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Published in: Abdominal Radiology 2/2015

01-02-2015

Evaluation of 68Ga-DOTANOC PET/CT imaging in a large exclusive population of pancreatic neuroendocrine tumors

Authors: Punit Sharma, Saurabh Arora, Varun Singh Dhull, Niraj Naswa, Rakesh Kumar, Ariachery C. Ammini, Chandrasekhar Bal

Published in: Abdominal Radiology | Issue 2/2015

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Abstract

Purpose

To evaluate the diagnostic accuracy of 68Ga-DOTANOC PET/CT imaging in a large exclusive population of pancreatic neuroendocrine tumors (NETs).

Methods

Data of 141 (mean age 46.2 ± 15.2 years) patients who underwent 178 68Ga-DOTANOC PET/CT studies for diagnosis/staging (n = 88) and restaging (n = 90) of pancreatic NET were retrospectively analyzed. PET/CT results were compared to conventional imaging (CIM) when available (n = 86). Histopathology and/or clinical/imaging follow-up (minimum 6 months) were used as reference standard.

Results

The overall sensitivity, specificity, and accuracy of 68Ga-DOTANOC PET/CT were 85.7%, 79.1%, and 84.8%. The corresponding values were 73%, 50%, and 70.4% for diagnosis/staging groups and 98.6%, 100%, and 98.8% for restaging groups. The accuracy was significantly higher for restaging as compared to diagnosis/staging (P < 0.0001) and in non-insulinoma tumors than insulinomas (P < 0.0001). The SUVmax of primary tumors was significantly higher than metastatic lesions overall (P = 0.001), as well as in diagnosis/staging (P = 0.041) and restaging (P = 0.0003) subgroups. When available, CIM was less specific than 68Ga-DOTANOC PET/CT (P < 0.001) and showed fewer lesions.

