gallium-ga-68-dotatate and Lung-Neoplasms

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

F18 Flurodeoxyglucose (FDG) is a nonspecific PET tracer representing tumor energy metabolism, with common false-positive and false-negative findings in clinical practice. Non-small cell lung cancer is highly heterogeneous histologically, biologically, and molecularly. Novel PET tracers designed to characterize a specific aspect of tumor biology or a pathway-specific molecular target have the potential to provide noninvasive key information in tumor heterogeneity for patient stratification and in the assessment of treatment response. Non-FDG PET tracers, including

Topics: Carcinoma, Non-Small-Cell Lung; Fluorodeoxyglucose F18; Gallium Radioisotopes; Humans; Lung; Lung Neoplasms; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Somatostatin

Neuroendocrine tumors (NETs) are uncommon tumors with increasing incidence and prevalence. Current reports suggest that (68)Ga-DOTATATE PET/CT imaging improves diagnosis and staging of NETs compared with (111)In-DTPA-octreotide and conventional imaging. We performed a systematic review of (68)Ga-DOTATATE for safety and efficacy compared with octreotide and conventional imaging to determine whether available evidence supports U.S. Food and Drug Administration approval.. Medline, EMBASE, Web of Science, and Cochrane Reviews electronic databases were searched from January 1999 to September 2015. Results were restricted to human studies comparing diagnostic accuracy of (68)Ga-DOTATATE with octreotide or conventional imaging for pulmonary or gastroenteropancreatic NET and for human studies reporting safety/toxicity for (68)Ga-DOTATATE with 10 subjects or more thought to have NETs. Direct communication with corresponding authors was attempted to obtain missing information. Abstracts meeting eligibility criteria were collected by a research librarian and assembled for reviewers; 2 reviewers independently determined whether or not to include each abstract. If either reviewer chose inclusion, the abstract was accepted for review.. Database and bibliography searches yielded 2,479 articles, of which 42 were eligible. Three studies compared the 2 radiopharmaceuticals in the same patient, finding (68)Ga-DOTATATE to be more sensitive than octreotide. Nine studies compared (68)Ga-DOTATATE with conventional imaging. (68)Ga-DOTATATE estimated sensitivity, 90.9% (95% confidence interval, 81.4%-96.4%), and specificity, 90.6% (95% confidence interval, 77.8%-96.1%), were high. Five studies were retained for safety reporting only. Report of harm possibly related to (68)Ga-DOTATATE was rare (6 of 974), and no study reported major toxicity or safety issues.. No direct comparison of octreotide and (68)Ga-DOTATATE imaging for diagnosis and staging in an unbiased population of NETs has been published. Available information in the peer-reviewed literature regarding diagnostic efficacy and safety supports the use of (68)Ga-DOTATATE for imaging of NETs where it is available.

Topics: Humans; Intestinal Neoplasms; Lung Neoplasms; Neuroendocrine Tumors; Octreotide; Organometallic Compounds; Pancreatic Neoplasms; Pentetic Acid; Positron Emission Tomography Computed Tomography; Stomach Neoplasms

18F-FDG PET/CT is widely used to evaluate indeterminate pulmonary nodules (IPNs). False positive results occur, especially from active granulomatous nodules. A PET-based imaging agent with superior specificity to 18F-FDG for IPNs, is badly needed, especially in areas of endemic granulomatous nodules. Somatostatin receptors (SSTR) are expressed in many malignant cells including small cell and non-small cell lung cancers (NSCLCs). 68Ga-DOTATATE, a positron emitter labeled somatostatin analog, combined with PET/CT imaging, may improve the diagnosis of IPNs over 18F-FDG by reducing false positives. Our study purpose was to test this hypothesis in our region with high endemic granulomatous IPNs.. We prospectively performed 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT scans in the same 30 patients with newly diagnosed, treatment-naïve lung cancer (N = 14) or IPNs (N = 15) and one metastatic nodule. 68Ga-DOTATATE SUVmax levels at or above 1.5 were considered likely malignant. We analyzed the scan results, correlating with ultimate diagnosis via biopsy or 2-year chest CT follow-up. We also correlated 68Ga-DOTATATE uptake with immunohistochemical (IHC) staining for SSTR subtype 2A (SSTR2A) in pathological specimens.. We analyzed 31 lesions in 30 individuals, with 14 (45%) being non-neuroendocrine lung cancers and 1 (3%) being metastatic disease. McNemar's result comparing the two radiopharmaceuticals (p = 0.65) indicates that their accuracy of diagnosis in this indication are equivalent. 68Ga-DOTATATE was more specific (94% compared to 81%) and less sensitive 73% compared to 93%) than 18F-FDG. 68Ga-DOTATATE uptake correlated with SSTR2A expression in tumor stroma determined by immunohistochemical (IHC) staining in 5 of 9 (55%) NSCLCs.. 68Ga-DOTATATE and 18F-FDG PET/CT had equivalent accuracy in the diagnosis of non-neuroendocrine lung cancer and 68Ga-DOTATATE was more specific than 18F-FDG for the diagnosis of IPNs. IHC staining for SSTR2A receptor expression correlated with tumor stroma but not tumor cells.

