Introduction and aim: Simultaneous positron emission tomography/magnetic resonance imaging (PET-MRI) combines the high sensitivity of PET with the high specificity of MRI and is a tool for the assessment of gastroenteropancreatic neuroendocrine neoplasms (G-NENs). However, it remains poorly evaluated with no clear recommendations in current guidelines. Thus, we evaluated the prognostic impact of PET-MRI in G-NEN patients. Methods: From June 2017 to December 2021, 71 G-NEN patients underwent whole-body PET-MRI for staging and/or follow-up purposes. A whole-body emission scan with18F-6-fluoro-L-dihydroxyphenylalanine (18FDOPA,n= 30),18F-fluoro-2-deoxy-D-glucose (18FDG,n= 21), or68Ga-(DOTA(0)-Phe(1)-Tyr(3))-octreotide (68Ga-DOTATOC,n= 20) with the simultaneous acquisition of a T1-Dixon sequence and diffusion-weighed imaging (DWI), followed by a dedicated step of MRI sequences with a Gadolinium contrast was performed. The patients underwent PET-MRI every 6–12 months during the follow-up period until death. Over this period, 50 patients with two or more PET-MRI were evaluated. Results: The mean age was 61 [extremes, 31–92] years. At the baseline, PET-MRI provided new information in 12 cases (17%) as compared to conventional imaging: there were more metastases in eight, an undescribed location (myocardia) in two, and an unknown primary location in two cases. G grading at the baseline influenced overall survival. During the follow-up (7–381 months, mean 194), clinical and therapy managements were influenced by PET-MRI in three (6%) patients due to new metastases findings when neither overall, nor disease-free survivals in these two subgroups (n= 12 vs.n= 59), were different. Conclusion: Our study suggests that using PET/MRI with the appropriate radiotracer improves the diagnostic performance with no benefit on survival. Further studies are warranted to evaluate the cost-effectiveness of this procedure.
引言与目的：正电子发射断层扫描/磁共振成像（PET-MRI）融合技术结合了PET的高灵敏度与MRI的高特异性，已成为评估胃肠胰神经内分泌肿瘤（G-NENs）的重要工具。然而，目前对其临床应用价值的评估仍不充分，现有指南亦缺乏明确推荐。为此，本研究旨在探讨PET-MRI对G-NEN患者预后的影响。方法：2017年6月至2021年12月期间，71例G-NEN患者为分期和/或随访目的接受了全身PET-MRI检查。检查采用¹⁸F-6-氟-L-二羟基苯丙氨酸（¹⁸F-DOPA，n=30）、¹⁸F-氟代脱氧葡萄糖（¹⁸F-FDG，n=21）或⁶⁸Ga-(DOTA(0)-Phe(1)-Tyr(3))-奥曲肽（⁶⁸Ga-DOTATOC，n=20）作为示踪剂进行全身发射扫描，同步采集T1-Dixon序列及弥散加权成像（DWI），并辅以钆对比剂增强的专项MRI序列。患者在随访期间每6-12个月接受一次PET-MRI检查，直至死亡。在此期间，对50例接受两次及以上PET-MRI检查的患者进行了评估。结果：患者平均年龄61岁（范围31-92岁）。基线检查中，与传统影像学相比，PET-MRI在12例（17%）患者中提供了新信息：其中8例发现更多转移灶，2例发现未描述部位（心肌）转移，2例明确原发灶位置。基线G分级影响总生存期。在随访期间（7-381个月，平均194个月），PET-MRI因发现新转移灶而改变了3例（6%）患者的临床与治疗策略，但两个亚组（n=12 vs. n=59）的总生存期和无病生存期均无显著差异。结论：本研究提示，采用适宜放射性示踪剂的PET/MRI可提升诊断效能，但对生存预后未见明显改善。该检查的成本效益仍需进一步研究验证。
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