gallium-ga-68-dotatate and Liver-Neoplasms

Neuroendocrine tumors are increasingly diagnosed, either incidentally as part of screening processes, or for symptoms, which have commonly been mistaken for other disorders initially. The diagnostic workup to characterize tumor behaviour and prognosis focuses on histologic, anatomic, and functional imaging assessments. Several therapeutic options exist for patients ranging from curative and debulking surgery through to liver-directed therapies and systemic treatments. Multimodal therapies are often required over the patient's disease history. The management paradigm can be complex but should be focused on curative resections and then on controlling symptoms and limiting disease progression. There are several new systemic therapies that have completed phase 3 studies with new compounds being studied in phase 2. Genetic and epigenetic markers may lead to a new era of personalised therapy in the future.

Topics: Antineoplastic Agents; Antineoplastic Agents, Hormonal; Chromogranin A; Digestive System Surgical Procedures; Embolization, Therapeutic; Fluorodeoxyglucose F18; Gallium Radioisotopes; Gastrointestinal Neoplasms; Hepatic Artery; Humans; Hydroxyindoleacetic Acid; Liver Neoplasms; Magnetic Resonance Imaging; Malignant Carcinoid Syndrome; Metastasectomy; Neoplasm Staging; Neuroendocrine Tumors; Octreotide; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Receptors, Somatostatin; Serotonin; Tomography, X-Ray Computed

A falcine meningioma was diagnosed in a 66-year-old woman and was treated by surgery and 2 times by radiotherapy during 9 years of follow-up with the diagnosis of atypical meningioma. Three months after the last radiotherapy, incidental liver lesions were detected on chest CT realized for suspected pneumonia. In view of the predisposing factors for meningioma metastases, 68Ga-DOTATOC hepatic and cerebral PET/MRI was performed and completed by total body PET/CT demonstrating a somatostatin receptor 2 overexpression of the multiple liver lesions and several bone lesions. Biopsies from the liver and iliac bone confirmed the metastatic origin of meningioma.

Topics: Aged; Female; Humans; Liver Neoplasms; Meningeal Neoplasms; Meningioma; Octreotide; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals

We developed a new data-driven gated (DDG) positron emission tomography (PET)/computed tomography (CT) to improve the registration of CT and DDG PET.. We acquired 10 repeat PET/CT and 35 cine CT scans for the mitigation of misregistration between CT and PET data. We also derived end-expiration phase CT as DDG CT for attenuation correction of DDG PET. Radiation exposure, body mass index (BMI), scan coverage, and effective radiation dose were compared between repeat PET/CT and cine CT. Of the 35 cine CT patients, 14 (capturing 59 total tumors) were compared among average PET/CT (baseline PET attenuation correction by average CT), DDG PET (DDG PET attenuation correction by baseline CT), and DDG PET/CT (DDG PET attenuation correction by DDG CT) for registration and quantification without increasing the scan time for DDG PET.. Our new DDG PET/CT approach alleviates misregistration artifacts and, compared with DDG PET, improves quantification and registration. The use of cine CT in our DDG PET/CT method also reduces the effective radiation dose and scan coverage compared with repeat CT.

Topics: Artifacts; Body Mass Index; Data Science; Exhalation; Fluorodeoxyglucose F18; Gallium Radioisotopes; Humans; Liver Neoplasms; Lung Neoplasms; Organ Motion; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiation Exposure; Radiotherapy Dosage; Respiratory Mechanics; Time Factors; Tomography, X-Ray Computed

