68ga-dotanoc and Gastrinoma

Primary lymph node gastrinoma has been defined as gastrin-producing tumor present in lymph nodes and predominantly found in well-defined anatomical region known as gastrinoma triangle. They are usually localized preoperatively with imaging, and their surgical resection results in long-term relief. The authors report a case of unresectable primary lymph nodal gastrinoma with liver metastases in a 14-year-old adolescent boy with proven histopathology detected on Ga-DOTANOC whole-body PET/CT scan followed by preoperative multiple Lu-DOTATATE cycles for cytoreduction. Subsequent surgical resection of residual mass resulted in complete response with a follow-up of around 4 years in this unusual case of Zollinger-Ellison syndrome.

Topics: Adolescent; Gastrinoma; Humans; Liver Neoplasms; Male; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Zollinger-Ellison Syndrome

Contrast-enhanced CT (CECT) is a standard investigative procedure in the localization of gastrinomas. Small tumors are often missed and metastatic lesions may remain occult on CT. The purpose of present study was to prospectively evaluate the diagnostic performance of (68)Ga-labeled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-NaI(3)-Octreotide ((68)Ga-DOTANOC) positron emission tomography/computed tomography (PET/CT) in gastrinoma patients with negative or equivocal CT findings.. Twenty-five patients (age 46.6 ± 13.3 years; male 60%) with clinical/biochemical diagnosis of gastrinoma and negative or equivocal findings on CECT were prospectively evaluated. All of them underwent (68)Ga-DOTANOC PET/CT which was evaluated by two nuclear medicine physicians in consensus. Combination of histopathology, serum gastrin, endoscopy, and follow-up imaging were taken as reference standard.. (68)Ga-DOTANOC PET/CT was positive in 17 patients and negative in 8 patients, yielding an overall detection rate of 68%. It was positive 13/20 patients who underwent baseline evaluation and in 4/5 post-treatment patients. Of the 11 patients who had a negative CT result, (68)Ga-DOTANOC PET/CT was positive in four cases (detection rate 36.4%), while it was abnormal in 13/14 patients who had equivocal CT findings (detection rate 92.8%). Diagnostic performance of (68)Ga-DOTANOC PET/CT was superior in patients with equivocal CECT findings than that in patients with negative CECT (P = 0.010).. (68)Ga-DOTANOC PET/CT appears to be useful in patients with gastrinoma with negative or equivocal results on CECT, especially the latter group.

Topics: Adult; Female; Gallium Radioisotopes; Gastrinoma; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Multimodal Imaging; Organometallic Compounds; Pancreatic Neoplasms; Prospective Studies; Radiography; Radionuclide Imaging; Receptors, Somatostatin