68ga-dotanoc and Pancreatic-Neoplasms

Pancreatic Neuroendocrine Tumors (PNETs) are rare neoplasms, sporadic or familial, even being part of a syndrome. Their diagnosis is based on symptoms, hormonal disorders or may be fortuitous. The role of Nuclear Medicine is important, mainly because of the possibility of a theranostic strategy. This approach is allowed by the availability of biochemical agents, which may be labeled with radionuclides suitable for diagnostic or therapeutic purposes, showing almost identical pharmacokinetics. The major role for radiopharmaceuticals is connected with radiolabeled Somatostatin Analogues (SSA), since somatostatin receptors are highly expressed on some of the neoplastic cell types.. Nowadays, in the category of radiolabeled SSA, although 111In-pentetreotide, firstly commercially proposed, is still used, the best choice for diagnosis is related to the so called DOTAPET radiotracers labeled with 68-Gallium (Ga), such as 68Ga-DOTATATE, 68Ga-DOTANOC, and 68Ga-DOTATOC. More recently, labeling with 64-Copper (Cu) (64Cu-DOTATATE) has also been proposed. In this review, we discuss the clinical interest of a SAA (Tektrotyd©) radiolabeled with 99mTc, a gamma emitter with better characteristics, with respect to 111Indium, radiolabeling Octreoscan ©. By comparing both pharmacokinetics and pharmacodynamics of Octreoscan©, Tektrotyd© and PET DOTA-peptides, on the basis of literature data and of our own experience, we tried to highlight these topics to stimulate further studies, individuating actual clinical indications for all of these radiotracers.. In our opinion, Tektrotyd© could already find its applicative dimension in the daily practice of NETs, either pancreatic or not, at least in centers without a PET/CT or a 68Ga generator. Because of wider availability, a lower cost, and a longer decay, compared with respect to peptides labeled with 68Ga, it could be also proposed, in a theranostic context, for a dosimetry evaluation of patients undergoing Peptide Receptor Radionuclide Therapy (PRRT), and for non-oncologic indications of radiolabelled SSA. In this direction, and for a more rigorous cost/effective evaluation, more precisely individuating its clinical role, further studies are needed.

Topics: Animals; Gamma Rays; Humans; Mice; Neuroendocrine Tumors; Octreotide; Organometallic Compounds; Organotechnetium Compounds; Pancreatic Neoplasms; Peptides; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radioisotopes; Radiopharmaceuticals; Somatostatin; Technetium

Topics: Aged; Female; Humans; Multimodal Imaging; Organometallic Compounds; Pancreatic Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Tomography, X-Ray Computed; Vipoma

Isolated pancreatic metastasis from choroidal melanoma is a rare phenomenon. We describe a case of a 38-year-old woman who underwent enucleation surgery for right choroidal melanoma and subsequently developed lesions in the pancreas 10 years after enucleation, which were depicted on Ga-DOTANOC PET/CT and confirmed to be metastasis from choroidal melanoma on surgical histopathology.

Topics: Adult; Choroid Neoplasms; Diagnosis, Differential; Female; Humans; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography

The aim of this study was to compare retrospectively 18F-DOPA PET/CT versus 68Ga-DOTANOC PET/CT in a group of patients affected by midgut NET.. Patients with histologically proven grade 1 or grade 2 midgut NET were explored after injection of 150 MBq of 68Ga-DOTANOC and 210 MBq of 18F-DOPA. The PET/CTs were analyzed visually and semiquantitatively at the patient level, regional level (7 defined regions), and lesion level (maximum of 5 lesions/organ). The criterion standard was determined on the basis of histology and imaging follow-up.. Thirty patients (17 males and 13 females; median age, 63.5 years [37-82 years]) were included. Both PET/CTs were negative in 3 patients and positive in 25 patients. PET/CTs were discordant in 2 patients, with 18F-DOPA positive and 68Ga-DOTANOC negative. 18F-DOPA PET/CT detected more involved regions and more metastatic lesions than 68Ga-DOTANOC PET/CT in 6 (20%) and 10 (33.3%) patients, respectively. Of the 81 confirmed affected regions, 77 (95%) were detected by 18F-DOPA PET/CT and 71 (87.7%) by 68Ga-DOTANOC PET/CT (P < 0.0001). 18F-DOPA PET/CT detected significantly more lesions (211/221) than 68Ga-DOTANOC PET/CT (195/221), corresponding to a sensitivity of 95.5% and 88.2%, respectively (P < 0.0001). Tumor-to-background ratios were more favorable in liver for 18F-DOPA than for 68Ga-DOTANOC. Interestingly, a correlation was found between 18F-DOPA SUVmax and tumor burden and especially with the number of regions involved by the disease (P = 0.019).. 18F-DOPA PET/CT is superior to 68Ga-DOTANOC PET/CT for the detection of lesions, and when available, this tracer may be recommended as the first-line examination for an accurate staging of midgut NET.

