68ga-dotanoc and Thyroid-Neoplasms

The purpose of the study was to evaluate the role of (68)Ga-DOTANOC PET-CT in differentiated thyroid cancer (DTC) patients with negative (131)I-whole body scan (WBS) along with serially increasing serum thyroglobulin (Tg), and compare the same with (18)F-FDG PET-CT.. Sixty two DTC patients with serially rising Tg levels and negative (131)I-WBS were prospectively enrolled. All patients underwent (68)Ga-DOTANOC PET-CT and (18)F-FDG PET-CT within an interval of two weeks. PET-CT analysis was done on a per-patient basis, location wise and lesion wise. All PET-CT lesions were divided into four categories-local, nodal, pulmonary and skeletal. Histopathology and/or serial serum Tg level, clinical and imaging follow up (minimum-1 year) were used as a reference standard.. Ga-DOTANOC PET-CT demonstrated disease in 40/62 (65 %) patients and (18)F-FDG PET-CT in 45/62 (72 %) patients, with no significant difference on McNemar analysis (p = 0.226). Per-patient sensitivity and specificity of (68)Ga-DOTANOC PET-CT was 78.4 %, 100 %, and for (18)F-FDG PET-CT was 86.3 %, 90.9 %, respectively. Out of 186 lesions detected by both PET-CTs, 121/186 (65 %) lesions were seen on (68)Ga-DOTANOC PET-CT and 168/186 (90.3 %) lesions on (18)F-FDG PET-CT (p < 0.0001). There were 103/186 (55 %) lesions concordant on both. Excellent agreement was noted between (68)Ga-DOTANOC PET-CT and (18)F-FDG PET-CT for detection of local disease (ĸ = 0.92), while moderate agreement was noted for nodal and pulmonary disease (ĸ = 0.67). (68)Ga-DOTANOC PET-CT changed management in 21/62 (34 %) patients and (18)F-FDG PET-CT in 17/62 (27 %) patients.. Ga-DOTANOC PET-CT is inferior to (18)F-FDG PET-CT on lesion based but not on patient based analysis for detection of recurrent/residual disease in DTC patients with negative WBS scan and elevated serum Tg levels. It can also help in selection of potential candidates for peptide receptor radionuclide therapy.

Topics: Adolescent; Adult; Aged; Child; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Iodine Radioisotopes; Male; Middle Aged; Multimodal Imaging; Organometallic Compounds; Positron-Emission Tomography; Prospective Studies; Thyroglobulin; Thyroid Neoplasms; Tomography, X-Ray Computed; Whole Body Imaging; Young Adult

A 58-year-old woman with 5-year history of grade 1 progressive metastatic intestinal neuroendocrine tumor with metachronous liver metastases initially treated by surgery and liver embolization underwent Ga-DOTANOC PET/CT before Lu-DOTATATE therapy. Ga-DOTANOC PET/CT revealed increased uptake in several liver metastases and right iliac lymph nodes, consistent with radiopeptide therapy, including a hypodense isthmic thyroid nodule. Fine needle ultrasound-guided biopsy of the thyroid nodule was realized. Immunohistochemistry was positive for CD56, chromogranin, and synaptophysin and negative for calcitonin, confirming neuroendocrine tumor intrathyroid metastasis. Lu-DOTATATE SPECT/CT showed therapeutic uptake on the thyroid metastasis.

Topics: Female; Humans; Intestinal Neoplasms; Middle Aged; Neuroendocrine Tumors; Octreotide; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Thyroid Neoplasms

Neuroendocrine tumors (NETs) of the thyroid gland are generally considered to be derived from parafollicular endocrine or C cells and are known as medullary thyroid carcinomas. Non-calcitonin-producing NETs of the thyroid are extremely rare in occurrence and pose a significant diagnostic dilemma for the physician and pathologist. We describe a case of a 58-year-old woman who was diagnosed as having primary NET thyroid with normal calcitonin levels and Ga DOTANOC PET-CT scan findings which were done for initial extent evaluation of the disease.

Topics: Calcitonin; Carcinoma, Neuroendocrine; Humans; Male; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Thyroid Neoplasms

Ectopic Cushing syndrome constitutes approximately 10% of all patients with Cushing syndrome. The clinical features of hypercortisolism result from elevated levels of adrenocorticotropic hormone produced by a tumor. The present case presented with clinical and biochemical parameters suggestive of Cushing syndrome with normal pituitary and adrenals on imaging. Ga-DOTANOC PET/CT done to localize an ectopic adrenocorticotropic hormone-producing tumor revealed metastatic medullary carcinoma of the thyroid as the culprit lesion.

Topics: Adrenocorticotropic Hormone; Carcinoma, Neuroendocrine; Cushing Syndrome; Humans; Male; Middle Aged; Neoplasm Metastasis; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Thyroid Neoplasms

Malignant melanoma is an aggressive tumor with poor prognosis that can have widespread metastases at presentation. Melanoma is known to undergo neuroendocrine differentiation. We report a case of a 60-year-old woman with malignant melanoma showing a metastatic lesion in the thyroid expressing somatostatin receptors as evident by Ga-DOTANOC PET/CT and metabolically active widespread subcutaneous metastases on F-FDG PET/CT imaging.

