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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 35-year-old female presenting with recurrent pain abdomen and multiple hepatic space occupying lesions on ultrasound. Fine needle aspiration cytology from liver lesions demonstrated metastatic neuroendocrine tumor (NET). 68Ga-DOTANOC PET/CT was done to localize the primary. Maximum intensity projections PET image (a) showed multiple liver lesions (broken arrows) along with two discrete foci in abdomen (arrow and arrowhead). Axial CT (b) and PET/CT (c) images of the abdomen revealed focal tracer uptake in ileum with minimal wall thickening (arrow). Also noted are 68Ga-DOTANOC avid retroperitoneal lymph node metastasis (d, arrowhead) and multiple liver metastases (e, broken arrows). The ileal lesion was proven to be carcinoid at histopathology
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Figure 4: A 35-year-old female presenting with recurrent pain abdomen and multiple hepatic space occupying lesions on ultrasound. Fine needle aspiration cytology from liver lesions demonstrated metastatic neuroendocrine tumor (NET). 68Ga-DOTANOC PET/CT was done to localize the primary. Maximum intensity projections PET image (a) showed multiple liver lesions (broken arrows) along with two discrete foci in abdomen (arrow and arrowhead). Axial CT (b) and PET/CT (c) images of the abdomen revealed focal tracer uptake in ileum with minimal wall thickening (arrow). Also noted are 68Ga-DOTANOC avid retroperitoneal lymph node metastasis (d, arrowhead) and multiple liver metastases (e, broken arrows). The ileal lesion was proven to be carcinoid at histopathology

Mentions: NETs account for about 2-4% of carcinoma of unknown primary site (CUP) and are often mentioned separately because this entity belongs to a treatable subset.[48] Identification of the primary site is of prime importance as many aspects of tumor management are dependent on it, ranging from disease prognosis, treatment outcome, and survival rates. Morphological imaging, though routinely performed, may not be very useful because of their low sensitivity for NETs. Conventional SRS has been explored to detect occult primary sites in patients with metastatic GEP-NETs with a detection rate of 39%.[49] Prasad et al., were the first to evaluate the role of 68Ga-DOTA-NOC PET/CT for CUP-NET.[50] They demonstrated that 68Ga-DOTA-NOC PET-CT was able to localize the primary tumor in 59% of the patients. Moreover, there was change in management in 10% of the patients. The experience from our center is similar [Figure 4]. In a prospective evaluation in 20 patients, we found that 68Ga-DOTANOC PET-CT was able to localize the primary tumor in 12/20 (60%) patients.[51] The most common site of primary was midgut. Even in patients where no primary tumor was localized, additional sites of metastatic disease were observed when compared to conventional imaging, mostly in lymph nodes and bones. There was a change in management in 3/20 patients (15%), who underwent surgery. In the remaining 17 patients, demonstration of SSTR expression by PET-CT made them suitable candidate for PRRT.


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 35-year-old female presenting with recurrent pain abdomen and multiple hepatic space occupying lesions on ultrasound. Fine needle aspiration cytology from liver lesions demonstrated metastatic neuroendocrine tumor (NET). 68Ga-DOTANOC PET/CT was done to localize the primary. Maximum intensity projections PET image (a) showed multiple liver lesions (broken arrows) along with two discrete foci in abdomen (arrow and arrowhead). Axial CT (b) and PET/CT (c) images of the abdomen revealed focal tracer uptake in ileum with minimal wall thickening (arrow). Also noted are 68Ga-DOTANOC avid retroperitoneal lymph node metastasis (d, arrowhead) and multiple liver metastases (e, broken arrows). The ileal lesion was proven to be carcinoid at histopathology
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: A 35-year-old female presenting with recurrent pain abdomen and multiple hepatic space occupying lesions on ultrasound. Fine needle aspiration cytology from liver lesions demonstrated metastatic neuroendocrine tumor (NET). 68Ga-DOTANOC PET/CT was done to localize the primary. Maximum intensity projections PET image (a) showed multiple liver lesions (broken arrows) along with two discrete foci in abdomen (arrow and arrowhead). Axial CT (b) and PET/CT (c) images of the abdomen revealed focal tracer uptake in ileum with minimal wall thickening (arrow). Also noted are 68Ga-DOTANOC avid retroperitoneal lymph node metastasis (d, arrowhead) and multiple liver metastases (e, broken arrows). The ileal lesion was proven to be carcinoid at histopathology
Mentions: NETs account for about 2-4% of carcinoma of unknown primary site (CUP) and are often mentioned separately because this entity belongs to a treatable subset.[48] Identification of the primary site is of prime importance as many aspects of tumor management are dependent on it, ranging from disease prognosis, treatment outcome, and survival rates. Morphological imaging, though routinely performed, may not be very useful because of their low sensitivity for NETs. Conventional SRS has been explored to detect occult primary sites in patients with metastatic GEP-NETs with a detection rate of 39%.[49] Prasad et al., were the first to evaluate the role of 68Ga-DOTA-NOC PET/CT for CUP-NET.[50] They demonstrated that 68Ga-DOTA-NOC PET-CT was able to localize the primary tumor in 59% of the patients. Moreover, there was change in management in 10% of the patients. The experience from our center is similar [Figure 4]. In a prospective evaluation in 20 patients, we found that 68Ga-DOTANOC PET-CT was able to localize the primary tumor in 12/20 (60%) patients.[51] The most common site of primary was midgut. Even in patients where no primary tumor was localized, additional sites of metastatic disease were observed when compared to conventional imaging, mostly in lymph nodes and bones. There was a change in management in 3/20 patients (15%), who underwent surgery. In the remaining 17 patients, demonstration of SSTR expression by PET-CT made them suitable candidate for PRRT.

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