Topics: Adult; Aged; Aged, 80 and over; Dihydroxyphenylalanine; Female; Humans; Intestinal Neoplasms; Male; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Retrospective Studies; Stomach Neoplasms

A 57-year-old man, on octreotide treatment for metastatic neuroendocrine tumor pancreas, was referred for whole-body Ga-DOTANOC PET/CT scan to evaluate treatment response. PET/CT scan revealed DOTANOC-avid lesion in the head of the pancreas with multiple tracer-avid soft tissue lesions in the liver, bilateral adrenal glands, and periportal lymph nodes. In addition, diffuse intense DOTANOC-avid mural thickening with intraluminal polypoidal mass formation was noted within the stomach causing significant luminal compromise, histopathological examination of which turned out be hypertrophic hypersecretory gastropathy. This case highlights the possibility of overexpression of somatostatin receptors in gastric hypertrophy, which has been little explored in literature.

Topics: Diagnosis, Differential; Gastritis, Hypertrophic; Humans; Male; Middle Aged; Neoplasm Metastasis; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals

Increase in incidence of neuroendocrine tumors (NETs) has been attributed in part to the availability of sensitive diagnostic modalities, such as Ga-DOTA-peptide PET/CT. However, it suffers from problems such as obscurement of tracer-avid lesions by physiological gut activity and collapsed gut lumen. Contrast-enhanced CT and CT enterography (CTE) do not have these drawbacks.. The aim of this study was to compare the diagnostic performances of contrast-enhanced CT + CTE and the Ga-DOTA-peptide PET/noncontrast CT in GEP-NETs.. Fifty-six patients (mean age, 57.8 ± 13.3 years [male:female, 1.95:1]), with histopathologically proven gastroenteropancreatic NETs, who had undergone both Ga-DOTANOC-PET/NCCT (60 minutes, post-IV injection of 111-185 MBq) and contrast-enhanced CT (CECT) + CTE (using 1.5-2 L isotonic mannitol solution and 1-2 mg/kg of IV contrast), were retrospectively selected. Twenty-three patients had been referred for identification of primary lesions and 33 for staging/restaging. The scans were independently evaluated by 2 blinded physicians, who documented the number and site of lesions, with reporting confidence (3 = high confidence, 2 = equivocal confidence, 1 = low confidence). Reference standard was created using clinical, biochemical, and imaging parameters (ie, uptake and contrast enhancement), along with corroboration from previous or follow-up scans. Finally, PET images coregistered to the CECT + CTE were independently evaluated for any additional benefit.. The numbers of primary lesions detected by CECT + CTE and PET/CT were 69 and 57, respectively. Lesion-wise sensitivities for patients with unknown primary in CECT + CTE and PET/CT were 57.7% (95% confidence interval [CI], 39.0%-74.5%) and 71.4% (95% CI, 52.9%-84.7%), respectively. Corresponding numbers in patients who had come for staging/restaging were 73.2% (95% CI, 58.1%-84.3%) and 73.8% (95% CI, 58.9%-84.7%). Lesions missed in CECT + CTE were gastrointestinal (n = 14), lymph nodes (n = 25), mesenteric (n = 1), and pancreatic (n = 7), whereas corresponding numbers for PET/CT were 14, 5, 3, and 2. Contrast-enhanced CT + CTE showed more false-positives (n = 26) than PET/CT (n = 9). Lesions missed by CECT + CTE were smaller than detected lesions (median, 9.7 mm [interquartile range, 7.5-31.1] vs 17.7 mm [interquartile range, 12.2-30.0]; P = 0.062), and lesions missed by PET had significantly lower tumor/background (liver) SUVmax ratio (median, 1.3 [interquartile range, 0.6-3.8] vs 4.7 [interquartile range, 2.7-10.8]). The ratio of true-positives to false-positives dropped markedly, when reporting confidence in CECT + CTE was low (4/15 [for rating 1 or 2] vs 93/11 [rating 3]). Corresponding numbers for PET/CT were (40/7 [for rating 1 or 2] vs 80/2 [rating 3]). Combination of these 2 modalities would have increased the lesion-wise sensitivities in patients with unknown primaries to 89.7% (95% CI, 73.6%-96.4%) and the confidence rating of soft tissue lesions to predominantly high (134 lesions rated 3, and 10 rated 1 or 2).. PET/CT is a sensitive modality for staging and restaging well-differentiated NETs. Use of CECT + CTE as a complementary modality in patients with uncertain uptake or high clinical suspicion of gastroenteropancreatic NETs should be considered, as it improves the lesion detection and reporting confidence.