Topics: Adult; Aged; Biopsy; Carcinoma, Non-Small-Cell Lung; Diagnosis, Differential; Female; Humans; Lung Neoplasms; Male; Middle Aged; Multimodal Imaging; Multiple Pulmonary Nodules; Neoplasm Metastasis; Organometallic Compounds; Positron Emission Tomography Computed Tomography

Measured human dosimetry of the (68)Ga-labeled synthetic somatostatin analog (68)Ga-DOTATATE has not been reported in the peer-reviewed literature. (68)Ga-DOTATATE is an investigational PET/CT imaging agent that binds with high affinity to somatostatin receptor subtype 2, found on many human cancers, most classically neuroendocrine tumors but also others. Reporting of measured dosimetry of (68)Ga-DOTATATE could be useful for investigations for diagnosis, staging, and restaging of somatostatin receptor-expressing tumors.. We performed measured dosimetry with (68)Ga-DOTATATE PET/CT scanning in 6 volunteer human subjects as part of an Institutional Review Board-approved biodistribution investigation of the use of this radiopharmaceutical for possible future use in the diagnosis of indeterminate lung nodules or lung cancer. Five subjects were imaged at 3 time points, and 1 subject was imaged at 2 time points. Dosimetry was then measured for the whole body and for specific organs.. There were no observed adverse events to the radiopharmaceutical in the immediate or delayed time frames, with a follow-up of 1 y. One patient had stage IV non-small cell lung cancer and remains alive but with disease progressing on treatment. For the other 5 patients, it was ultimately proven that they had benign nodules. The measured dosimetry shows that the critical organ with (68)Ga-DOTATATE is the spleen, followed by the uroepithelium of the bladder, the kidneys, and the liver, in that order. Organ-specific and whole-body dosimetries for (68)Ga-DOTATATE were similar to but often slightly greater than those for (68)Ga-DOTATOC or (68)Ga-DOTANOC but less than those for (111)In-diethylenetriaminepentaacetic acid-octreotide.. No toxicity was observed in our 6 patients, and no adverse events occurred. The measured human dosimetry of (68)Ga-DOTATATE is similar to that of other (68)Ga-labeled somatostatin receptor analogs.

Topics: Humans; Lung Neoplasms; Male; Organometallic Compounds; Radiometry

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

Leptomeningeal metastasis is the metastatic spread of the disease to leptomeninges from solid tumors such as breast, lung cancer, and melanoma. Cauda equine syndrome is a neurological condition caused by compression of the cauda equine. The incidence of large cell neuroendocrine carcinoma in resected lung cancers appears to be 2.1% and 3.5%. The incidence of clinically diagnosed leptomeningeal metastasis in patients with solid tumors is approximately 5%. Here, we present cauda equine syndrome caused by the metastasis of large cell neuroendocrine carcinoma detected by 18F-FDG PET/CT and also 68Ga-DOTATATE PET/CT.

Topics: Cauda Equina Syndrome; Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Meningeal Neoplasms; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Positron Emission Tomography Computed Tomography