Conclusions

68Ga-DOTANOC PET/CT is useful for diagnosis/staging and restaging of patients with pancreatic NET. It demonstrates more lesions compared to CIM and is more specific.
Literature
1.
go back to reference Yao JC, Hassan M, Phan A, et al. (2008) One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 26:3063–3072PubMedCrossRef Yao JC, Hassan M, Phan A, et al. (2008) One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 26:3063–3072PubMedCrossRef
2.
go back to reference Oberg K, Eriksson B (2005) Endocrine tumours of the pancreas. Best Pract Res Clin Gastroenterol 19:753–781PubMedCrossRef Oberg K, Eriksson B (2005) Endocrine tumours of the pancreas. Best Pract Res Clin Gastroenterol 19:753–781PubMedCrossRef
3.
go back to reference Nissen NN, Kim AS, Yu R, et al. (2009) Pancreatic neuroendocrine tumors: presentation, management, and outcomes. Am Surg 75:1025–1029PubMed Nissen NN, Kim AS, Yu R, et al. (2009) Pancreatic neuroendocrine tumors: presentation, management, and outcomes. Am Surg 75:1025–1029PubMed
4.
go back to reference Kitajima K, Murakami K, Yamasaki E, et al. (2010) Performance of integrated FDG-PET/contrast-enhanced CT in the diagnosis of recurrent pancreatic cancer: comparison with integrated FDG-PET/non-contrast-enhanced CT and enhanced CT. Mol Imaging Biol 12:452–459PubMedCrossRef Kitajima K, Murakami K, Yamasaki E, et al. (2010) Performance of integrated FDG-PET/contrast-enhanced CT in the diagnosis of recurrent pancreatic cancer: comparison with integrated FDG-PET/non-contrast-enhanced CT and enhanced CT. Mol Imaging Biol 12:452–459PubMedCrossRef
5.
go back to reference Oda Y, Tanaka Y, Naruse T, Sasanabe R, Tsubamoto MFH (2002) Expression of somatostatin receptor and effects of somatostatin analog on pancreatic endocrine tumors. Surg Today 32:690–694PubMedCrossRef Oda Y, Tanaka Y, Naruse T, Sasanabe R, Tsubamoto MFH (2002) Expression of somatostatin receptor and effects of somatostatin analog on pancreatic endocrine tumors. Surg Today 32:690–694PubMedCrossRef
6.
go back to reference Buchmann I, Henze M, Engelbrecht S, et al. (2007) Comparison of 68Ga-DOTATOC PET and 111 In-DTPAOC (octreoscan) SPECT in patients with neuroendocrine tumours. Eur J Nucl Med Mol Imaging 34:1617–1626PubMedCrossRef Buchmann I, Henze M, Engelbrecht S, et al. (2007) Comparison of 68Ga-DOTATOC PET and 111 In-DTPAOC (octreoscan) SPECT in patients with neuroendocrine tumours. Eur J Nucl Med Mol Imaging 34:1617–1626PubMedCrossRef
7.
go back to reference Krausz Y, Rubinstein R, Appelbaum L, et al. (2012) Ga-68 DOTA-NOC uptake in the pancreas: pathological and physiological patterns. Clin Nucl Med 37:57–62PubMedCrossRef Krausz Y, Rubinstein R, Appelbaum L, et al. (2012) Ga-68 DOTA-NOC uptake in the pancreas: pathological and physiological patterns. Clin Nucl Med 37:57–62PubMedCrossRef
9.
go back to reference Zimmer T, Stölzel U, Bäder M, et al. (1996) Endoscopic ultrasonography and somatostatin receptor scintigraphy in the preoperative localisation of insulinomas and gastrinomas. Gut 39:562–568PubMedCentralPubMedCrossRef Zimmer T, Stölzel U, Bäder M, et al. (1996) Endoscopic ultrasonography and somatostatin receptor scintigraphy in the preoperative localisation of insulinomas and gastrinomas. Gut 39:562–568PubMedCentralPubMedCrossRef
10.
go back to reference Geijer H, Breimer LH (2013) Somatostatin receptor PET/CT in neuroendocrine tumours: update on systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 40:1770–1780PubMedCrossRef Geijer H, Breimer LH (2013) Somatostatin receptor PET/CT in neuroendocrine tumours: update on systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 40:1770–1780PubMedCrossRef
11.
go back to reference Kumar R, Sharma P, Garg P, et al. (2011) Role of (68)Ga-DOTATOC PET-CT in the diagnosis and staging of pancreatic neuroendocrine tumours. Eur Radiol 21:2408–2416PubMedCrossRef Kumar R, Sharma P, Garg P, et al. (2011) Role of (68)Ga-DOTATOC PET-CT in the diagnosis and staging of pancreatic neuroendocrine tumours. Eur Radiol 21:2408–2416PubMedCrossRef
12.