Topics: Adult; Aged; Female; Humans; Intestinal Neoplasms; Male; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Retrospective Studies; Stomach Neoplasms

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

Functional imaging using radiolabeled somatostatin analogues plays an important role in the management of patients with neuroendocrine tumors, and it is a promising tool in the new era of theragnosis and personalized medicine.. The authors present the case of a 63-year-old woman referred for evaluation of a suspected pancreatic neuroendocrine tumor by Ga-68-DOTA-1-Nal3-octreotide positron emission tomography/computed tomography (Ga-68-DOTA-NOC PET/CT).. PET/CT confirmed increased uptake of Ga-68-DOTA-NOC in a pancreatic lesion compatible with hyperexpression of somatostatin receptors in a neuroendocrine tumor. Furthermore, PET/CT revealed increased uptake in a breast lesion and in lymphadenomegalies (less intense than in the pancreatic tumor), which conducted to the incidental diagnosis of a breast carcinoma with lymph node metastases.. For the breast cancer, the patient underwentneoadjuvant chemotherapy and anti-HER2 monoclonal antibody, after which she was submitted to surgery. Regarding thepancreatic neuroendocrine tumor, it was decided to maintain itunder surveillance.. Breast carcinomas are known to express somatostatin receptors and this is the first report of Ga-68-DOTA-NOC uptake in a breast tumor.. Ga-68-DOTA-NOC PET/CT could be useful for the management of breast cancer patients in the new era of theragnosis and personalized medicine.

Topics: Breast Neoplasms; Carcinoma; Female; Humans; Incidental Findings; Lymphadenopathy; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals

The aim of the study was to assess the value and potential pitfalls of Ga-DOTANOC positron emission tomography/computed tomography (PET/CT) in patients with suspected pancreatic neuroendocrine neoplasms (pNEN).. Consecutive patients referred for Ga-DOTANOC PET/CT for suspected pNEN between May 1, 2011, and October 31, 2014, were retrospectively assessed. Scan data were compared with cytological/histological final diagnosis. Pancreatic neuroendocrine neoplasm detection rate was determined on per-patient and per-lesion basis. Maximum standardized uptake values of lesions were determined.. Fifty-eight patients with 65 lesions were enrolled. Twelve patients had nonconfirmed diagnosis; of these, 7 were positive and 5 negative at PET/CT. Of 46 patients with confirmed diagnosis, 36 had pNEN; of these, 33 were positive, 1 negative, and 2 nonevaluable at PET/CT. Ten patients had non-NE lesions, of which 8 were positive, 1 negative, and 1 nonevaluable at PET/CT. Of 48 patients with positive PET/CT, 8 proved to have non-NE lesions, of which 6 were intrapancreatic accessory spleen. No significant maximum standardized uptake values difference was found between pNEN and non-NE lesions.. Intrapancreatic accessory spleen is an important pitfall in Ga-DOTANOC PET/CT for suspected pNEN. Cytological/histological confirmation is mandatory before any surgical procedure is undertaken.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Choristoma; Female; Humans; Longitudinal Studies; Male; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Spleen; Young Adult