68Ga-DOTATATE PET is becoming a popular imaging technique for detecting neuroendocrine tumors (NETs). The sensitivity and specificity of 68Ga-DOTATATE PET compared to standard cross-sectional imaging with triple phase CT or MRI with Eovist has not been studied extensively.. 68Ga-DOTATATE PET scans ordered at our institution between 11/2017 and 7/2018 were reviewed. Patients with evidence of liver metastases were sorted and cross-sectional imaging results were reviewed. Specifically, the number of lesions detected by standard cross-sectional imaging versus 68Ga-DOTATATE PET was compared.. 32 patients with 68Ga-DOTATATE PET scans and a corresponding MRI or CT were identified. Primary tumors were pancreatic (43.8%), small bowel (25%), hepatic (9.4%), gastric (6.3%), appendiceal (3.1%), and not localized (12.5%). 26/32 (81%) patients had CT scans and 17/32 (53%) had MRI scans. 25/32 (78%) patients had at least equal or increased number of lesions identified on 68Ga-DOTATATE PET when compared with CT or MRI. 7/32 (21.9%) had fewer lesions on 68Ga-DOTATATE PET compared to CT or MRI. However, 3 of these cases had numerous liver lesions. The overall sensitivity and specificity of 68Ga-DOTATATE PET are 92.9% and 75% respectively.. 68Ga-DOTATATE PET appears to have superior sensitivity in detecting metastatic NET to the liver. Further studies are needed to determine if it should be considered the test of choice for evaluating patients with metastatic NET to the liver. While standard cross-sectional imaging will be needed for surgical planning, 68Ga-DOTATATE PET will identify lesions that may not be seen on other imaging modalities.

Topics: Humans; Liver Neoplasms; Neuroendocrine Tumors; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography

A 69-year-old man with history of metastatic neuroendocrine tumor presented for initial staging with 68Ga-DOTATE PET/CT. 68Ga-DOTATATE PET/CT showed incidental focal increased DOTATATE uptake in the left apical prostate tissue, which was thought to be of benign etiology. Digital rectal examination later was consistent with a palpable nodule along with elevated prostate-specific antigen of 7.0 ng/mL. MRI of prostate demonstrated a 3.8-cm lesion followed by a targeted biopsy that revealed prostatic acinar adenocarcinoma. Chronic inflammatory cell infiltrates were also noted on biopsy, and this may have been the cause of increased DOTATATE uptake seen on 68Ga-DOTATATE PET/CT study.

Topics: Aged; Biological Transport; Biopsy; Carcinoma, Acinar Cell; Humans; Incidental Findings; Liver Neoplasms; Male; Neuroendocrine Tumors; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Prostate; Prostatic Neoplasms

We present image findings of 18F-FDG, 68Ga-FAPI, and 68Ga-DOTATATE PET/CT in a 35-year-old woman with multiple metastases of pancreatic neuroendocrine tumor. The images of PET/CTs using 3 different tracers all showed multiple foci of increased activities in the liver and pancreas body, in which 68Ga-FAPI PET/CT displayed the highest tumor-to-liver ratios. However, 68Ga-DOTATATE PET/CT detected more small metastatic lymph node and bone metastases, which were missed by both FDG and FAPI PET/CT.

Topics: Adult; Female; Fluorodeoxyglucose F18; Humans; Liver Neoplasms; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Quinolines

To assess the usefulness of a single-phase contrast-enhanced CT to differentiate subtypes of neuroendocrine tumour (NET) liver metastases and to evaluate the correlation between CT features and Ga-68 DOTATATE positron emission tomography/CT (PET/CT) findings.. Between December 2017 and April 2019 patients with liver metastases of neuroendocrine tumours who underwent CT and Ga-68 DOTATATE PET/CT were enrolled in the study. All patients involved in the study had undergone a standardised single-phase contrast-enhanced CT. Whole body PET/CT images were obtained with a combined PET/CT scanner. All CT images were retrospectively analysed by two radiologists. Enhancement patterns of lesions were assessed. For quantitative examination; CT attenuation values of metastatic lesions, liver parenchyma and aorta were measured using a freehand ROI and tumour-to-liver ratio [T-L = (Tumour-Liver) / Liver] and tumour-to-aorta ratio [T-A = (Tumour-Aorta) / Aorta] were calculated. The lesion with the highest Ga-68 DOTATATE uptake in the liver was used for calculations. The metabolic tumour volume (MTV), maximum standardised uptake value (SUV. A total of 137 NET liver metastases divided into in three groups: 49 (35.7%) pancreatic, 60 (44.5%) gastroenteric and 26 (18.9%) lung NET liver metastases were analysed. Gastroenteric NET metastases often showed heterogeneous enhancement which was significantly higher than in the pancreas and lung NET liver metastases (. We noticed statistically significant differences in both qualitative and quantitative CT features between histologic subgroups of neuroendocrine tumour liver metastases at a single phase contrast-enhanced CT.. Our study will be the first in the literature which extensively focus on assessing the CT features of liver metastases of NETs at a single phase CT and Ga-68DOTATATE PET/CT. As the different histological subtypes of NET liver metastases exhibit different clinical outcomes, these features might help to identify the primary tumour to provide optimal treatment.