Somatostatin analog functional imaging with gallium-68 (Ga-68) dotatate positron emission tomography/computed tomography (PET/CT) has demonstrated superiority in lesion detection in patients with neuroendocrine tumors (NETs). The clinical impact of this imaging modality on US surgical and medical oncology practices has not been established.. Consecutive patients with NET at our institution who received an initial Ga-68 dotatate PET/CT between July 2017 and September 2018 were included. Ga-68 dotatate PET/CT was compared with prior imaging.. Among 101 eligible patients, 51 of 50 were female/male, site of origin was gastroenteropancreatic (75%), unknown primary (13%), lung (8%), thymus (2%), and other (2%). All NETs were histologically well/moderately differentiated. Ga-68 dotatate imaging findings altered management in 36 (35.6%) patients: documentation of progression led to the initiation of systemic therapy in 14 patients, obviated the need for biopsy in four patients, and altered surgical plans in 7 of 14 (50%) patients referred for surgery. In 11 patients, decisions regarding peptide receptor radionucleotide therapy and somatostatin analogs were altered.. In this series, Ga-68 dotatate PET/CT altered diagnosis and management in one-third of patients and changed operative plans in half of the patients who were referred for surgical evaluation. These results support the routine use of this imaging in the care of patients with early-stage and advanced NETs.

Topics: Female; Gallium Radioisotopes; Humans; Intestinal Neoplasms; Lung Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasms, Unknown Primary; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Retrospective Studies; Stomach Neoplasms; Thymus Neoplasms

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

Records of patients who underwent. Performing

Topics: Clinical Decision-Making; Digestive System Neoplasms; Female; Gallium Radioisotopes; Humans; Lung Neoplasms; Male; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Prospective Studies; Thymus Neoplasms

This study was designed to compare the 18-Fluorodeoxyglucose positron emission tomography/computed tomography [(F)FDG PET/CT] and 1,4,7,10-tetraazacyclododecane-NI,NII,NIII,NIIII-tetraacetic acid (D)-Phe1-thy3-octreotate [(Ga)DOTATATE PET/CT) findings in patients with pulmonary carcinoid (PC) tumors.. A total of 20 patients [mean (SD) age: 52.2 (12.9) years, 60% women] with PC tumors and available records on digital images of (F)FDG PET/CT and (Ga)DOTATATE PET/CT and histopathological analysis were included in this retrospective single-center study. Patient characteristics, structural and functional imaging, and final histopathology were recorded in all patients. Typical and atypical PC tumors were compared in terms of patient age, tumor site, tumor size, and SUV max values obtained by (F)FDG PET/CT and (Ga)DOTATATE PET/CT imaging.. Overall, median (minimum-maximum) SUVmax values were 3.2 (1.2-11.2) in (F)FDG PET/CT and 17.2 (2.5-89.0) in (Ga)DOTATATE PET/CT. Atypical PC tumor was associated with significantly higher mean±SD age (64.6±5.4 vs. 45.5±10.5 years, P=0.036) and median (minimum-maximum) (F)FDG PET/CT SUVmax values [7.3 (4.8-11.2) vs. 2.4 (1.2-3.9), P=0.003], but with significantly lower median (minimum-maximum) (Ga)DOTATATE PET/CT SUVmax values [6.4 (2.5-10.6) vs. 23.7 (14.2-89), P<0.001], compared with typical PC tumor. (F)FDG PET/CT and (Ga)DOTATATE PET/CT SUVmax values were negatively correlated (r=-0.429, P=0.011).. Our findings in patients with histologically proven PC tumors showed higher SUV max values for (F)FDG PET/CT in atypical PC tumors and for (Ga)DOTATATE PET/CT in typical PC tumors. Our findings indicate the likelihood of higher detection rates particularly for typical PC tumors by (Ga)DOTATATE PET/CT imaging and the potential utility of the SUVmax ratio in predicting the histological subtype of PC tumors.

Topics: Adult; Aged; Biological Transport; Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Middle Aged; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Retrospective Studies

A 69-year-old man with recurrent multiple myeloma underwent FDG PET/CT evaluation. A pulmonary nodule without higher-than-background FDG avidity was later biopsied as a low-grade neuroendocrine tumor. On further Ga-DOTATATE PET/CT evaluation of patient's neuroendocrine tumor, the lytic myeloma lesions revealed only mild DOTATATE avidity while the primary pulmonary neuroendocrine tumor showed intense DOTATATE uptake. The distinct imaging characteristics of different primary malignancies correlated with their underlying different pathology.

Topics: Aged; Biopsy; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Multiple Myeloma; Neoplasm Grading; Neoplasms, Multiple Primary; 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

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

Carney triad is a very rare syndrome characterized by the synchronous or metachronous occurrence of gastrointestinal stromal tumors, pulmonary chondroma, and extra-adrenal paraganglioma. We present the case of a 36-year-old woman with complete Carney triad who underwent a Ga-DOTA-TATE PET/CT scan for restaging of metastasizing extra-adrenal paraganglioma and for evaluation of targeted radionuclide therapy potential. On the Ga-DOTA-TATE PET scan, increased tracer accumulation was observed in paraganglioma metastases. This case highlights the usefulness of Ga-DOTA-TATE PET/CT for restaging of metastasizing paraganglioma in Carney triad and the option of targeted radionuclide therapy in this entity.

