gallium-ga-68-dotatate and Bone-Neoplasms

Although use of the term "theranostic" is relatively recent, the concept goes back to the earliest days of nuclear medicine, with the use of radioiodine for diagnosis and therapy of benign and malignant thyroid disease being arguably the most successful molecular radiotherapy in history. A diagnostic scan with

Topics: 3-Iodobenzylguanidine; Antigens, CD20; Bone Neoplasms; Dipeptides; Diphosphonates; Drug Approval; Forecasting; Heterocyclic Compounds, 1-Ring; Hodgkin Disease; Humans; Iodine Radioisotopes; Lutetium; Octreotide; Organometallic Compounds; Prostate-Specific Antigen; Radiopharmaceuticals; Somatostatin; Theranostic Nanomedicine; Thyroid Diseases

Choline (CH) positron emission tomography (PET)/computed tomography (CT) with fluorine 18 (F) CH is increasingly used not only to evaluate patients with biochemically recurrent prostate cancer but also to assess metastatic lesions that are difficult or impossible to identify using more conventional modalities. Our experience with CH PET/CT has shown that it can also be used for many other malignancies.. A 71-year-old male with a neuroendocrine tumor (NET) of unknown origin showed osteoblastic bone metastases positive to F-CH PET.. Diffuse bone and liver metastases were gallium-DOTATOC PET-positive with only mild uptake on FDG PET/CT. An increased prostate specific antigen (8 μg/L) gave rise to a suspicion of concurrent prostate cancer and the patient underwent F-CH PET/CT which showed diffuse uptake in the bone. A CT-guided bone biopsy confirmed osteoblastic bone metastases from NET.. Given the aggressiveness of the tumor, the patient underwent treatment with temozolomide from July 2015 to December 2015, maintaining stable disease. However, progression was documented in January 2016 and the patient was enrolled onto a phase II peptide receptor radionuclide therapy retreatment trial, which is currently ongoing.. Our study highlights that NETs should be taken into consideration in the differential diagnosis of osteoblastic bone metastases showing F-CH uptake. A prognostic role for this imaging technique can also be hypothesized.

Topics: Aged; Bone Neoplasms; Choline; Humans; Ilium; Male; Neuroendocrine Tumors; Organometallic Compounds; Positron Emission Tomography Computed Tomography

Persistent disease after surgery is common in medullary thyroid cancer (MTC), requiring lifelong radiological surveillance. Staging workup includes imaging of neck, chest, abdomen, and bones. A study integrating all sites would be ideal. Despite the established use of gallium-68 (68Ga) positron emission tomography (PET)/CT with somatostatin analogues in most neuroendocrine tumors, its efficacy is controversial in MTC.. Evaluate the efficacy of 68Ga PET/CT in detecting MTC lesions and evaluate tumor expression of somatostatin receptors (SSTRs) associated with 68Ga PET/CT findings.. Prospective study evaluating 30 patients with MTC [group 1 (n = 16), biochemical disease; group 2 (n = 14), metastatic disease]. Patients underwent 68Ga PET/CT, bone scan, CT and ultrasound of the neck, CT of the chest, CT/MRI of the abdomen, and MRI of the spine. 68Ga PET/CT findings were analyzed by disease site as positive or negative and as concordant or discordant with conventional studies. Sensitivity and specificity were calculated using pathological or cytological analysis or unequivocal identification by standard imaging studies. Immunohistochemical analysis of SSTRs was compared with 68Ga PET/CT findings.. In both groups, 68Ga PET/CT was inferior to currently used imaging studies except for bone scan. In group 2, 68Ga PET/CT sensitivities were 56%, 57%, and 9% for detecting neck lymph nodes, lung metastases, and liver metastases, respectively, and 100% for bone metastases, superior to the bone scan (44%). Expression of SSTRs, observed in 44% of tumors, was not associated with 68Ga-DOTATATE uptake.. 68Ga PET/CT does not provide optimal whole-body imaging as a single procedure in patients with MTC. However, it is highly sensitive in detecting bone lesions and could be a substitute for a bone scan and MRI.