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

Somatostatin receptor (Sstr) scintigraphy with radiolabelled somatostatin analogues has been used extensively for the diagnosis and therapy of Sstr-expressing tumours. It has been shown that well-differentiated thyroid cancer (WDTC) cells have a high expression of Sstr2, Sstr3 and Sstr5. Hence, WDTC cells could be an ideal target for the evaluation of lesion uptake of Ga-68 DOTA-1-NaI3-octreotide (DOTA-NOC), which has a high affinity not only to Sstr2 but also to Sstr3 and Sstr5. The aim of the present study was to evaluate the value of Ga-68 DOTA-NOC as a target for Sstr2-expressing, Sstr3-expressing and Sstr5-expressing tumours in WDTC patients and to compare the results with those of Ga-68 DOTA-TATE in the same patient population.. Thirteen patients with WDTC were included in our study: nine with papillary thyroid cancer, three with Hurthle cell carcinoma and one with follicular thyroid carcinoma. All patients had elevated serum thyroglobulin levels and negative post-therapeutic I-131 whole-body scans, which were obtained after the last radioiodine treatment. All patients had undergone two consecutive PET imaging studies with Ga-68 DOTA-D-Phe1-Tyr3-octreotate (DOTA-TATE) and Ga-68 DOTA-NOC, respectively. All images were evaluated visually, and maximum standardized uptake values were calculated.. Both Ga-68 DOTA-TATE and Ga-68 DOTA-NOC PET images gave comparable results. Among the 13 patients, imaging with both Ga-68 DOTA-TATE and Ga-68 DOTA-NOC gave negative results in five (38%) patients and positive results in eight (62%) patients. A total of 45 lesions were identified on Ga-68 DOTA-TATE images and 42 on Ga-68 DOTA-NOC images; three lesions were missed. Lesion uptake was significantly higher on Ga-68 DOTA-TATE images. Maximum standardized uptake values of Ga-68 DOTA-TATE and Ga-68 DOTA-NOC were 12.9±9.1 and 6.3±4.1 (n=54, P<0.001), respectively.. Our study suggested that Ga-68 DOTA-TATE has a higher lesion uptake even in WDTC patients and may have potential advantage over Ga-68 DOTA-NOC.

Topics: Adenocarcinoma, Follicular; Adenoma, Oxyphilic; Adult; Aged; Antineoplastic Agents, Hormonal; Carcinoma; Carcinoma, Papillary; Female; Gallium Radioisotopes; Humans; Male; Middle Aged; Octreotide; Organometallic Compounds; Positron-Emission Tomography; Radiopharmaceuticals; Thyroid Cancer, Papillary; Thyroid Neoplasms; Tomography, X-Ray Computed

To prospectively evaluate the role of Ga-labelled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-NaI-octreotide (Ga-DOTA-NOC) PET-CT in patients with recurrent medullary thyroid carcinoma (MTC) and compare the same with F-fluorodeoxyglucose (F-FDG) PET-CT.. Fifty-two consecutive patients with recurrent MTC based on raised serum calcitonin levels underwent Ga-DOTA-NOC PET-CT. In addition, 41 patients also underwent F-FDG PET-CT. PET-CT images were evaluated by two experienced nuclear medicine physicians both qualitatively and quantitatively (standardized uptake value). Histopathology (when available), correlation with conventional imaging modalities (ultrasonography/CT/MRI) and subsequent clinical/imaging follow-up were used as reference standard. Serum calcitonin levels were correlated with findings of PET-CT.. Overall, Ga-DOTA-NOC PET-CT showed a sensitivity of 80.7% [95% confidence interval (CI) 67.4-90.3] and a positive predictive value of 100% (95% CI 91.5-100) for detecting recurrent MTC. When both were available (n=41), Ga-DOTA-NOC PET-CT proved superior to F-FDG PET-CT with a higher sensitivity (75.61 vs. 63.4%). However, the difference was statistically not significant (P=0.179). Ga-DOTA-NOC PET-CT was superior to F-FDG PET-CT for detecting recurrence in cervical lymph nodes (P<0.001). Both modalities were concordant in 75% of cases. No significant cut-off level of calcitonin could be derived for either Ga-DOTA-NOC or F-FDG PET-CT.. Both Ga-DOTA-NOC PET-CT and F-FDG PET-CT are able to localize disease recurrence in patients with MTC, and their role appears to be complementary for this purpose.

Topics: Adult; Aged; Carcinoma, Medullary; Female; Fluorodeoxyglucose F18; Humans; Lymph Nodes; Male; Middle Aged; Multimodal Imaging; Neck; Neoplasm Recurrence, Local; Organometallic Compounds; Positron-Emission Tomography; Prospective Studies; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Thyroid Neoplasms; Tomography, X-Ray Computed

A patient with a history of radical thyroidectomy for medullary thyroid carcinoma (MTC) was studied by 68Ga [DOTA,1-Nal3]octreotide PET/CT for suspected relapse. PET/CT documented a focal area of somatostatin receptors expression at bone level. Although 68Ga DOTA-peptides PET has been successfully used for the detection of neuroendocrine tumors, its role in MTC patients is still under evaluation. In fact, although deriving from the neural crest, MTC cells may show a variable expression of somatostatin receptors. This case shows that PET/CT with DOTANOC may be a useful complementary imaging modality in patients with well-differentiated MTC.

Topics: Bone Neoplasms; Carcinoma, Neuroendocrine; Female; Humans; Middle Aged; Multimodal Imaging; Organometallic Compounds; Positron-Emission Tomography; Recurrence; Thyroid Neoplasms; Tomography, X-Ray Computed