gallium-ga-68-dotatate and Carcinoid-Tumor

Recently, advancement of somatostatin receptor (SSTR) imaging and theragnostic approach using peptide receptor radionuclide therapy (PRRT) have changed the paradigm of diagnosis and management of neuroendocrine tumor. 68Ga-DOTATATE PET/CT can diagnose the lung carcinoids with high SSTR expression. With combination of 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT, tumor heterogeneity of lung carcinoid can be identified, which may guide optimal patient selection for PRRT. PRRT may be an effective and safe treatment of advanced lung carcinoids during progression with first-line somatostatin analog therapy. This review provides updates on the diagnosis and management of lung carcinoids, focusing on SSTR imaging and PRRT.

Topics: Carcinoid Tumor; Humans; Lung; Lung Neoplasms; Neuroendocrine Tumors; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radioisotopes; Receptors, Somatostatin

A 71-year-old man with history of prostate cancer is evaluated for rising prostate-specific antigen. The patient also has a history of rectal well-differentiated neuroendocrine tumor. On F-fluciclovine PET/CT, 2 retroperitoneal lymph nodes exhibited intense fluciclovine avidity, whereas one enlarged perirectal lymph node only showed background uptake. On further Ga-DOTATATE PET/CT, the perirectal lymph node revealed intense DOTATATE avidity, whereas the 2 retroperitoneal lymph nodes only with similar to background DOTATATE avidity. Biopsy of the perirectal lymph node confirmed metastasis from neuroendocrine tumor. The distinct imaging characteristics of metastases from different primary malignancies correlated with their underlying different pathology.

Topics: Adenocarcinoma; Aged; Carboxylic Acids; Carcinoid Tumor; Cyclobutanes; Humans; Intestinal Neoplasms; Male; Neoplasm Metastasis; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Rectal Neoplasms

Carcinoid is a subtype of neuroendocrine tumor, a rare group of tumors that are known to express somatostatin receptor 2. Ga-DOTATATE is a somatostatin analog that is specific for somatostatin receptor 2 and therefore allows visualization of neuroendocrine tumors. We present 2 cases of primary multifocal small bowel carcinoid evaluated using Ga-DOTATATE PET/CT, along with contrast-enhanced CT corollary findings. Given the increased sensitivity of Ga-DOTATATE PET/CT compared with CT and In-octreotide scintigraphy, we expect multifocal carcinoid to become increasingly recognized.

Topics: Aged; Carcinoid Tumor; Humans; Intestinal Neoplasms; Intestine, Small; Male; Middle Aged; Organometallic Compounds; Positron Emission Tomography Computed Tomography

Incidental findings on PET CT studies are common. The distribution of Ga-DOTATATE is dependent on cell surface expression of somatostatin receptors, which may be pathologic or physiologic. Osteoporosis circumscripta is the early lytic phase of Paget disease associated with well-defined osteopenia, most commonly seen within the skull on imaging. The appearance has been well demonstrated on Tc HDP/MDP bone scans. Here, we present the case of a 76-year-old man with a small bowel carcinoid tumor who underwent staging imaging with Ga-DOTATATE PET CT with the incidental finding of osteoporosis circumscripta.

Topics: Aged; Carcinoid Tumor; Humans; Incidental Findings; Intestinal Neoplasms; Male; Neoplasm Staging; Organometallic Compounds; Osteitis Deformans; Positron Emission Tomography Computed Tomography

Topics: Aged; Biopsy; Carcinoid Tumor; Diagnosis, Differential; Female; Humans; Hyperplasia; Lung; Lung Neoplasms; Multiple Pulmonary Nodules; Neuroendocrine Cells; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Receptors, Somatostatin

Ectopic adrenocorticotropic hormone (ACTH) secretion is a less common cause of Cushing syndrome and is seen in 5 to 10% of cases with endogenous hypercortisolemia. We hereby describe our experience of patients with ectopic ACTH syndrome, who have been managed over the past 10 years at a tertiary care center in Southern India.. The inpatient and outpatient records of patients from 2006 to 2015 were retrospectively reviewed. The clinical features, clinical history, biochemical values, imaging features, including radiologic findings and positron emission tomography scans, management, details of follow-up, and outcomes, were documented. We compared the biochemical findings in these patients with 20 consecutive patients with Cushing disease (Cushing syndrome of pituitary origin).. A total of 21 patients were studied. The median age at presentation was 34 years (range, 19 to 55 years). Seven patients had thymic carcinoid, 7 had bronchial carcinoid, 3 had lung malignancies, 2 had medullary carcinoma thyroid, 1 patient had a pancreatic neuroendocrine tumor, and 1 patient had an occult source of ACTH. The most common clinical features at presentation were muscle weakness (95%), hyperpigmentation (90%), facial puffiness (76%), easy bruising (61%), edema (57%), and striae (52%). Extensive acne was seen in a large number of patients (43%). Only 3 patients (14%) had central obesity. The median 8 am cortisol was 55.5 μg/dL (range, 3.8 to 131 μg/dL), median 8 am ACTH was 207 pg/mL (range, 31.1 to 703 pg/mL), and the median 24-hour urinary free cortisol was 2,484 μg (range, 248 to 25,438 μg). Basal cortisol and ACTH, as well as midnight cortisol and ACTH level, were markedly higher in patients with ectopic Cushing syndrome as compared to patients with Cushing disease. Twelve of 21 patients had developed life-threatening infections by follow-up. Nine patients had undergone surgical intervention to address the primary tumor. However, only 1 patient exhibited a complete cure on follow-up.. In our series, ectopic Cushing syndrome was most commonly seen in association with intrathoracic tumors such as bronchial or thymic carcinoid. Hyperpigmentation and proximal myopathy were frequent, while central obesity was uncommon. Early and rapid control of hypercortisolemia was important in order to prevent life-threatening infections and metabolic complications.. ACTH = adrenocorticotropic hormone CT = computed tomography DOTATATE =

