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PET/CT imaging of neuroendocrine tumors with (68)Gallium-labeled somatostatin analogues: An overview and single institutional experience from India.

Sharma P, Singh H, Bal C, Kumar R - Indian J Nucl Med (2014)

Bottom Line: Recently, positron emission tomography/computed tomography (PET/CT) with (68)Gallium ((68)Ga)-labeled somatostatin analogues has shown excellent results for imaging of NETs and better results than conventional SSTR scintigraphy.In this review we have discussed the utility of (68)Ga-labeled somatostatin analogue PET/CT in NETs for various established and potential indications.In addition we have also shared our own experience from a tertiary care center in India.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Neuroendocrine tumors (NETs) are rare neoplasms characterized by overexpression of somatostatin receptors (SSTRs). Functional imaging plays a crucial role in management of NETs. Recently, positron emission tomography/computed tomography (PET/CT) with (68)Gallium ((68)Ga)-labeled somatostatin analogues has shown excellent results for imaging of NETs and better results than conventional SSTR scintigraphy. In this review we have discussed the utility of (68)Ga-labeled somatostatin analogue PET/CT in NETs for various established and potential indications. In addition we have also shared our own experience from a tertiary care center in India.

No MeSH data available.


Related in: MedlinePlus

A 50-year-old male, operated case of gastrinoma of stomach, presented with recurrent abdominal pain and raised serum gastrin levels. CT findings were suspicious for recurrence in thickened gastric folds. 68Ga-DOTANOC PET/CT was done for restaging. Maximum intensity projection PET image (a) shows a focal area of increased radiotracer uptake in abdomen near midline (arrow), confirmed as positive portal lymph node on PET/CT (b-d, arrow). No abnormal radiotracer uptake was noted in region of stomach
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Figure 3: A 50-year-old male, operated case of gastrinoma of stomach, presented with recurrent abdominal pain and raised serum gastrin levels. CT findings were suspicious for recurrence in thickened gastric folds. 68Ga-DOTANOC PET/CT was done for restaging. Maximum intensity projection PET image (a) shows a focal area of increased radiotracer uptake in abdomen near midline (arrow), confirmed as positive portal lymph node on PET/CT (b-d, arrow). No abnormal radiotracer uptake was noted in region of stomach

Mentions: A recent meta-analysis by Treglia et al., evaluated 16 studies comprising 567 patients with GEP and thoracic NETs.[25] The pooled sensitivity and specificity of 68Ga-DOTA peptide PET or PET/CT in detecting NETs were 93% (95% confidence interval (CI): 91-95%) and 91% (95% CI: 82-97%), respectively, on per patient-based analysis. They advised that this accurate technique should be considered as first-line diagnostic imaging methods in patients with suspicious thoracic and/or GEP NETs. Ambrosini et al., reviewed their experience of imaging GEP-NETs in 1,239 patients.[26] The sensitivity was 92% and specificity was 98% for the detection of NET. The mean SUVmax of positive lesions was 22.8 ± 18.6 (2.2-150.0), reflecting high SSTR expression by GEP-NETs. Our experience has been similar [Figures 2 and 3]. In a prospective analysis of 109 patients done at our center, 68Ga-DOTA-NOC PET/CT has shown a sensitivity and specificity of 78.3 and 92.5% for primary tumor and 97.4 and 100% for metastases, respectively.[27] It changed the management strategy in 21 patients (19%) and supported management decisions in 32 patients (29%). It was better than conventional imaging modality for the detection of both primary tumor (P < 0.001) and metastases (P < 0.0001). In that study 68Ga-DOTA-NOC PET/CT was superior to conventional imaging for the detection of lymph node (P < 0.0001) and bone (P = 0.002), but not liver metastases (P = 1.000). These findings were similar to those reported by Putzer et al.[28] Kumar et al., from our center prospectively compared 68Ga-DOTA-TOC PET/CT and contrast enhanced CT (CECT) for diagnosis and staging of 20 patients with pancreatic NET.[29] The detection rate of CECT was lower than 68Ga-DOTA-TOC PET-CT, both for primary tumor (20 vs 15) and metastatic disease (13 vs 7). Another of our studies addressed subgroup of gastrinoma patients with negative or equivocal CECT findings.[30] 68Ga-DOTA-NOC PET/CT showed a detection rate of 68% overall, 92.8% in those with equivocal CT findings and 36.4% in those with negative CT. Diagnostic performance of 68Ga-DOTA-NOC PET/CT was superior in patients with equivocal CECT findings than that in patients with negative CECT (P = 0.010). Frilling et al., have also demonstrated the superiority of 68Ga-DOTA-TOC PET/CT over conventional imaging (CT/MRI) in GEP-NETs.[31] In that series of 52 patients, PET/CT altered the treatment plan in 31 (59.6%) patients.