Localization of primary tumor in insulinoma is often difficult. We evaluated the role of 68Ga-DOTA-Nal3-Octreotide (DOTANOC) PET/CT for localization of primary tumor in patients with clinical and biochemical suspicion of insulinoma.. Data of 35 patients (age: 38.4±16.5 years) who underwent 68Ga-DOTANOC PET/CT for clinical and biochemical suspicion of insulinoma (hypoglycemia, raised serum insulin and C-peptide levels) were retrospectively analyzed. PET/CT images were evaluated visually and semiquantitatively (SUV) by two experienced nuclear medicine physicians. A definite lesion in pancreas on non contrast CT showing increased 68Ga-DOTANOC was taken as positive. In the absence of CT lesion focal 68Ga-DOTANOC uptake in the pancreas more than liver was taken as positive. All patients had also undergone conventional imaging (CIM) (CT/MRI/endosonography) and their reports were retrieved for comparison. Histopathology and/or imaging/clinical/biochemical follow up (minimum 6 months) was used as reference standard.. The mean serum insulin levels was 51.6±54 µIU/mL and C-peptide level was 6.9±7.3 ng/mL. 68Ga-DOTANOC PET/CT was interpreted as positive in 11 patients (31.5%) and negative in 24 (68.5%). PET/CT demonstrated total 16 pancreatic lesions in 11 patients. In two patients it also showed both liver and lymph nodal metastases. 68Ga-DOTANOC PET/CT was true positive in 8, true negative in 1, false positive in 3 and false negative in 23 patients. Per patient based sensitivity of PET/CT was 25.8% (95% CI: 11.8-44.6), specificity was 25% (95% CI: 0.6-80.5) and accuracy was 25.7%. The mean SUVmax of pancreatic lesions was 13.8±11.1. On comparison no significant difference was seen between CIM and PET/CT on patient based (P=1.00) or lesion based comparison (P=0.790).. 68Ga-DOTANOC PET/CT has limited utility for localizing the primary tumor in patients with clinical and biochemical suspicion of insulinoma. However, it might be useful for differentiating benign and malignant insulinoma. Further prospective comparative studies are warranted.

Topics: Adolescent; Adult; Child; Female; Humans; Insulinoma; Male; Middle Aged; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Receptors, Somatostatin; Young Adult

The aims of this study were to investigate the added value of diffusion-weighted imaging (DWI) in pancreatic neuroendocrine tumor (pNET) evaluation and to compare magnetic resonance imaging (MRI) to Ga-DOTANOC positron emission tomography/computed tomography (PET/CT) results.. Morphological MRI (T2-weighted [T2-w] + contrast-enhanced [CE] T1-w) and DWI (T2-w + DWI) and Ga-DOTANOC PET/CT in 25 patients/30 pNETs were retrospectively evaluated. Per-patient and per-lesion detection rates (pDR and lDR, respectively) were calculated. Apparent diffusion coefficient values were compared among pNET and surrounding and normal pancreas (control group, 18 patients). Apparent diffusion coefficient and standardized uptake value (SUV) values were compared among different grading and staging groups.. No statistically significant differences in PET/CT and MRI session detection rates were found (morphological MRI and DW-MRI, 88% pDR and 87% lDR; combined evaluation, 92% pDR and 90% lDR; Ga-DOTANOC PET/CT, 88% pDR and 80% lDR). Consensus reading (morphological/DW-MRI + PET/CT) improved pDR and lDR (100%). Apparent diffusion coefficient mean value was significantly lower compared with surrounding and normal parenchyma (P < 0.01). The apparent diffusion coefficient and SUV values of pNETs among different grading and staging groups were not statistically different.. Conventional MRI, DW-MRI + T2-w sequences, and Ga-DOTANOC PET/CT can be alternative tools in pNET detection. Diffusion-weighted MRI could be valuable in patients with clinical suspicion but negative conventional imaging findings. However, the consensus reading of the 3 techniques seems the best approach.

Topics: Adult; Aged; Aged, 80 and over; Diffusion Magnetic Resonance Imaging; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Neoplasm Grading; Neoplasm Staging; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron-Emission Tomography; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

Malignant insulinoma is an extremely rare pancreatic tumor variant characterized by an aggressive clinical behavior with local and distant spread. Delays in the diagnosis are common because symptoms usually precede tumor detection and may be misattributed. Aggressive surgical resection is the primary treatment option; therefore accurate tumor localization is important for appropriate management. Although somatostatin receptor imaging has a limited role in the visualization of benign insulinoma (characterized by a low expression of somatostatin receptors), it can still have a role in the detection of malignant forms.