Topics: Acne Vulgaris; ACTH Syndrome, Ectopic; Adult; Bronchial Neoplasms; Carcinoid Tumor; Carcinoma, Neuroendocrine; Cushing Syndrome; Edema; Female; Humans; Hydrocortisone; Hyperpigmentation; India; Lung Neoplasms; Male; Middle Aged; Muscle Weakness; Neoplasms; Neuroendocrine Tumors; Obesity, Abdominal; Organometallic Compounds; Pancreatic Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Retrospective Studies; Tertiary Care Centers; Thymus Neoplasms; Thyroid Neoplasms; Young Adult

Ga-DOTATATE PET/CT is increasingly used to image somatostatin receptor expressing tumors. Various intracranial tumors including medulloblastoma are known to express somatostatin receptors. We present a case of incidental cerebellar medulloblastoma on a staging Ga-DOTATATE PET/CT for appendiceal carcinoid.

Topics: Adult; Appendiceal Neoplasms; Carcinoid Tumor; Cerebellar Neoplasms; Female; Humans; Incidental Findings; Intestinal Neoplasms; Medulloblastoma; Organometallic Compounds; Positron Emission Tomography Computed Tomography

A 71-year-old woman with a history of surgically treated bronchial atypical carcinoid underwent Ga DOTATATE PET/CT for restaging. Somatostatin receptor PET/CT revealed a focal area of mild radiopharmaceutical uptake corresponding to a thickening of the right choroid. No other areas of abnormal tracer uptake were detected in the rest of the body. Based on these PET/CT findings, the patient underwent examination of fundus oculi, MRI, and fluoroangiography, which confirmed the presence of a choroidal lesion interpreted as solitary choroidal metastasis of neuroendocrine tumor. Subsequently, the patient was referred for brachytherapy with radical intent.

Topics: Aged; Carcinoid Tumor; Choroid; Eye Neoplasms; Female; Humans; Lung Neoplasms; Multimodal Imaging; Organometallic Compounds; Positron-Emission Tomography; Radiopharmaceuticals; Tomography, X-Ray Computed

The aims of this study were to retrospectively evaluate and compare the detection rate (DR) of 68Ga-DOTA-peptide and 18F-FDG PET/CT in the preoperative workup of patients with pulmonary carcinoid (PC) and to assess the utility of various functional indices obtained with the 2 tracers in predicting the histological characterization of PC, that is, typical versus atypical.. Thirty-three consecutive patients with confirmed PC referred for 18F-FDG and 68Ga-DOTA-peptide PET/CT in 2 centers between January 2009 and April 2013 were included. The semiquantitative evaluation included the SUV max, the SUV of the tumor relative to the maximal liver uptake for 18F-FDG (SUV T/L) or the maximal spleen uptake for 68Ga-DOTA-peptides (SUV T/S), the ratio between SUV max of 68Ga-DOTA-peptides PET/CT, and the SUV max of 18F-FDG PET/CT (SUV max ratio). Histology was used as reference standard.. Definitive diagnosis consisted of 23 typical carcinoids (TCs) and 10 atypical carcinoids. 18F-FDG PET/CT was positive in 18 cases and negative in 15 (55% DR). 68Ga-DOTA-peptide PET/CT was positive in 26 cases and negative in 7 (79% DR). In the subgroup analysis, 68Ga-DOTA-peptide PET/CT was superior in detecting TC (91% DR; P < 0.001), whereas 18F-FDG PET/CT was superior in detecting atypical carcinoid (100% DR; P = 0.04). The SUV max ratio was the most accurate semiquantitative index in identifying TC.. Overall diagnostic performance of PET/CT in detecting PC is optimal when integrating 18F-FDG and 68Ga-DOTA-peptide PET/CT findings. In the subgroup analysis, the SUV max ratio seems to be the most accurate index in predicting TC. Both methods should be performed when PC is suspected or when the histological subtype is undefined.

Topics: Adult; Aged; Aged, 80 and over; Carcinoid Tumor; Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Middle Aged; Multimodal Imaging; Octreotide; Organometallic Compounds; Positron-Emission Tomography; Retrospective Studies; Tomography, X-Ray Computed

⁶⁸Ga DOTATATE PET/CT is a well-established method in the diagnostic workup of neuroendocrine tumors. We report the case of a 15-year-old adolescent boy with histologically proven appendiceal carcinoid tumor referred for ⁶⁸Ga DOTATATE PET/CT to identify residual or metastatic disease. PET images showed increased tracer uptake in the body of T4 vertebra. This uptake could be misdiagnosed for bone metastasis, but CT characteristic appearance was in keeping with vertebral hemangioma. Both bone metastasis in carcinoid tumor and bone hemangiomas in adolescents are rare conditions, but the combined metabolic and morphological information on PET/CT can lead to the correct diagnosis.

Topics: Adolescent; Carcinoid Tumor; Hemangioma; Humans; Male; Multimodal Imaging; Neoplasm Metastasis; Neuroendocrine Tumors; Organometallic Compounds; Positron-Emission Tomography; Radiopharmaceuticals; Spinal Neoplasms; Tomography, X-Ray Computed

Topics: Carcinoid Tumor; Gallium Radioisotopes; Humans; Lung Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Octreotide; Organometallic Compounds; Positron-Emission Tomography; Radiopharmaceuticals

Topics: ACTH Syndrome, Ectopic; Aged; Carcinoid Tumor; Carcinoma, Bronchogenic; Drug Combinations; Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Organometallic Compounds; Pituitary ACTH Hypersecretion; Radionuclide Imaging

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