PET/CT imaging of neuroendocrine tumors with (68)Gallium-labeled somatostatin analogues: An overview and single institutional experience from India.

Sharma P, Singh H, Bal C, Kumar R - Indian J Nucl Med (2014)

A 50-year-old male, operated case of gastrinoma of stomach, presented with recurrent abdominal pain and raised serum gastrin levels. CT findings were suspicious for recurrence in thickened gastric folds. 68Ga-DOTANOC PET/CT was done for restaging. Maximum intensity projection PET image (a) shows a focal area of increased radiotracer uptake in abdomen near midline (arrow), confirmed as positive portal lymph node on PET/CT (b-d, arrow). No abnormal radiotracer uptake was noted in region of stomach
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928745&req=5

Figure 3: A 50-year-old male, operated case of gastrinoma of stomach, presented with recurrent abdominal pain and raised serum gastrin levels. CT findings were suspicious for recurrence in thickened gastric folds. 68Ga-DOTANOC PET/CT was done for restaging. Maximum intensity projection PET image (a) shows a focal area of increased radiotracer uptake in abdomen near midline (arrow), confirmed as positive portal lymph node on PET/CT (b-d, arrow). No abnormal radiotracer uptake was noted in region of stomach
Mentions: A recent meta-analysis by Treglia et al., evaluated 16 studies comprising 567 patients with GEP and thoracic NETs.[25] The pooled sensitivity and specificity of 68Ga-DOTA peptide PET or PET/CT in detecting NETs were 93% (95% confidence interval (CI): 91-95%) and 91% (95% CI: 82-97%), respectively, on per patient-based analysis. They advised that this accurate technique should be considered as first-line diagnostic imaging methods in patients with suspicious thoracic and/or GEP NETs. Ambrosini et al., reviewed their experience of imaging GEP-NETs in 1,239 patients.[26] The sensitivity was 92% and specificity was 98% for the detection of NET. The mean SUVmax of positive lesions was 22.8 ± 18.6 (2.2-150.0), reflecting high SSTR expression by GEP-NETs. Our experience has been similar [Figures 2 and 3]. In a prospective analysis of 109 patients done at our center, 68Ga-DOTA-NOC PET/CT has shown a sensitivity and specificity of 78.3 and 92.5% for primary tumor and 97.4 and 100% for metastases, respectively.[27] It changed the management strategy in 21 patients (19%) and supported management decisions in 32 patients (29%). It was better than conventional imaging modality for the detection of both primary tumor (P < 0.001) and metastases (P < 0.0001). In that study 68Ga-DOTA-NOC PET/CT was superior to conventional imaging for the detection of lymph node (P < 0.0001) and bone (P = 0.002), but not liver metastases (P = 1.000). These findings were similar to those reported by Putzer et al.[28] Kumar et al., from our center prospectively compared 68Ga-DOTA-TOC PET/CT and contrast enhanced CT (CECT) for diagnosis and staging of 20 patients with pancreatic NET.[29] The detection rate of CECT was lower than 68Ga-DOTA-TOC PET-CT, both for primary tumor (20 vs 15) and metastatic disease (13 vs 7). Another of our studies addressed subgroup of gastrinoma patients with negative or equivocal CECT findings.[30] 68Ga-DOTA-NOC PET/CT showed a detection rate of 68% overall, 92.8% in those with equivocal CT findings and 36.4% in those with negative CT. Diagnostic performance of 68Ga-DOTA-NOC PET/CT was superior in patients with equivocal CECT findings than that in patients with negative CECT (P = 0.010). Frilling et al., have also demonstrated the superiority of 68Ga-DOTA-TOC PET/CT over conventional imaging (CT/MRI) in GEP-NETs.[31] In that series of 52 patients, PET/CT altered the treatment plan in 31 (59.6%) patients.

Bottom Line: Recently, positron emission tomography/computed tomography (PET/CT) with (68)Gallium ((68)Ga)-labeled somatostatin analogues has shown excellent results for imaging of NETs and better results than conventional SSTR scintigraphy.In this review we have discussed the utility of (68)Ga-labeled somatostatin analogue PET/CT in NETs for various established and potential indications.In addition we have also shared our own experience from a tertiary care center in India.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Neuroendocrine tumors (NETs) are rare neoplasms characterized by overexpression of somatostatin receptors (SSTRs). Functional imaging plays a crucial role in management of NETs. Recently, positron emission tomography/computed tomography (PET/CT) with (68)Gallium ((68)Ga)-labeled somatostatin analogues has shown excellent results for imaging of NETs and better results than conventional SSTR scintigraphy. In this review we have discussed the utility of (68)Ga-labeled somatostatin analogue PET/CT in NETs for various established and potential indications. In addition we have also shared our own experience from a tertiary care center in India.

No MeSH data available.


Related in: MedlinePlus