Topics: Female; Gastrointestinal Neoplasms; Humans; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Neuroendocrine Tumors; Observer Variation; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Retrospective Studies; Whole Body Imaging

Topics: Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Neuroendocrine Tumors; Organometallic Compounds; Positron Emission Tomography Computed Tomography

Ga-DOTATATE is a radiolabeled somatostatin analog used for the detection and characterization of somatostatin receptor (SSR)-overexpressing tumors, particularly well-differentiated neuroendocrine tumors. We present a case of a 65-year-old man with well-differentiated pancreatic neuroendocrine tumor post-Whipple surgery and a new liver lesion on CT. Ga-DOTATATE PET/CT was performed for SSR characterization and restaging, which demonstrated the lesion to be intensely SSR positive and interpreted as a neuroendocrine metastasis. However, subsequent pathology proved the lesion to be a hepatocellular carcinoma. This case adds hepatocellular carcinoma as a potentially DOTATATE-avid malignancy to be considered in the differential diagnoses of SSR-positive liver lesions.

Topics: Aged; Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Male; Neoplasm Metastasis; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Receptors, Somatostatin

A 54-year-old man with mesenteric carcinoid tumor metastatic to the liver completed staging Ga-DOTATATE PET/CT demonstrating uptake in multiple hepatic lesions consistent with liver metastases with additional asymmetric increased uptake in the right greater than the left breast. Subsequent bilateral diagnostic mammogram revealed benign right greater than left gynecomastia without suspicious underlying mass. With Food and Drug Administration approval of Ga-DOTATATE and the increased use of this analog in neuroendocrine tumor imaging, this case illustrates a relevant example of uptake that can potentially mimic malignancy.

Topics: Diagnosis, Differential; Gynecomastia; Humans; Incidental Findings; Liver Neoplasms; Male; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Positron Emission Tomography Computed Tomography

Ga-DOTATATE imaging is commonly used for the detection of metastatic disease in neuroendocrine tumors. We present a case of a 69-year-old woman postsurgery for lung carcinoid tumor in which sequential follow-up Ga-DOTATATE PET/CT studies identified focal hepatic uptake that was presumed to represent a liver metastasis. However, correlative imaging with MRI revealed a focal fatty sparing of the liver composed of benign hepatic parenchyma at that area accompanied with diffuse liver steatosis in the background of the "pseudolesion." This report demonstrates a potential "false-positive" hepatic finding that can strikingly mimic a metastasis in neuroendocrine tumor imaging.

Topics: Aged; Biological Transport; False Positive Reactions; Fatty Liver; Female; Humans; Liver Neoplasms; Lung Neoplasms; Magnetic Resonance Imaging; Neuroendocrine Tumors; Organometallic Compounds; Positron Emission Tomography Computed Tomography

Ninety-two patients (44 men and 48 women, mean age of 59.5-year-old) with pathologically confirmed WD-NET (grades 1 or 2) were enrolled in a prospective expanded access protocol. Selected data was analyzed retrospectively for this project. Maximum standardized uptake value (SUV. Univariate analyses revealed significant difference of PFS for WHO tumor grade and ΣSRETV (P < 0.05), while there were no significant differences in age, sex, SUV

Topics: Adult; Aged; Aged, 80 and over; Disease Progression; Disease-Free Survival; Female; Humans; Image Processing, Computer-Assisted; Kaplan-Meier Estimate; Liver Neoplasms; Male; Middle Aged; Multivariate Analysis; Neoplasm Metastasis; Neuroendocrine Tumors; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Prognosis; Progression-Free Survival; Proportional Hazards Models; Prospective Studies; Receptors, Somatostatin; Retrospective Studies

Ga-DOTATATE, a positron-emitting somatostatin analog, has been approved by the Food and Drug Administration for imaging neuroendocrine tumors (NETs). The presence of a second primary malignancy is common in NETs; however, synchronous primary malignancy in the thyroid has rarely been reported. The value of Ga-DOTATATE in medullary thyroid cancer is being investigated and is currently recommended for use when treatment with somatostatin analogs is an option. We present a 55-year-old man with abdominal pain associated with well-differentiated NET liver metastases and incidental medullary thyroid carcinoma demonstrated on a Ga-DOTATATE PET/CT.

