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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 31-year-old male with medullary carcinoma thyroid post total thyroidectomy, central neck dissection, and right side radical neck dissection. He presented with rising calcitonin level. 68Ga-DOTANOC PET/CT was done for restaging. Maximum intensity projection PET image (a) revealed presence of multiple focal areas of increased radiotracer uptake (arrows) in cervical and high mediastinal region, confirmed as SSTR positive cervical and high mediastinal lymph nodes on PET/CT (b, arrows). Resurgery confirmed the diagnosis. In addition, horseshoe kidney was incidentally detected on PET/CT
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Figure 5: A 31-year-old male with medullary carcinoma thyroid post total thyroidectomy, central neck dissection, and right side radical neck dissection. He presented with rising calcitonin level. 68Ga-DOTANOC PET/CT was done for restaging. Maximum intensity projection PET image (a) revealed presence of multiple focal areas of increased radiotracer uptake (arrows) in cervical and high mediastinal region, confirmed as SSTR positive cervical and high mediastinal lymph nodes on PET/CT (b, arrows). Resurgery confirmed the diagnosis. In addition, horseshoe kidney was incidentally detected on PET/CT

Mentions: MTC cells are also known to express SSTRs owing to their neuroendocrine origin and behavior.[60] Conventional SRS with 111In-pentriotide have been used in MTC with variable success.[61] More recently, PET/CT with 68Ga-DOTA-peptides has been evaluated in MTC [Figure 5]. Conry et al., compared the accuracy of 68Ga-DOTA-TATE and 18F-FDG PET/CT for detection of recurrent MTC and mapping the extent of disease in 18 patients.[62] Per patient based sensitivity of 72.2% for 68Ga-DOTA-TATE versus 77.8% for 18F-FDG PET/CT was seen and the difference was not significant. While 18F-FDG PET/CT detected more lesions, in 10 patients a discordant tracer pattern of per-region and/or per-lesion distribution of recurrent disease was observed. The authors concluded that the role of two tracers is complimentary. We have prospectively compared 68Ga-DOTA-NOC and 18F-FDG PET/CT in 41 patients with recurrent MTC.[63] In our study, 68Ga-DOTA-NOC PET/CT proved superior to 18F-FDG PET-CT with a higher sensitivity (75.61 vs 63.4%). However, the difference was not statistically significant (P = 0.179). 68Ga-DOTA-NOC PET/CT was superior to 18F-FDG PET-CT for detecting recurrence in cervical lymph nodes (P < 0.001), but not for other sites. Discordance was observed in 25% patients between the two imaging agents, mainly for lymph nodal lesions. Although, no cutoff for serum calcitonin could be obtained for disease detection on PET/CT, values > 500 pg/ml was more commonly associated with distant metastasis. At present it appears wise to evaluate patients with recurrent MTC using dual tracers (68Ga-DOTA-NOC and 18F-FDG) and their role appears complimentary in such patients.[64] There is small difference between our study and that by Conry et al.,[62] which might be because of the different receptor affinity profile of tracers used. 68Ga-DOTA-NOC has an affinity profile for broader SSTR subtypes: SSTR2, SSTR3, and SSTR5; whereas 68Ga-DOTA-TATE is more active at SSTR2 and SSTR3.[9]


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 31-year-old male with medullary carcinoma thyroid post total thyroidectomy, central neck dissection, and right side radical neck dissection. He presented with rising calcitonin level. 68Ga-DOTANOC PET/CT was done for restaging. Maximum intensity projection PET image (a) revealed presence of multiple focal areas of increased radiotracer uptake (arrows) in cervical and high mediastinal region, confirmed as SSTR positive cervical and high mediastinal lymph nodes on PET/CT (b, arrows). Resurgery confirmed the diagnosis. In addition, horseshoe kidney was incidentally detected on PET/CT
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: A 31-year-old male with medullary carcinoma thyroid post total thyroidectomy, central neck dissection, and right side radical neck dissection. He presented with rising calcitonin level. 68Ga-DOTANOC PET/CT was done for restaging. Maximum intensity projection PET image (a) revealed presence of multiple focal areas of increased radiotracer uptake (arrows) in cervical and high mediastinal region, confirmed as SSTR positive cervical and high mediastinal lymph nodes on PET/CT (b, arrows). Resurgery confirmed the diagnosis. In addition, horseshoe kidney was incidentally detected on PET/CT
Mentions: MTC cells are also known to express SSTRs owing to their neuroendocrine origin and behavior.[60] Conventional SRS with 111In-pentriotide have been used in MTC with variable success.[61] More recently, PET/CT with 68Ga-DOTA-peptides has been evaluated in MTC [Figure 5]. Conry et al., compared the accuracy of 68Ga-DOTA-TATE and 18F-FDG PET/CT for detection of recurrent MTC and mapping the extent of disease in 18 patients.[62] Per patient based sensitivity of 72.2% for 68Ga-DOTA-TATE versus 77.8% for 18F-FDG PET/CT was seen and the difference was not significant. While 18F-FDG PET/CT detected more lesions, in 10 patients a discordant tracer pattern of per-region and/or per-lesion distribution of recurrent disease was observed. The authors concluded that the role of two tracers is complimentary. We have prospectively compared 68Ga-DOTA-NOC and 18F-FDG PET/CT in 41 patients with recurrent MTC.[63] In our study, 68Ga-DOTA-NOC PET/CT proved superior to 18F-FDG PET-CT with a higher sensitivity (75.61 vs 63.4%). However, the difference was not statistically significant (P = 0.179). 68Ga-DOTA-NOC PET/CT was superior to 18F-FDG PET-CT for detecting recurrence in cervical lymph nodes (P < 0.001), but not for other sites. Discordance was observed in 25% patients between the two imaging agents, mainly for lymph nodal lesions. Although, no cutoff for serum calcitonin could be obtained for disease detection on PET/CT, values > 500 pg/ml was more commonly associated with distant metastasis. At present it appears wise to evaluate patients with recurrent MTC using dual tracers (68Ga-DOTA-NOC and 18F-FDG) and their role appears complimentary in such patients.[64] There is small difference between our study and that by Conry et al.,[62] which might be because of the different receptor affinity profile of tracers used. 68Ga-DOTA-NOC has an affinity profile for broader SSTR subtypes: SSTR2, SSTR3, and SSTR5; whereas 68Ga-DOTA-TATE is more active at SSTR2 and SSTR3.[9]

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