Topics: Adult; Chondroma; Female; Gene Expression Regulation, Neoplastic; Humans; Leiomyosarcoma; Lung Neoplasms; Organometallic Compounds; Paraganglioma, Extra-Adrenal; Positron Emission Tomography Computed Tomography; Receptors, Somatostatin; Stomach Neoplasms

Pheochromocytomas/paragangliomas are somatostatin receptor 2-overexpressing tumors. Ga-DOTA-peptide imaging has recently shown excellent results in the detection of metastatic lesions in these tumors. However, currently used Ga-DOTA peptides show different somatostatin receptor affinities. Here, we report the remarkable differences in a patient who was imaged with Ga-DOTANOC and Ga-DOTATATE PET/CT within a 7-month period. The patient presented with a nearly negative Ga-DOTANOC PET/CT scan, whereas on Ga-DOTATATE PET/CT, multiple highly positive lesions were identified.

Topics: Abdominal Neoplasms; Child; Female; Humans; Lung Neoplasms; Neoplasm Metastasis; Organometallic Compounds; Paraganglioma; Positron Emission Tomography Computed Tomography; Protein Binding; Radiopharmaceuticals; Receptors, Somatostatin; Succinate Dehydrogenase

Our purpose was to evaluate the safety and efficacy of (68)Ga-DOTATATE PET/CT compared with (111)In-pentetreotide imaging for diagnosis, staging, and restaging of pulmonary and gastroenteropancreatic neuroendocrine tumors.. (68)Ga-DOTATATE PET/CT and (111)In-pentetreotide scans were obtained for 78 of 97 consecutively enrolled patients with known or suspected pulmonary or gastroenteropancreatic neuroendocrine tumors. Safety and toxicity were measured by comparing vital signs, serum chemistry values, or acquisition-related medical complications before and after (68)Ga-DOTATATE injection. Added value was determined by changes in treatment plan when (68)Ga-DOTATATE PET/CT results were added to all prior imaging, including (111)In-pentetreotide. Interobserver reproducibility of (68)Ga-DOTATATE PET/CT scan interpretation was measured between blinded and nonblinded interpreters.. (68)Ga-DOTATATE PET/CT and (111)In-pentetreotide scans were significantly different in impact on treatment (P < 0.001). (68)Ga-DOTATATE PET/CT combined with CT or liver MRI changed care in 28 of 78 (36%) patients. Interobserver agreement between blinded and nonblinded interpreters was high. No participant had a trial-related event requiring treatment. Mild, transient events were tachycardia in 1, alanine transaminase elevation in 1, and hyperglycemia in 2 participants. No clinically significant arrhythmias occurred. (68)Ga-DOTATATE PET/CT correctly identified 3 patients for peptide-receptor radiotherapy incorrectly classified by (111)In-pentetreotide.. (68)Ga-DOTATATE PET/CT was equivalent or superior to (111)In-pentetreotide imaging in all 78 patients. No adverse events requiring treatment were observed. (68)Ga-DOTATATE PET/CT changed treatment in 36% of participants. Given the lack of significant toxicity, lower radiation exposure, and improved accuracy compared with (111)In-pentetreotide, (68)Ga-DOTATATE imaging should be used instead of (111)In-pentetreotide imaging where available.

Topics: Female; Humans; Indium Radioisotopes; Intestinal Neoplasms; Lung Neoplasms; Male; Middle Aged; Neoplasm Staging; Neuroendocrine Tumors; Observer Variation; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Safety; Somatostatin; Stomach Neoplasms