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

We present a case of metastatic meningioma detected on Ga-DOTA-octreotate PET. A 52-year-old woman presented with multiply recurrent multifocal meningioma. A staging Ga-DOTATATE PET/CT demonstrated focal radiotracer uptake within the known intracranial meningiomas. In addition, a DOTATATE-avid mass was found in the liver that was biopsied, confirming metastatic meningioma. This report suggests that Ga-DOTATATE PET/CT should be considered whenever screening meningioma patients for metastases.

Topics: Female; Humans; Liver Neoplasms; Meningeal Neoplasms; Meningioma; Middle Aged; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals

Primary neuroendocrine tumors of the liver are a diagnostic challenge. We present a rare case of primary hepatic neuroendocrine tumor in which Ga-DOTATATE PET/CT imaging played an important role in the diagnosis and follow-up.

Topics: Adolescent; Humans; Liver Neoplasms; Male; Neuroendocrine Tumors; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals

Gastro-entero-pancreatic neuroendocrine tumors (GEPNETs) are increasing in incidence, and accurate staging is important for selecting the appropriate treatment. (68)Ga-DOTATATE imaging is a promising approach for detecting GEPNETs and could help in selecting optimal therapeutic strategies. The aim of this study was to prospectively determine the clinical utility of (68)Ga-DOTATATE positron emission tomography (PET)/computed tomography (CT) in detecting unknown primary and metastatic GEPNETs.. One hundred thirty-one patients were enrolled in a prospective study of patients undergoing (68)Ga-DOTATATE PET/CT, (111)In-pentetreotide single-photon emission computed tomography (SPECT)/CT and multiphasic CT scan, and/or magnetic resonance imaging in a blinded fashion with comprehensive biochemical testing. The primary outcome measure was the detection of lesions by each imaging study.. (68)Ga-DOTATATE PET/CT imaging detected 95.1% of lesions (95% CI, 92.4% to 96.8%) with an average maximum standardized uptake value of 65.4 ± 47 (range, 6.9 to 244), anatomic imaging detected 45.3% of lesions (95% CI, 37.9% to 52.9%), and (111)In-pentetreotide SPECT/CT detected 30.9% of lesions (95% CI, 25.0% to 37.5%), with a significant difference between imaging modalities (P < .001). In four of 14 patients (28.6%), (68)Ga-DOTATATE PET/CT found a previously unknown primary tumor, and detected primary GEPNET, lymph node, and distant metastases correctly in 72 of 113 lesions (63.7%) when compared with histopathology, with 22.1% and 38.9% detected by using (111)In-pentetreotide SPECT/CT and anatomic imaging, respectively. On the basis of findings with (68)Ga-DOTATATE PET/CT, 43 of 131 patients (32.8%) had a change in management recommendation. In patients with carcinoid symptoms but negative biochemical testing, (68)Ga-DOTATATE PET/CT detected lesions in 65.2% of patients, 40% of which were detected neither by anatomic imaging nor by (111)In-pentetreotide SPECT/CT.. (68)Ga-DOTATATE PET/CT imaging provides important information for accurate staging of GEPNETs and selection of appropriate treatment interventions even in the absence of biochemical evidence of disease in symptomatic patients.