go back to reference Schmid-Tannwald C, Schmid-Tannwald CM, Morelli JN, et al. (2013) Comparison of abdominal MRI with diffusion-weighted imaging to 68Ga-DOTATATE PET/CT in detection of neuroendocrine tumors of the pancreas. Eur J Nucl Med Mol Imaging 40:897–907PubMedCrossRef Schmid-Tannwald C, Schmid-Tannwald CM, Morelli JN, et al. (2013) Comparison of abdominal MRI with diffusion-weighted imaging to 68Ga-DOTATATE PET/CT in detection of neuroendocrine tumors of the pancreas. Eur J Nucl Med Mol Imaging 40:897–907PubMedCrossRef
13.
go back to reference Zhernosekov KP, Filosofov DV, Baum RP, et al. (2007) Processing of generator-produced 68 Ga for medical application. J Nucl Med 48:1741–1748PubMedCrossRef Zhernosekov KP, Filosofov DV, Baum RP, et al. (2007) Processing of generator-produced 68 Ga for medical application. J Nucl Med 48:1741–1748PubMedCrossRef
14.
go back to reference Al-Ibraheem A, Bundschuh RA, Notni J, et al. (2011) Focal uptake of 68 Ga-DOTATOC in the pancreas: pathological or physiological correlate in patients with neuroendocrine tumours? Eur J Nucl Med Mol Imaging 38:2005–2013PubMedCrossRef Al-Ibraheem A, Bundschuh RA, Notni J, et al. (2011) Focal uptake of 68 Ga-DOTATOC in the pancreas: pathological or physiological correlate in patients with neuroendocrine tumours? Eur J Nucl Med Mol Imaging 38:2005–2013PubMedCrossRef
15.
go back to reference Naswa N, Sharma P, Kumar A, et al. (2011) Gallium-68-DOTA-NOC PET/CT of patients with gastroenteropancreatic neuroendocrine tumors: a prospective single-center study. AJR Am J Roentgenol 197:1221–1228PubMedCrossRef Naswa N, Sharma P, Kumar A, et al. (2011) Gallium-68-DOTA-NOC PET/CT of patients with gastroenteropancreatic neuroendocrine tumors: a prospective single-center study. AJR Am J Roentgenol 197:1221–1228PubMedCrossRef
16.
go back to reference Wild D, Christ E, Caplin ME, et al. (2011) Glucagon-like peptide-1 versus somatostatin receptor targeting reveals 2 distinct forms of malignant insulinomas. J Nucl Med 52:1073–1078PubMedCrossRef Wild D, Christ E, Caplin ME, et al. (2011) Glucagon-like peptide-1 versus somatostatin receptor targeting reveals 2 distinct forms of malignant insulinomas. J Nucl Med 52:1073–1078PubMedCrossRef
17.
go back to reference Kumar U, Sasi R, Suresh S, et al. (1999) Subtype-selective expression of the five somatostatin receptors (hSSTR1–5) in human pancreatic islet cells: a quantitative double-label immunohistochemical analysis. Diabetes 48:77–85PubMedCrossRef Kumar U, Sasi R, Suresh S, et al. (1999) Subtype-selective expression of the five somatostatin receptors (hSSTR1–5) in human pancreatic islet cells: a quantitative double-label immunohistochemical analysis. Diabetes 48:77–85PubMedCrossRef
18.
go back to reference Castellucci P, Pou Ucha J, Fuccio C, et al. (2011) Incidence of increased 68Ga-DOTANOC uptake in the pancreatic head in a large series of extrapancreatic NET patients studied with sequential PET/CT. J Nucl Med 52:886–890PubMedCrossRef Castellucci P, Pou Ucha J, Fuccio C, et al. (2011) Incidence of increased 68Ga-DOTANOC uptake in the pancreatic head in a large series of extrapancreatic NET patients studied with sequential PET/CT. J Nucl Med 52:886–890PubMedCrossRef
19.
go back to reference Taïeb D, Neumann H, Rubello D, et al. (2012) Modern nuclear imaging for paragangliomas: beyond SPECT. J Nucl Med 53:264–274PubMedCrossRef Taïeb D, Neumann H, Rubello D, et al. (2012) Modern nuclear imaging for paragangliomas: beyond SPECT. J Nucl Med 53:264–274PubMedCrossRef
20.
go back to reference Kayani I, Bomanji JB, Groves A, et al. (2008) Functional imaging of neuroendocrine tumors with combined PET/CT using 68Ga-DOTATATE (Dota-DPhe1, Tyr3-octreotate) and 18F-FDG. Cancer 112:2447–2455PubMedCrossRef Kayani I, Bomanji JB, Groves A, et al. (2008) Functional imaging of neuroendocrine tumors with combined PET/CT using 68Ga-DOTATATE (Dota-DPhe1, Tyr3-octreotate) and 18F-FDG. Cancer 112:2447–2455PubMedCrossRef
21.