Topics: Adult; Aged; Bone Neoplasms; Carcinoma, Neuroendocrine; Female; Gallium Radioisotopes; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Prospective Studies; Sensitivity and Specificity; Thyroid Neoplasms; Ultrasonography; Young Adult

The neuroendocrine small cell carcinoma of the cervix is a rare malignancy that has a poor prognosis due to early lymphatic and hematogenous spread. We herein report a case of a 27- year-old woman who was referred for initial staging of a neuroendocrine small cell carcinoma with previous unremarkable structural imaging. Ga-DOTATATE PET/CT revealed focal uptake at the primary tumor and in a solitary pelvic bone lesion suggestive of metastases that was further confirmed by CT-guided biopsy. Somatostatin receptor PET/CT may be a useful image modality for early detection of metastases to guide treatment in these patients.

Topics: Adult; Bone Neoplasms; Carcinoma, Neuroendocrine; Carcinoma, Small Cell; Female; Humans; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Uterine Cervical Neoplasms

Topics: Bone Neoplasms; Carcinoma, Neuroendocrine; Decision Making; Fluorides; Fluorine Radioisotopes; Humans; Neuroendocrine Tumors; Octreotide; Organometallic Compounds; Organophosphorus Compounds; Pain; Positron-Emission Tomography; Precision Medicine; Thyroid Neoplasms; Tomography, X-Ray Computed

To compare and outline the beneficial skills of combined (68)Ga-DOTATATE positron emission tomography (PET) with concurrent contrast enhanced X-ray computed tomography (ceCT) against stand-alone ceCT in 54 patients with neuroendocrine tumours (NET).. Patients with histologically confirmed NET and available follow-up of at least 6 months (median 12.6 months; range 6.1-23.2) were included. PET/CT and ceCT images were initially analyzed separately by two blinded nuclear medicine physicians and two radiologists, respectively. In a second step all four physicians reviewed all detected lesions together reaching a consensus-grading for PET/ceCT. The results were then compared to the reference standard consisting of clinical follow-up data.. With regard to true positive lesions, PET/ceCT vs. stand alone ceCT detected 139 vs. 48 bone-lesions, 106 vs. 71 lymph node metastases and 26 vs. 26 pulmonary lesions. On a per-patient basis, PET/ceCT achieved a higher sensitivity (100% vs. 47%) and specificity (89% vs. 49%) for bone lesions than ceCT. For lymph nodes the effect was similar (sensitivity 92% vs. 64% and specificity 83% vs. 59%). For the detection of pulmonary lesions the sensitivity was identical (100%) while specificity of PET/ceCT was superior to ceCT-alone (95% vs. 82%).. In summary, the use of (68)Ga-DOTATATE PET/ceCT leads to an increase in sensitivity and specificity in the detection of extra-hepatic NET metastases compared to stand-alone ceCT. Therefore, (68)Ga-DOTATATE PET/ceCT should be the imaging modality of choice in patients with NET.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Contrast Media; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Multimodal Imaging; Neoplasm Grading; Neoplasm Staging; Neuroendocrine Tumors; Organometallic Compounds; Positron-Emission Tomography; Predictive Value of Tests; Reference Standards; Sensitivity and Specificity; Tomography, X-Ray Computed; Whole Body Imaging

A 17-year-old adolescent boy with biochemically raised 2-hour urinary metanephrine and normetanephrine as well as CT findings of retroperitoneal soft tissue mass and bony metastases was referred for further assessment. Apart from Ga DOTATATE PET/CT evaluation, pretargeted systemic radionuclide therapy assessment with I-MIBG scintigraphy showed unusual phenomenon of MIBG superscan. Postsurgically, restaging Tc-MDP bone scintigraphy showed typical bone superscan features. The MIBG superscan was better delineated on post-I-MIBG therapy images.

Topics: 3-Iodobenzylguanidine; Adolescent; Adrenal Gland Neoplasms; Bone Neoplasms; Humans; Male; Multimodal Imaging; Organometallic Compounds; Pheochromocytoma; Positron-Emission Tomography; Radiopharmaceuticals; Tomography, X-Ray Computed

Topics: Adult; Bone Neoplasms; Bronchial Neoplasms; Carcinoid Tumor; Diagnosis, Differential; False Positive Reactions; Female; Humans; Neoplasm Recurrence, Local; Organometallic Compounds; Positron-Emission Tomography; Pregnancy; Pregnancy Complications, Neoplastic; Radiopharmaceuticals; Subtraction Technique; Tomography, X-Ray Computed