Topics: Female; Humans; Insulinoma; Middle Aged; Multimodal Imaging; Organometallic Compounds; Pancreatic Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Tomography, X-Ray Computed

A 77-year-old man was referred to our center for a suspected neuroendocrine neoplasm in the pancreatic tail, incidentally detected at CT. Ga DOTANOC PET/CT showed intense tracer uptake in the pancreatic lesion. At MRI, the lesion was similar to the spleen on all sequences, suggesting the presence of intrapancreatic accessory spleen. A Tc-colloid SPECT/CT scan performed to differentiate spleen tissue from neuroendocrine tumor revealed a focal uptake in the pancreatic lesion, thus confirming the presence of ectopic spleen and avoiding unnecessary surgery.

Topics: Aged; False Positive Reactions; Humans; Male; Multimodal Imaging; Neuroendocrine Tumors; Organometallic Compounds; Pancreas; Pancreatic Neoplasms; Radiopharmaceuticals; Spleen; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

This study was performed to investigate the role of (68)Ga-DOTANOC SUVmax as a potential prognostic factor in patients with pancreatic neuroendocrine tumor (pNET).. Among the patients who underwent (68)Ga-DOTANOC PET/CT, we retrospectively collected the data of those who had G1 or G2 pNET (2010 World Health Organization classification), presented with disease on PET/CT and CT, and had at least 6 mo of follow-up. Patients with multiple endocrine neoplasia were excluded.. Overall, 43 patients were included. No significant differences in SUVmax were observed with respect to sex, tumor syndrome, stage, World Health Organization classification, or Ki-67. During follow-up (median, 20 mo), 11 patients (35.6%; median, 33 mo; interquartile range, 20-48 mo) had stable disease and 32 (74.4%; median, 19 mo; interquartile range, 14-26 mo) had progressive disease. SUVmax at 24 mo of follow-up was significantly higher (P = 0.022) in patients with stable disease than in patients with progressive disease. The best SUVmax cutoff ranged from 37.8 to 38.0. The major risk factors for progression included an SUVmax of no more than 37.8 (hazard ratio, 3.09; P = 0.003), a Ki-67 of more than 5% (hazard ratio, 2.89; P = 0.009), and medical therapy alone (hazard ratio, 2.36; P = 0.018). Advanced stage (IV) (P = 0.026), an SUVmax of less than 37.8 (P = 0.043), and medical therapy alone (P = 0.015) were also confirmed at multivariate analysis. Median progression-free survival was 23 mo. Significant differences in progression-free survival were observed in relationship to Ki-67 (median, 45 mo for Ki-67 ≤ 5% and 20 mo for Ki-67 > 5%; P = 0.005), SUVmax (<37.8 vs. >38.0: 16.0 vs. 27.0 mo; P = 0.002), and type of therapy (medical vs. peptide receptor radionuclide therapy: 16.0 vs. 26.0 mo; P = 0.014).. (68)Ga-DOTANOC SUVmax is a relevant prognostic factor in patients with G1 and G2 pNET, and its routine use will improve disease characterization and management in these patients, who may present with atypical cases showing heterogeneous clinical behavior.

Topics: Adult; Disease-Free Survival; Female; Follow-Up Studies; Humans; Ki-67 Antigen; Male; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron-Emission Tomography; Predictive Value of Tests; Prognosis; Radiopharmaceuticals; Retrospective Studies; Risk Factors

This study aimed to compare the diagnostic performance of Ga-DOTANOC PET/CT with F-FDG PET/CT in the patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs).. Data of 51 patients with definite histological diagnosis of GEP-NET who underwent both Ga-DOTA-NOC PET-CT and F-FDG PET-CT within a span of 15 days were selected for this retrospective analysis. Sensitivity, specificity, and predictive values were calculated for Ga-DOTA-NOC PET-CT and F-FDG PET-CT, and results were compared both on patientwise and regionwise analysis.. Ga-DOTA-NOC PET-CT is superior to F-FDG PET-CT on patientwise analysis (P < 0.0001). On regionwise analysis, Ga-DOTA-NOC PET-CT is superior to F-FDG PET-CT only for lymph node metastases (P < 0.003). Although Ga-DOTA-NOC PET-CT detected more liver and skeletal lesions compared with F-FDG PET-CT, the difference was not statistically significant. In addition, the results of combined imaging helped in selecting candidates who would undergo the appropriate mode of treatment, whether octreotide therapy or conventional chemotherapy. Ga-DOTA-NOC PET-CT seems to be superior to F-FDG PET-CT for imaging GEP-NETs. However, their role seems to be complementary because combination of Ga-DOTA-NOC PET-CT and F-FDG PET-CT in such patients helps demonstrate the total disease burden and segregate them to proper therapeutic groups.