Topics: Adult; Aged; Aged, 80 and over; Chromogranin A; Female; Humans; Hydroxyindoleacetic Acid; Intestinal Neoplasms; Liver Neoplasms; Lymphatic Metastasis; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Neoplasms, Unknown Primary; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Pancreatic Polypeptide; Phosphopyruvate Hydratase; Positron-Emission Tomography; Prospective Studies; Somatostatin; Stomach Neoplasms; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Vasoactive Intestinal Peptide; Young Adult

A 72-year-old man was diagnosed with well-differentiated neuroendocrine tumor of unknown primary with liver metastasis. All liver lesions were detectable only on Ga-DOTATATE PET/CT and were negative on F-FDG PET/CT. Intrahepatic Y radioembolization therapy was planned, but the hepatopulmonary shunt fraction was found to be 31.6%. Because the hepatopulmonary shunt fraction greater than 20% is an absolute contraindication to radioembolization, we decided to give him Lu-DOTATATE therapy. He received 4 courses of Lu-DOTATATE and showed regression in posttherapy Ga-DOTATATE PET/CT imaging. The hepatopulmonary shunt fraction was reduced to 8% after Lu-DOTATATE therapy.

Topics: Aged; Fluorodeoxyglucose F18; Humans; Liver Neoplasms; Male; Neuroendocrine Tumors; Octreotide; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals

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

The objective of this study was to evaluate the correlation between dynamic gadoxetic acid-enhanced magnetic resonance imaging parameters and specific uptake values (SUVs) derived from ¹⁸fluorodeoxyglucose (¹⁸F-FDG) and ⁶⁸Ga-DOTA-Tyr(3)-octreotate (⁶⁸Ga-DOTATATE) positron emission tomography/computed tomography (PET/CT) in patients with liver metastases of neuroendocrine neoplasms.. A total of 42 patients with hepatic metastases of neuroendocrine neoplasms were prospectively enrolled and underwent both dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and PET/CT, using either ¹⁸F-FDG or ⁶⁸Ga-DOTATATE as tracer. The DCE-MRI was performed at 3 T with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid acquiring 48 slices every 2.2 seconds for 5 minutes. Three regions of interest (ROIs) representing the liver background and up to 3 ROIs representing metastatic liver tissue were coregistered in the PET/CT and in the DCE-MRI data sets. For each patient, a dedicated dual-inlet, 2-compartment uptake model was fitted to the enhancement curves of DCE-MRI ROIs and perfusion parameters were calculated. Lesion-to-background ratios of SUVs were correlated with corresponding lesion-to-background ratios of the perfusion parameters arterial plasma flow, venous plasma flow, total plasma flow, extracellular mean transit time, extracellular volume, arterial flow fraction, intracellular uptake rate, and hepatic uptake fraction using the Spearman coefficient.. Whereas the lesion-to-background ratios of arterial plasma flow and arterial flow fraction of liver metastases correlated negatively with the lesion-to-background ratios of SUV(mean) derived from ⁶⁸Ga-DOTATATE PET/CT (r = -0.54, P < 0.001; r = -0.39, P < 0.001, respectively), they correlated positively with the lesion-to-background ratios of SUV(mean) derived from ¹⁸F-FDG-PET/CT (r = 0.51, P < 0.05; r = 0.68, P < 0.01, respectively). The lesion-to-background ratios of the DCE-MRI parameters extracellular mean transit time and extracellular volume correlated very weakly with the lesion-to-background ratios of SUV(mean) from ⁶⁸Ga-DOTATATE PET/CT, whereas venous plasma flow, total plasma flow, hepatic uptake fraction, and intracellular uptake rate showed no correlation between DCE-MRI and PET/CT.. Both ⁶⁸Ga-DOTATATE and ¹⁸fluorodeoxyglucose PET/CT partially correlate with MRI perfusion parameters from the dual-inlet, 2-compartment uptake model. The results indicate that the paired imaging methods deliver complementary functional information.

Topics: Contrast Media; Coordination Complexes; Female; Fluorodeoxyglucose F18; Humans; Image Interpretation, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Neuroendocrine Tumors; Octreotide; Organometallic Compounds; Positron-Emission Tomography; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed

A 50-year-old male patient with a history of medullary thyroid cancer and extensive previous investigation including FDG PET 18 months earlier presented for a Ga-dotatate scan. A single area of abnormal uptake was identified in the right ninth rib. An MRI scan and bone scan confirmed the bony metastasis; however, the MRI of the liver demonstrated multiple liver metastases not apparent on the PET study. These remained occult despite coregistration of the MRI and PET data. The occult nature of these lesions may have been due to a similar degree of uptake in the liver and metastases.

