Background/Objectives: This study aims to evaluate the additional value of [18F]F-fluorocholine ([18F]F-FCH) PET/CT over contrast-enhanced magnetic resonance imaging (CE-MRI) in detecting the recurrence of brain metastases (BMs) after stereotactic radiosurgery (SRS) in patients with lung cancer brain metastases (LCBMs). Methods: Thirty-one patients with suspected recurrence of BM in LCBM after SRS were enrolled in this retrospective study. They underwent both [18F]F-FCH PET/CT and CE-MRI within 2 weeks. The tumor imaging parameters and clinical features were analyzed. The results of histopathology or radiographic follow-up served as the reference standard for the final diagnosis. Results: In these 31 patients, there were 54 lesions, of which 27 lesions were proven to be BM recurrence, while 27 lesions were non-recurrence. [18F]F-FCH PET/CT showed high radiotracer uptake in recurrent lesions of BM and identified 24 positive lesions (88.89% of sensitivity), while CE-MRI indicated 23 positive lesions (85.19% of sensitivity). [18F]F-FCH PET/CT indicated higher specificity (81.48%) and accuracy (85.19%) in detecting recurrence of BM than CE-MRI (40.74% and 62.96%, bothp< 0.05), particularly in frontal lobes and cerebella. For lesion sizes, the accuracy of [18F]F-FCH PET/CT in detecting recurrent lesions was higher than that of CE-MRI for lesions over 1.0 cm but below 2.0 cm (p= 0.016). The detective performance of [18F]F-FCH PET/CT combined with CE-MRI was higher than [18F]F-FCH PET/CT or CE-MRI alone (allp< 0.05). Interestingly, TLC (≥4.11) was significantly correlated with poor intracranial PFS (iPFS), meaning it was a significant prognostic factor for iPFS. Conclusions: This study identified that compared with CE-MRI, [18F]F-FCH PET/CT demonstrated higher specificity and accuracy in diagnosing recurrence of BM in LCBM after SRS. Combining [18F]F-FCH PET/CT with CE-MRI has the potential to improve diagnostic performance for recurrence of BM and management of patient treatment. TLC was an independent risk factor for iPFS.
背景/目的：本研究旨在评估[18F]氟代胆碱（[18F]F-FCH）PET/CT相较于对比增强磁共振成像（CE-MRI）在检测肺癌脑转移（LCBM）患者立体定向放射外科（SRS）治疗后脑转移（BM）复发方面的附加价值。方法：本回顾性研究纳入了31例SRS治疗后疑似BM复发的LCBM患者。所有患者在两周内均接受了[18F]F-FCH PET/CT和CE-MRI检查。分析了肿瘤影像学参数和临床特征。组织病理学或影像学随访结果作为最终诊断的参考标准。结果：在这31例患者中，共发现54个病灶，其中27个病灶被证实为BM复发，27个病灶为非复发。[18F]F-FCH PET/CT显示BM复发病灶处放射性示踪剂摄取增高，识别出24个阳性病灶（敏感性为88.89%），而CE-MRI识别出23个阳性病灶（敏感性为85.19%）。在检测BM复发方面，[18F]F-FCH PET/CT显示出比CE-MRI更高的特异性（81.48%）和准确性（85.19%）（CE-MRI分别为40.74%和62.96%，两者p < 0.05），尤其是在额叶和小脑区域。对于病灶大小，在检测1.0厘米以上但低于2.0厘米的复发灶时，[18F]F-FCH PET/CT的准确性高于CE-MRI（p = 0.016）。[18F]F-FCH PET/CT联合CE-MRI的检测效能高于单独使用[18F]F-FCH PET/CT或CE-MRI（所有p < 0.05）。有趣的是，TLC（≥4.11）与较差的颅内无进展生存期（iPFS）显著相关，意味着它是iPFS的一个重要预后因素。结论：本研究发现，与CE-MRI相比，[18F]F-FCH PET/CT在诊断LCBM患者SRS治疗后BM复发方面表现出更高的特异性和准确性。[18F]F-FCH PET/CT联合CE-MRI有望提高BM复发的诊断效能并改善患者治疗管理。TLC是iPFS的独立危险因素。
肿瘤(癌症)患者之家