Despite initial responsiveness to both chemotherapy and radiotherapy, small cell lung cancer (SCLC) commonly relapses within months. Although neuroendocrine characteristics may be difficult to demonstrate in individual cases, a relevant expression of somatostatin receptors (SSTR) on the cell surface has been described. We aimed to evaluate the prognostic value of SSTR-expression in advanced SCLC. We further examined pre-requisites for successful peptide receptor radionuclide therapy (PRRT). 21 patients with extensive stage SCLC were enrolled. All patients underwent positron emission tomography/computed tomography (PET/CT) with 68Ga-DOTATATE to select patients for SSTR-directed therapy. PET scans were visually and semi-quantitatively assessed and compared to SSTR2a and SSTR5 expression in biopsy samples. Peak standardized uptake values (SUVpeak) of tumors as well as tumor-to-liver ratios were correlated to progression-free (PFS) and overall survival (OS). In 4/21 patients all SCLC lesions were PET-positive. 6/21 subjects were rated "intermediate" with the majority of lesions positive, the remaining 11/21 patients were PET-negative. PET-positivity correlated well with histologic SSTR2a, but not with SSTR5 expression. Neither PET-positivity nor SUVpeak were predictors of PFS or OS. In 4 patients with intensive SSTR2a-receptor expression, PRRT was performed with one partial response and one stable disease, respectively. SSTR-expression as detected by 68Ga-DOTATATE-PET and/or histology is not predictive of PFS or OS in patients with advanced SCLC. However, in patients exhibiting sufficient tracer uptake, PRRT might be a treatment option given its low toxicity and the absence of effective alternatives.

Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Prognosis; Radiopharmaceuticals; Receptors, Somatostatin; Small Cell Lung Carcinoma

We present the FDG and Ga DOTATATE PET/CT findings of a 68-year-old woman with pulmonary metastases 28 years after her initial diagnosis of central nervous system hemangiopericytoma. The largest of the pulmonary lesions showed prominent Ga DOTATATE uptake with comparatively minimal FDG avidity. Hemangiopericytoma is a rare mesenchymal tumor that arises from malignant pericytes, cells that form the walls of capillaries and postcapillary venules. This case demonstrates the potential of radiolabeled somatostatin analogs as a therapeutic option in the setting of widespread metastatic disease.

Topics: Aged; Female; Hemangiopericytoma; Humans; Lung Neoplasms; Neuroendocrine Tumors; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals

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

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

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

Our purpose was to compare the performance of (68)Ga-1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetic acid-d-Phe(1),Tyr(3)-octreotate (DOTATATE), a novel selective somatostatin receptor 2 PET ligand, and (18)F-FDG in the detection of pulmonary neuroendocrine tumors using PET/CT, with correlation of uptake and tumor grade on histology.. The imaging findings of the first 18 consecutive patients (8 men and 10 women) with pulmonary neuroendocrine tumors (11 typical carcinoids, 2 atypical carcinoids, 1 large cell neuroendocrine tumor, 1 small cell neuroendocrine carcinoma, 1 non-small cell lung cancer with neuroendocrine differentiation, and 2 cases of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia) who underwent (68)Ga-DOTATATE and (18)F-FDG PET/CT were reviewed. In all cases, the diagnosis was established on histology.. Of 18 patients, 15 had primary tumors (median size, 2.7 cm; range, 0.5-8 cm) and 3 had recurrent tumors. All typical carcinoids showed high uptake of (68)Ga-DOTATATE (maximum standardized uptake value [SUV(max)] >or= 8.2), but 4 of 11 showed negative or minimal (18)F-FDG uptake (SUV(max) = 1.7-2.9). All tumors of higher grade showed high uptake of (18)F-FDG (SUV(max) >or= 11.7), but 3 of 5 showed only minimal accumulation of (68)Ga-DOTATATE (SUV(max) = 2.2-2.8). Neither case of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia showed uptake of (68)Ga-DOTATATE or (18)F-FDG. Typical carcinoids showed significantly higher uptake of (68)Ga-DOTATATE and significantly less uptake of (18)F-FDG than did tumors of higher grade (P = 0.002 and 0.005). There was no instance of false-positive uptake of (68)Ga-DOTATATE, but there were 3 sites of (18)F-FDG uptake secondary to inflammation. (68)Ga-DOTATATE was superior to (18)F-FDG in discriminating endobronchial tumor from distal collapsed lung (P = 0.02).. Typical bronchial carcinoids showed higher and more selective uptake of (68)Ga-DOTATATE than of (18)F-FDG. Atypical carcinoids and higher grades had less (68)Ga-DOTATATE avidity but were (18)F-FDG-avid.

Topics: Adult; Aged; Aged, 80 and over; Biological Transport; Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Positron-Emission Tomography; Receptors, Somatostatin; Retrospective Studies; Tomography, X-Ray Computed