Ga-68 DOTATOC PET, Endoscopic Ultrasonography, and Multidetector CT in the Diagnosis of Duodenopancreatic Neuroendocrine Tumors

Versari, Annibale; Camellini, Lorenzo; Carlinfante, Gabriele; Frasoldati, Andrea; Nicoli, Franco; Grassi, Elisa; Gallo, Carmine; Giunta, Francesca; Fraternali, Alessandro; Salvo, Diana; Asti, Mattia; Azzolini, Francesco; Iori, Veronica; Sassatelli, Romano

doi:10.1097/rlu.0b013e3181d6677c

Cited by 61 publications

(49 citation statements)

References 24 publications

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“…However, because of the better sensitivity, spatial resolution, and inherently quantitative nature of PET, somatostatin receptor imaging (SRI) with PET is increasingly used. Most common is the use of the 68 Ga-labeled somatostatin analogs, for example, 68 Ga-DOTATATE (6)(7)(8)(9), 68 Ga-DOTATOC (10)(11)(12), and 68 Ga-DOTANOC (13). However, the high positron energy of 68 Ga limits spatial resolution and the short half-life of 68 min may be challenging logistically, because production has to be aligned with patients and to be repeated several times a day.…”

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confidence: 99%

⁶⁴Cu-DOTATATE PET for Neuroendocrine Tumors: A Prospective Head-to-Head Comparison with ¹¹¹In-DTPA-Octreotide in 112 Patients

et al. 2015

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Neuroendocrine tumors (NETs) can be visualized using radiolabeled somatostatin analogs. We have previously shown the clinical potential of 64 Cu-DOTATATE in a small first-in-human feasibility study. The aim of the present study was, in a larger prospective design, to compare on a head-to-head basis the performance of 64 In-diethylenetriaminepentaacetic acid (DTPA)-octreotide ( 111 In-DTPA-OC) as a basis for implementing 64 Cu-DOTATATE as a routine. Methods: We prospectively enrolled 112 patients with pathologically confirmed NETs of gastroenteropancreatic or pulmonary origin. All patients underwent both PET/CT with 64 Cu-DOTATATE and SPECT/CT with 111 In-DTPA-OC within 60 d. PET scans were acquired 1 h after injection of 202 MBq (range, 183-232 MBq) of 64 Cu-DOTATATE after a diagnostic contrast-enhanced CT scan. Patients were followed for 42-60 mo for evaluation of discrepant imaging findings. The McNemar test was used to compare the diagnostic performance. Results: Eightyseven patients were congruently PET-and SPECT-positive. No SPECT-positive cases were PET-negative, whereas 10 false-negative SPECT cases were identified using PET. The diagnostic sensitivity and accuracy of 64 Cu-DOTATATE (97% for both) were significantly better than those of 111 In-DTPA-OC (87% and 88%, respectively, P 5 0.017). In 84 patients (75%), 64 Cu-DOTATATE identified more lesions than 111 In-DTPA-OC and always at least as many. In total, twice as many lesions were detected with 64 Cu-DOTATATE than with 111 In-DTPA-OC. Moreover, in 40 of 112 cases (36%) lesions were detected by 64 Cu-DOTATATE in organs not identified as disease-involved by 111 In-DTPA-OC. Conclusion: With these results, we demonstrate that 64 Cu-DOTATATE is far superior to 111 In-DTPA-OC in diagnostic performance in NET patients. Therefore, we do not hesitate to recommend implementation of 64 Cu-DOTATATE as a replacement for 111 In-DTPA-OC.

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confidence: 99%

⁶⁴Cu-DOTATATE PET for Neuroendocrine Tumors: A Prospective Head-to-Head Comparison with ¹¹¹In-DTPA-Octreotide in 112 Patients

et al. 2015

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“…The superiority of 68 Ga-labeled somatostatin analogs in terms of specificity, sensitivity, staging accuracy, detection rate, quantification, and acquisition time over 18 F-FDG (5), 18 F-3,4-dihydroxyphenylalanine (6), 123 Imetaiodobenzylguanidine (7,8), 111 In-DTPA-pentetreotide (9), 18 F-NaF, and 99m Tc-dicarboxypropanediphosphonate (10) has been demonstrated. The high impact of 68 Ga PET/CT on patient management can be illustrated by the fact that the course of treatments was changed or adjusted in 50%-60% of cases on the basis of 68 Ga PET/CT results (11)(12)(13)(14)(15). Thorough analysis of the publications on 16 clinical studies involving 567 patients with suspected thoracic or gastroenteropancreatic NETs suggested PET/CT with 68 Galabeled somatostatin analogs as an independent first-line diagnostic imaging method for this category of patients (16).…”

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Quantitative and Qualitative Intrapatient Comparison of ⁶⁸Ga-DOTATOC and ⁶⁸Ga-DOTATATE: Net Uptake Rate for Accurate Quantification

