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Panminerva Medica 2002 September;44(3):185-96

lingua: Inglese

Clinical role of positron emission tomography (PET) in endocrine tumours

Rubello D., Rufini V., Casara D., Calcagni M. L., Samanes Gajate A. M. *, Shapiro B. **

Service of Nuclear Medicine II Radiotherapy Operative Unite Azienda Ospedaliera, Padua (Italy)
*Institute of Nuclear Medicine Università Cattolica del Sacro Cuore, Rome (Italy)
**Division of Nuclear Medicine, Department of Radiology University of Michigan Medical Center Ann Arbor, Michigan, USA


Positron emis­sion tomog­raphy (PET) is con­sid­ered one of the ­most effec­tive nucle­ar med­i­cine imag­ing modal­ity in oncol­o­gy. In ­many ­types of malig­nant ­tumours PET has prov­en to be ­high sen­si­tive in detect­ing ­both pri­mary neo­plasm and met­a­stat­ic dis­ease ­both ­before ther­a­py for stag­ing pur­pos­es and ­after sur­gery, radio­ther­a­py and chem­o­ther­a­py dur­ing fol­low-up. In par­tic­u­lar, PET ­showed ­high accu­ra­cy in dif­fer­en­tiat­ing ­post-treat­ment ­scar ­from ­viable tumou­ral tis­sue and ­high sen­si­tiv­ity in visu­al­is­ing ­very ­small met­a­stat­ic ­foci as ­those in nor­mal-­sized (­less ­than 1 cm in diam­e­ter) ­lymph ­nodes. A ­large varie­ty of posi­tron emit­ter trac­ers ­have ­been pro­duced for PET imag­ing: the ­most wide­ly ­used trac­er in clin­i­cal oncol­o­gy is 18F-flu­o­ro-2-­deoxy-D-glu­cose (18F-FDG). Deoxy-glu­cose (DG) is a glu­cose ana­log ­that ­enters the ­cell ­using spe­cif­ic trans­men­brane car­ri­er pro­teins (espe­cial­ly ­GLUT-1). Once with­in the cyto­plasm, DG is phos­phor­y­lat­ed to FG-6-phos­phate but ­does not ­appear to be fur­ther metab­o­lised. In ­most malig­nant ­tumours ­there is an ­increase of the gly­col­i­tyc metab­olism ­which ­accounts for an ­increase of the FDG ­uptake. However, the meta­bol­ic cel­lu­lar activ­ity can be ­only slight­ly ­increased or ­even nor­mal in ­well dif­fer­en­tiat­ed and ­slow grow­ing ­tumours as ­some endo­crine neo­plasms. In the ­present ­review, the clin­i­cal use­ful­ness and lim­its of PET imag­ing are dis­cussed in the man­age­ment of ­patients ­with endo­crine ­tumors.

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