go back to reference Naswa N, Sharma P, Gupta SK, et al. (2014) Dual tracer functional imaging of Gastroenteropancreatic Neuroendocrine tumours using 68 Ga-DOTANOC PET-CT and 18F-FDG PET-CT: competitive or Complimentary? Clin Nucl Med 39:e27–e34PubMedCrossRef Naswa N, Sharma P, Gupta SK, et al. (2014) Dual tracer functional imaging of Gastroenteropancreatic Neuroendocrine tumours using 68 Ga-DOTANOC PET-CT and 18F-FDG PET-CT: competitive or Complimentary? Clin Nucl Med 39:e27–e34PubMedCrossRef
22.
go back to reference Kaltsas GA, Besser GM, Grossman AB (2004) The diagnosis and medical management of advanced neuroendocrine tumors. Endocr Rev 25:458–511PubMedCrossRef Kaltsas GA, Besser GM, Grossman AB (2004) The diagnosis and medical management of advanced neuroendocrine tumors. Endocr Rev 25:458–511PubMedCrossRef
23.
go back to reference Gabriel M, Decristoforo C, Kendler D, et al. (2007) 68Ga-DOTA-Tyr3-octreotide PET in neuroendocrine tumors: comparison with somatostatin receptor scintigraphy and CT. J Nucl Med 48:508–518PubMedCrossRef Gabriel M, Decristoforo C, Kendler D, et al. (2007) 68Ga-DOTA-Tyr3-octreotide PET in neuroendocrine tumors: comparison with somatostatin receptor scintigraphy and CT. J Nucl Med 48:508–518PubMedCrossRef
24.
go back to reference Versari A, Camellini L, Carlinfante G, et al. (2010) Ga-68 DOTATOC PET, endoscopic ultrasonography, and multidetector CT in the diagnosis of duodenopancreatic neuroendocrine tumors: a single-centre retrospective study. Clin Nucl Med 35:321–328PubMedCrossRef Versari A, Camellini L, Carlinfante G, et al. (2010) Ga-68 DOTATOC PET, endoscopic ultrasonography, and multidetector CT in the diagnosis of duodenopancreatic neuroendocrine tumors: a single-centre retrospective study. Clin Nucl Med 35:321–328PubMedCrossRef
25.
go back to reference Baum RP, Kulkarni HR (2012) THERANOSTICS: from molecular imaging using Ga-68 labeled tracers and PET/CT to personalized radionuclide therapy—the Bad Berka Experience. Theranostics 2:437–447PubMedCentralPubMedCrossRef Baum RP, Kulkarni HR (2012) THERANOSTICS: from molecular imaging using Ga-68 labeled tracers and PET/CT to personalized radionuclide therapy—the Bad Berka Experience. Theranostics 2:437–447PubMedCentralPubMedCrossRef
26.
go back to reference Koopmans KP, Neels OC, Kema IP, et al. (2008) Improved staging of patients with carcinoid and islet cell tumors with 18F-dihydroxy-phenyl-alanine and 11C-5-hydroxy-tryptophan positron emission tomography. J Clin Oncol 26:1489–1495PubMedCrossRef Koopmans KP, Neels OC, Kema IP, et al. (2008) Improved staging of patients with carcinoid and islet cell tumors with 18F-dihydroxy-phenyl-alanine and 11C-5-hydroxy-tryptophan positron emission tomography. J Clin Oncol 26:1489–1495PubMedCrossRef
27.
go back to reference Haug A, Auernhammer CJ, Wängler B, et al. (2009) Intraindividual comparison of 68Ga-DOTA-TATE and 18F-DOPA PET in patients with well-differentiated metastatic neuroendocrine tumours. Eur J Nucl Med Mol Imaging 36:765–770PubMedCrossRef Haug A, Auernhammer CJ, Wängler B, et al. (2009) Intraindividual comparison of 68Ga-DOTA-TATE and 18F-DOPA PET in patients with well-differentiated metastatic neuroendocrine tumours. Eur J Nucl Med Mol Imaging 36:765–770PubMedCrossRef
28.
go back to reference Mayerhoefer ME, Ba-Ssalamah A, Weber M, et al. (2013) Gadoxetate-enhanced versus diffusion-weighted MRI for fused Ga-68-DOTANOC PET/MRI in patients with neuroendocrine tumours of the upper abdomen. Eur Radiol 23:1978–1985PubMedCrossRef Mayerhoefer ME, Ba-Ssalamah A, Weber M, et al. (2013) Gadoxetate-enhanced versus diffusion-weighted MRI for fused Ga-68-DOTANOC PET/MRI in patients with neuroendocrine tumours of the upper abdomen. Eur Radiol 23:1978–1985PubMedCrossRef
Metadata
Title
Evaluation of 68Ga-DOTANOC PET/CT imaging in a large exclusive population of pancreatic neuroendocrine tumors
Authors
Punit Sharma
Saurabh Arora
Varun Singh Dhull
Niraj Naswa
Rakesh Kumar
Ariachery C. Ammini
Chandrasekhar Bal
Publication date
01-02-2015
Publisher
Springer US
Published in
Abdominal Radiology / Issue 2/2015
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-014-0219-5

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