Topics: Adolescent; Adult; Aged; Female; Fluorodeoxyglucose F18; Humans; Intestinal Neoplasms; Male; Middle Aged; Multimodal Imaging; Neoplasm Metastasis; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron-Emission Tomography; Radioactive Tracers; Retrospective Studies; Stomach Neoplasms; Tomography, X-Ray Computed

The aim of this study was to evaluate the effect of combined (68)Ga and (18)F-FDG PET/CT on treatment management for patients with pancreatic neuroendocrine tumor (PNET).. Between January 2012 and April 2014, 49 consecutive patients with a cytologically and/or histologically proven diagnosis of PNET underwent combined (68)Ga and (18)FDG PET/CT on the same day.. The study group consisted of 21 males and 28 females with a median age of 59 years. Disease detection was achieved in 48 out of the 49 cases with (68)Ga imaging, and in 36 of the 49 cases with (18)FDG PET/CT. These results corresponded to sensitivities of 98% for (68)Ga versus 73% for (18)FDG PET/CT. Patients with NET-G1/NET-G2 had a positive (68)Ga and negative (18)FDG PET/CT in 13 cases, whereas both (68)Ga and (18)FDG PET/CT were positive in 27 cases. Patients with NEC-G3 were positive by both (68)Ga and (18)FDG PET/CT in 7 cases and positive only by (18)FDG in 1 case. Another NEC-G3 patient was only positive by (68)Ga PET/CT. The median Ki67 was 7% for (68)Ga PET/CT-positive tumors and 10% for tumors with both (68)Ga and (18)FDG PET/CT positivity (p = 0.130). Half of the patients with a prevalent uptake of (18)FDG (n = 7) had an NEC-G3 compared with 12% of patients with a prevalent uptake of (68)Ga (p = 0.012). There were no significant differences between patients with positive (68)Ga and those with positive (18)FDG with regards to treatment choice.. The association of (18)FDG slightly increases sensitivity of (68)Ga PET/CT alone in the diagnosis of PNET. A combined dual tracer PET/CT does not influence the choice of treatment strategy.

Topics: Aged; Female; Fluorodeoxyglucose F18; Gallium Radioisotopes; Humans; Male; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron-Emission Tomography; Sensitivity and Specificity; Tomography, X-Ray Computed

We report a rare case of ectopic adrenocorticotropic hormone (ACTH) syndrome caused by a metastatic neuroendocrine tumor (NET) of the pancreas detected by PET/CT using different tracers. A 43-year-old female patient with Cushing syndrome (CS) by suspected ectopic ACTH secretion underwent a 68Ga-DOTANOC and a 18F-FDG PET/CT. Both these functional imaging techniques revealed increased tracer uptake in a pancreatic mass and multiple liver metastases. Histology showed the presence of a mildly differentiated pancreatic NET. 68Ga-DOTANOC PET/CT may be a useful functional imaging method, complementary to 18F-FDG PET/CT, in detecting ACTH-secreting pancreatic NETs.

Topics: ACTH Syndrome, Ectopic; Adult; Cell Differentiation; Female; Fluorodeoxyglucose F18; Glucose; Humans; Multimodal Imaging; Neoplasm Metastasis; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron-Emission Tomography; Tomography, X-Ray Computed

Topics: Female; Humans; Middle Aged; Multimodal Imaging; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Pancreatitis, Chronic; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Somatostatin