Topics: Carcinoma, Neuroendocrine; Fluorodeoxyglucose F18; Humans; Liver Neoplasms; Male; Middle Aged; Organometallic Compounds; Positron-Emission Tomography; Thyroid Neoplasms

To evaluate the diagnostic accuracy of dynamic-contrast-enhanced (DCE) MRI in comparison to both (18)F-FDG- and (68)Ga-DOTATATE-PET/CT in patients with liver metastases of neuroendocrine neoplasms (NEN).. Thirty-two patients with hepatic metastases from NEN were examined both in DCE-MRI and positron emission tomography/computed tomography (PET/CT), using either (18)F-fluorodeoxyglucose ((18)F-FDG) or (68)Ga-DOTATATE as tracer. DCE-MRI was performed at 3 Tesla with Gd-EOB-DTPA acquiring 48 slices every 2.2 s for 5 min. Three regions of interest (ROIs) representing liver background and liver metastases were defined in fat-saturated T1w three-dimensional GRE MRI sequences in the hepatobiliary phase. Corresponding ROIs were then defined in the DCE-MRI- and in the PET/CT-dataset. Area under the curve (AUC) was calculated for the differentiation between metastases and liver background for DCE-MRI and PET-CT parameters.. AUC was very high for SUVmean (mean standardized uptake value) derived from (68)Ga-DOTATATE- (AUC = 0.966), and (18)F-FDG-PET/CT (AUC = 0.989). For DCE-MRI parameters, arterial flow fraction and intracellular uptake fraction showed the highest AUCs (AUC = 0.826, AUC = 0.819, respectively). The combination of those two had an AUC of 0.949. The combination of DCE-MRI and PET-CT parameters resulted in the highest AUC.. Both PET/CT parameters and DCE-MRI perfusion parameters show a high diagnostic accuracy in the distinction between liver metastases and liver tissue. Our data suggest that both modalities provide complementary information.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Female; Fluorodeoxyglucose F18; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Neuroendocrine Tumors; Organometallic Compounds; Positron-Emission Tomography; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed

Topics: Aged; Humans; Liver Neoplasms; Male; Organometallic Compounds; Radionuclide Imaging

Synchronous malignant neoplasms in a single patient are well documented in the literature. It is also recognized that there is increasing incidence of synchronous non-neuroendocrine neoplasm in patients with neuroendocrine tumor (NET). We present a case, of a patient with synchronous colorectal cancer and pancreatic NET, both cancers presenting with liver metastasis. By using 18F-FDG PET and 68Ga-DOTATATE PET imaging, we showed 2 different tumor types within the liver, which was subsequently confirmed on liver biopsy. This case report shows the utility of molecular imaging using different PET peptides. These newer modalities are useful in understanding the biology of the NET and in determining the best patient management.

Topics: Biopsy; Colorectal Neoplasms; Diagnosis, Differential; Fluorodeoxyglucose F18; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasms, Multiple Primary; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron-Emission Tomography

We report a 74-year-old male with liver metastases from a neuroendocrine tumor (NET) of unknown origin. Conventional imaging studies with ultrasound, computed tomography colonoscopy and Positron emission tomography-computed tomography (PET/CT) with 18Fluor odeoxyglucose did not identify the site of origin of the primary tumor. The patient was submitted for a PET/CT scan with a new radiopharmaceuticai, the somatostatin analogue 68Ga-DOTATATE. This new technique demonstrated increased focal uptake at the ileocecal valve. This lesion and other two liver metastases were surgically removed. The histopathology and immunohistochemistry analysis confirmed the diagnosis of NET (carcinoid). This case illustrates the advantages of the PET/CT scan with 68Ga-DOTATATE.

Topics: Aged; Humans; Ileal Neoplasms; Ileocecal Valve; Liver Neoplasms; Male; Neuroendocrine Tumors; Organometallic Compounds; Positron-Emission Tomography; Tomography, X-Ray Computed