging.

Anahtar Kelimeler

small cell lung cancer, positron emission tomography, brain metastasis

Kaynakça

• 1. Ko J, Winslow MM, Sage J. Mechanisms of small cell lung cancer metastasis. EMBO Mol Med 2021; 13(1): e13122. 2020/12/10. doi: 10.15252/emmm.202013122.
• 2. Rittberg R, Banerji S, Kim JO, Rathod S, Dawe DE. Treatment and Prevention of Brain Metastases in Small Cell Lung Cancer. Am J Clin Oncol 2021; 44(12): 629-38. 2021/10/11. doi: 10.1097/coc.0000000000000867.
• 3. Hochstenbag MM, Twijnstra A, Wilmink JT, Wouters EF, ten Velde GP. Asymptomatic brain metastases (BM) in small cell lung cancer (SCLC): MR-imaging is useful at initial diagnosis. J Neurooncol 2000; 48(3): 243-8. 2000/12/02. doi: 10.1023/a:1006427407281.
• 4. Lu YY, Chen JH, Liang JA et al. 18F-FDG PET or PET/CT for detecting extensive disease in small-cell lung cancer: a systematic review and meta-analysis. Nucl Med Commun 2014; 35(7): 697-703. 2014/04/04. doi: 10.1097/mnm.0000000000000122.
• 5. Vinjamuri M, Craig M, Campbell-Fontaine A, et al. Can positron emission tomography be used as a staging tool for small-cell lung cancer? Clin Lung Cancer 2008; 9(1): 30-4. 2008/02/20. doi: 10.3816/CLC.2008.n.005.
• 6. Palomar Muñoz A, García Vicente AM, Bellón Guardia ME, et al. Is a selective brain (18)F-FDG PET/CT study profitable in patients with small cell lung cancer? Rev Esp Med Nucl Imagen Mol 2012; 31(3): 124-9. 2011/07/05. doi: 10.1016/j.remn.2011.05.002.
• 7. Omuro AM, Leite CC, Mokhtari K, Delattre JY. Pitfalls in the diagnosis of brain tumours. Lancet Neurol 2006; 5(11): 937-48. 2006/10/21. doi: 10.1016/s1474-4422(06)70597-x.
• 8. Lee HY, Chung JK, Jeong JM, et al. Comparison of FDG-PET findings of brain metastasis from non-small-cell lung cancer and small-cell lung cancer. Ann Nucl Med 2008; 22(4): 281-6. 2008/06/07. doi: 10.1007/s12149-007-0104-1.
• 9. Stahel RA, Ginsberg R, Havemann K, et al. Staging and prognostic factors in small cell lung cancer: a consensus report. Lung cancer 1989; 5(4-6): 119-26.
• 10. Brink I, Schumacher T, Mix M, et al. Impact of [18F]FDG-PET on the primary staging of small-cell lung cancer. Eur J Nucl Med Mol Imaging 2004; 31(12): 1614-20. 2004/07/20. doi: 10.1007/s00259-004-1606-x.
• 11. Hjorthaug K, Højbjerg JA, Knap MM, et al. Accuracy of 18F-FDG PET-CT in triaging lung cancer patients with suspected brain metastases for MRI. Nucl Med Commun 2015; 36(11): 1084-90. 2015/08/25. doi: 10.1097/mnm.0000000000000371.
• 12. Zimmer L, Luxen A. PET radiotracers for molecular imaging in the brain: past, present and future. Neuroimage 2012; 61(2): 363-70. 2012/01/10. doi: 10.1016/j.neuroimage.2011.12.037.
• 13. Fink KR, Fink JR. Imaging of brain metastases. Surg Neurol Int 2013; 4(Suppl 4): S209-19. 2013/05/30. doi: 10.4103/2152-7806.111298.
• 14. Kitajima K, Nakamoto Y, Okizuka H, et al. Accuracy of whole-body FDG-PET/CT for detecting brain metastases from non-central nervous system tumors. Ann Nucl Med 2008; 22(7): 595-602. 2008/08/30. doi: 10.1007/s12149-008-0145-0.
• 15. Juhász C, Dwivedi S, Kamson DO, Michelhaugh SK, Mittal S. Comparison of amino acid positron emission tomographic radiotracers for molecular imaging of primary and metastatic brain tumors. Mol Imaging 2014; 13. 2014/05/16. DOI: 10.2310/7290.2014.00015.
• 16. De Wever W, Bruyeer E, Demaerel P, et al. Staging of lung cancer. Do we need a diagnostic CT of the brain after an integrated PET/CT for the detection of brain metastases? Jbr-btr 2010; 93(2): 71-6. 2010/06/09. doi: 10.5334/jbr-btr.122.