56-year old woman was operated of a pancreatic NET in May 2011. Abdominal pain had led to imaging and consecutively the finding of cholecystolithiasis and the tumor. The gall bladder, left hemi-pancreas, regional lymph nodes and the (unintentional injured) spleen were resected. At routine control examination in October 2012 CT presented three contract enhancing intra-abdominal lesions with a diameter of 2-3.5 cm. Consecutively 68Ga-DOTA-NOC PET-CT showed high tracer uptake (SUV 10-12) at these lesions. Therefore a relapse of the neuro-endocrine tumor was suspected. After reoperation in December 2012 histology did not reveal any sign of neuroendocrine tumor but identified spleen tissue most probably caused by splenosis accidentally seeded at the first operation. Physiologically the spleen is highly avid at 68Ga-DOTATOC PET, but splenosis presents with less standard uptake value. In our case the described lesions presented with an SUV quite comparable to that of neuroendocrine tumor tissue.

Topics: Diagnosis, Differential; Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Receptors, Somatostatin; Splenosis

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

Gallium-68 (Ga-68) DOTA-1-NaI3-octreotide (DOTA-NOC) positron emission tomography (PET)/computed tomography (CT) is increasingly used for neuroendocrine tumors (NETs), often found primarily in the pancreas. However, physiologic uptake of DOTA-NOC has been described in the uncinate process of the pancreas. We studied DOTA-NOC uptake in this organ.. Ninety-six patients underwent 103 DOTA-NOC scans, with pathology-proven pancreatic NET (n = 40) and nonpancreatic NET or biochemical suspicion of NET (n = 63).. DOTA-NOC uptake was detected in 35 documented pancreatic tumor sites (SUV: 5.5-165; mean: 25.7 ± 28.8; median: 17.8). Among 63 cases without previous known pathology, uptake was suspicious for tumor in 24 sites (SUV: 4.7-35; mean 16.3 ± 8.0; median: 14.1), and in 38 sites, it was judged as physiological, generally lower relative to adjacent structures (SUV: 2.2-12.6; mean: 6.6 ± 2.2; median: 6.2). In 24 scans with suspected tumor and in 37 of 38 scans with physiological uptake, diagnostic computed tomography or magnetic resonance imaging or endoscopic ultrasonography failed to detect tumor.. Pancreatic DOTA-NOC uptake must be interpreted with caution, and further studies are required.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Tissue Distribution; Young Adult

We present an interesting image that demonstrates utility of (68)Ga-DOTANOC PET/CT for demonstrating rare metastatic sites of neuroendocrime tumor.

Topics: Gallium Radioisotopes; Heart Neoplasms; Humans; Male; Middle Aged; Multimodal Imaging; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron-Emission Tomography; Tomography, X-Ray Computed

The objective of this study was to evaluate the role of (68)Ga-labeled [1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid]-1-NaI(3)-octreotide (DOTA-NOC) PET/CT in the diagnosis and management of gastroenteropancreatic neuroendocrine tumors (NETs).. One hundred nine patients (median age, 50 years) with gastroenteropancreatic NETs underwent (68)Ga-DOTA-NOC PET/CT. PET/CT was performed after injection of 132-222 MBq (4-6 mCi) of (68)Ga-DOTA-NOC. Images were evaluated by two experienced nuclear medicine physicians both qualitatively as well as quantitatively (maximum standardized uptake value [SUV(max)]). Results of PET/CT were compared with the results of conventional imaging. Histopathology results, when available, and follow-up PET/CT or conventional imaging with biochemical markers were considered to be the reference standards.. Gallium-68-DOTA-NOC PET/CT showed sensitivity and specificity of 78.3% and 92.5%, respectively, for primary tumor and 97.4% and 100% for metastases. It was better than a conventional imaging modality for the detection of both primary tumor (p < 0.001) and metastases (p < 0.0001). It changed the management strategy in 21 patients (19%) and supported management decisions in 32 patients (29%).. Gallium-68-DOTA-NOC PET/CT appears to be a highly sensitive and specific modality for the detection of gastroenteropancreatic NET. It is better than conventional imaging for the evaluation of gastroenteropancreatic NETs and can have a significant impact on patient management.