et al. 2013

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Quantitative imaging and dosimetry are crucial for individualized treatment during peptide receptor radionuclide therapy (PRRT). 177 Lu-DOTATATE and 68 Ga-DOTATOC/ 68 Ga-DOTATATE are used, respectively, for PRRT and PET examinations targeting somatostatin receptors (SSTRs) in patients affected by neuroendocrine tumors. The aim of the study was to quantitatively and qualitatively compare the performance of 68 Ga-DOTATOC and 68 Ga-DOTATATE in the context of subsequent PRRT with 177 Lu-DOTATATE under standardized conditions in the same patient as well as to investigate the sufficiency of standardized uptake value (SUV) for estimation of SSTR expression. Methods: Ten patients with metastatic neuroendocrine tumors underwent one 45-min dynamic and 3 whole-body PET/CT examinations at 1, 2, and 3 h after injection with both tracers. The number of detected lesions, SUVs in lesions and normal tissue, total functional tumor volume, and SSTR volume (functional tumor volume multiplied by mean SUV) were investigated for each time point. Net uptake rate (K i ) was calculated according to the Patlak method for 3 tumors per patient. Results: There were no significant differences in lesion count, lesion SUV, K i , functional tumor volume, or SSTR volume between 68 Ga-DOTATOC and 68 Ga-DOTATATE at any time point. The detection rate was similar, although with differences for single lesions in occasional patients. For healthy organs, marginally higher uptake of 68 Ga-DOTATATE was observed in kidneys, bone marrow, and liver at 1 h. 68 Ga-DOTATOC uptake was higher in mediastinal blood pool at the 1-h time point (P 5 0.018). The tumor-toliver ratio was marginally higher for 68 Ga-DOTATOC at the 3-h time point (P 5 0.037). Blood clearance was fast and similar for both tracers. SUV did not correlate with K i linearly and achieved saturation for a K i of greater than 0.2 mL/cm 3 /min, corresponding to an SUV of more than 25. Conclusion: 68 Ga-DOTATOC and 68 Ga-DOTATATE are suited equally well for staging and patient selection for PRRT with 177 Lu-DOTATATE. However, the slight difference in the healthy organ distribution and excretion may render 68 Ga-DOTATATE preferable. SUV did not correlate linearly with K i and thus may not reflect the SSTR density accurately at its higher values, whereas K i might be the outcome measure of choice for quantification of SSTR density and assessment of treatment outcome.

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“…Ninety (62%) pNENs detected by conventional imaging were missed by Ga-68-DOTATOC-PET/CT. However, Ga-68-DOTATOC-PET/CT detected more liver and lymph node metastases in patients with known metastatic disease, which was already reported for sporadic metastatic pNENs (Versari et al 2010). Based on the available data, somatostatin PET/CT imaging cannot be recommended for routine screening of MEN1 patients, but it probably provides important additional information in patients with suspected or known metastatic disease.…”

Section: :10mentioning

confidence: 86%

The future: diagnostic and imaging advances in MEN1 therapeutic approaches and management strategies

Manoharan¹,

Albers²,

Bartsch³

2017

Endocrine-Related Cancer

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Prospective randomized data are lacking, but current clinical expert guidelines recommend annual screening examinations, including laboratory assessments and various imaging modalities (e.g. CT, MRI, scintigraphy and EUS) for patients with multiple endocrine neoplasia type 1 (MEN1). Routine screening is proposed to detect and localize neuroendocrine manifestations as early as possible. The goal is timely intervention to improve quality of life and to increase life expectancy by preventing the development of life-threatening hormonal syndromes and/or metastatic disease. In recent years, some studies compared different and new imaging methods regarding their sensitivity and utility in MEN1 patients. This present article reviews the proposed diagnostic tools for MEN1 screening as well as potential future perspectives.

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Ga-68 DOTATOC PET, Endoscopic Ultrasonography, and Multidetector CT in the Diagnosis of Duodenopancreatic Neuroendocrine Tumors

Abstract: EUS, Ga-68 DOTATOC PET, and MDCT seem to have comparable accuracy in diagnosis of duodenopancreatic NET and their combination may allow an optimal preoperative diagnosis.

Cited by 61 publications

References 24 publications

⁶⁴Cu-DOTATATE PET for Neuroendocrine Tumors: A Prospective Head-to-Head Comparison with ¹¹¹In-DTPA-Octreotide in 112 Patients

⁶⁴Cu-DOTATATE PET for Neuroendocrine Tumors: A Prospective Head-to-Head Comparison with ¹¹¹In-DTPA-Octreotide in 112 Patients

Quantitative and Qualitative Intrapatient Comparison of ⁶⁸Ga-DOTATOC and ⁶⁸Ga-DOTATATE: Net Uptake Rate for Accurate Quantification

The future: diagnostic and imaging advances in MEN1 therapeutic approaches and management strategies

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Ga-68 DOTATOC PET, Endoscopic Ultrasonography, and Multidetector CT in the Diagnosis of Duodenopancreatic Neuroendocrine Tumors

Abstract: EUS, Ga-68 DOTATOC PET, and MDCT seem to have comparable accuracy in diagnosis of duodenopancreatic NET and their combination may allow an optimal preoperative diagnosis.

Cited by 61 publications

References 24 publications

64Cu-DOTATATE PET for Neuroendocrine Tumors: A Prospective Head-to-Head Comparison with 111In-DTPA-Octreotide in 112 Patients

64Cu-DOTATATE PET for Neuroendocrine Tumors: A Prospective Head-to-Head Comparison with 111In-DTPA-Octreotide in 112 Patients

Quantitative and Qualitative Intrapatient Comparison of 68Ga-DOTATOC and 68Ga-DOTATATE: Net Uptake Rate for Accurate Quantification

The future: diagnostic and imaging advances in MEN1 therapeutic approaches and management strategies

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⁶⁴Cu-DOTATATE PET for Neuroendocrine Tumors: A Prospective Head-to-Head Comparison with ¹¹¹In-DTPA-Octreotide in 112 Patients

⁶⁴Cu-DOTATATE PET for Neuroendocrine Tumors: A Prospective Head-to-Head Comparison with ¹¹¹In-DTPA-Octreotide in 112 Patients

Quantitative and Qualitative Intrapatient Comparison of ⁶⁸Ga-DOTATOC and ⁶⁸Ga-DOTATATE: Net Uptake Rate for Accurate Quantification