Topics: Female; Gallium Radioisotopes; Gastrointestinal Neoplasms; Humans; Male; Middle Aged; Multimodal Imaging; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron-Emission Tomography; Prospective Studies; Radiopharmaceuticals; Sensitivity and Specificity; Tomography, X-Ray Computed

The aim of the study was 1) to determine the normal biodistribution of radiolabeled somatostatin analogue (68)Ga DOTA-NOC; 2) to establish the range of its uptake in liver, bone and lymph node metastases in patients with NET, 3) to establish the cut-off value for differentiating between physiological uptake and tumor related sstr expression in the processus uncinatus of pancreas.. Maximum standardized uptake values (SUV(max)) of (68)Ga DOTA-NOC were determined in normal organs of 89 NET patients undergoing receptor PET/CT. In addition, SUV(max) of primary pancreatic neuroendocrine tumors (pNET), liver, bone and lymph node metastases were evaluated.. SUV(max) (mean + or - standard deviation) were determined in: pituitary gland 2.6 + or - 1.3, thyroid: 3.4 + or - 1.4, lung: 0.9 + or - 0.8, normal liver: 6.9 + or - 2 , spleen: 22.0 + or - 10.0, adrenal 6.0 + or - 2.5, kidney: 12.9 + or - 3.8, gastrointestinal tract 2.3 + or - 1.0, gluteal muscle:1.0 + or - 0.3, femur 0.8 + or - 0.3, blood pool 2.6 + or - 1.2 and processus uncinatus of pancreas 5.8 + or - 2.0. SUV(max) of (68)Ga DOTA-NOC was 19.6 + or - 13.4 (N.=200) in liver metastases, 12.5 + or - 10 (N.=67) in lymph nodes metastasis, 9.5 + or - 6.0 (N.=78) in bone lesions, and 20.8 + or - 10.8 (N.=26) in pancreatic neuroendocrine primary tumors. Target to non target (T/NT) ratios were 3.4 + or - 2.3 for liver metastases (with normal. There is a broad range of sstr expression in metastastic lesions and in pNET. The splenic uptake of (68)Ga DOTA-NOC is highly variable. (68)Ga DOTA-NOC is an excellent tracer for imaging somatostatin receptor positive tumors, which, due to the high target to non-target ratios, allows the detection of very small lesions, especially of lymph node and bone metastases.

Topics: Adult; Aged; Biological Transport; Drug-Related Side Effects and Adverse Reactions; Humans; Middle Aged; Neoplasm Metastasis; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Retrospective Studies; Somatostatin; Young Adult

(18)F-FDG positron emission tomography (PET) value for the assessment of neuro-endocrine tumours (NET) is limited. Preliminary studies indicate that (18)F-DOPA and (68)Ga-DOTA-NOC are more accurate for disease assessment and (68)Ga-DOTA peptides provide additional data on receptor status that are crucial for targeted radionuclide therapy. At present, there are no comparative studies investigating their role in NET.. The aim of this study was to compare (68)Ga-DOTA-NOC and (18)F-DOPA for the evaluation of gastro-entero-pancreatic and lung neuro-endocrine tumours.. Thirteen patients with biopsy-proven NET (gastro-entero-pancreatic or pulmonary) were prospectively enrolled and scheduled for (18)F-DOPA and (68)Ga-DOTA-NOC PET. PET results obtained with both tracers were compared with each other, with other conventional diagnostic procedures (CT, ultrasound) and with follow-up (clinical, imaging).. The most common primary tumour site was the pancreas (8/13) followed by the ileum (2/13), the lung (2/13) and the duodenum (1/13). The carcinoma was well differentiated in 10/13 and poorly differentiated in 3/13 cases. (68)Ga-DOTA-NOC PET was positive, showing at least one lesion, in 13/13 cases while (18)F-DOPA PET was positive in 9/13. On a lesions basis, (68)Ga-DOTA-NOC identified more lesions than (18)F-DOPA (71 vs 45), especially at liver, lung and lymph node level. (68)Ga-DOTA-NOC correctly identified the primary site in six of eight non-operated cases (in five cases, the primary was surgically removed before PET), while (18)F-DOPA identified the primary only in two of eight cases.. Although the patients studied are few and heterogeneous, our data show that (68)Ga-DOTA-NOC is accurate for the detection of gastro-entero-pancreatic and lung neuro-endocrine tumours in either the primary or metastatic site and that it offers several advantages over (18)F-DOPA.

Topics: Aged; Aged, 80 and over; Dihydroxyphenylalanine; Female; Gastrointestinal Neoplasms; Humans; Lung Neoplasms; Male; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity