The [68Ga]Ga-DOTATATE and [18F]FDG PET-CT imaging characteristics of metastatic neuroendocrine tumors

Document Type : Original Article

Authors

1 Nuclear Medicine Department, Faculty of Medicine, Mersin University, Mersin, Turkey

2 Oncology Department, Faculty of Medicine, Mersin University, Mersin, Turkey

3 Pathology Department, Faculty of Medicine, Mersin University, Mersin, Turkey

Abstract

Introduction: The [68Ga]Ga-DOTA-conjugated somatostatin receptor imaging (SR) is becoming the standard imaging procedure in the management of the neuroendocrine tumors (NET). Meanwhile [18F]FDG PET-CT as an adjunctive tool provides useful information in the imaging of NETs. The aim of this study was to compare the diagnostic utility of these imaging methods as well as demonstrate uptake characteristics of NETs.
Methods: 41 patients (17 M, 21 F; mean: 57.1 years old) with the diagnosis of metastatic neuroendocrine tumors were included in the study. [18F]FDG PET-CT and/or [68Ga]Ga-DOTATATE PET-CT imaging was performed in patients for initial staging, restaging, treatment response evaluation, lesion characterization or to find an unknown primary tumor. The results of the patients were compared with oncologic follow up results and/or pathology results.
Results: The size of the lesions were mean: 34 mm and the standardized uptake value in [18F]FDG PET/CT SUVmax(F) and SUV in [68Ga]Ga-DOTATATE PET/CT SUVmax(G) of the lesions were mean: 10.6 and 32.4 respectively. According to the follow up results of the 23 patients with available initial and follow up imaging studies; the management of seven patients were changed (30%). Among the NET group grade 1-3 tumors SUVmax(F) and SUVmax(G) levels were not significantly different.
Conclusion: Diagnostic workup of metastatic NET’s should include either or both of the [68Ga] DOTATATE and [18F]FDG PET-CT imaging studies. Individualization of the imaging method of choice in every single patient would be an appropriate approach.

Keywords

Main Subjects

References

  1. Chang CA, Pattison DA, Tothill RW, Kong G, Akhurst TJ, Hicks RJ, Hofman MS. (68)Ga-DOTATATE and (18)F-FDG PET/CT in Paraganglioma and Pheochromocytoma: utility, patterns and heterogeneity. Cancer Imaging. 2016 Aug 17;16(1):22.
  2. Abdulrezzak U, Kurt YK, Kula M, Tutus A. Combined imaging with 68Ga-DOTA-TATE and 18F-FDG PET/CT on the basis of volumetric parameters in neuroendocrine tumors. Nucl Med Commun. 2016 Aug;37(8): 874-81.
  3. Kayani I, Conry BG, Groves AM, Win T, Dickson J, Caplin M, Bomanji JB. A comparison of 68Ga-DOTATATE and 18F-FDG PET/CT in pulmonary neuroendocrine tumors. J Nucl Med, 2009 Dec;50(12):1927-32.
  4. Şimşek DH, Şanlı Y, Kuyumcu S, Başaran B, Mudun A. 68Ga-DOTATATE PET-CT imaging in carotid body paragangliomas. Ann Nucl Med. 2018 May;32(4):297-301.
  5. Decristoforo C, Knopp R, von Guggenberg E, Rupprich M, Dreger T, Hess A,  Virgolini I, Haubner R . A fully automated synthesis for the preparation of Ga-68 labelled peptides. Nucl Med Commun. 2007 Nov;28(11):870–5
  6. Brogsitter C, Zöphel K, Wunderlich G, Kämmerer E, Stein A, Kotzerke J. Comparison between F-18 fluorodeoxyglucose and Ga-68 DOTATOC in metastasized melanoma. Nucl Med Commun. 2013 Jan;34(1): 47-9.
  7. Desai K, Watkins J, Woodward N, Quigley AM, Toumpanakis C, Bomanji J, Caplin M. Use of molecular imaging to differentiate liver metastasis of colorectal cancer metastasis from neuroendocrine tumor origin. J Clin Gastroenterol. Jan 2011;45(1): e8-11.
  8. Goodwin JD. Carcinoid tumors: an analysis of 2837 cases. Cancer. 1975;36: 560–9.
  9. Kayani I, Bomanji JB, Groves A, Conway G, Gacinovic S, Win T, Dickson J, Caplin M, Ell PJ. Functional imaging of neuroendocrine tumors with combined PET/CT using 68Ga-DOTATATE (DOTA-DPhe1,Tyr3-octreotate) and 18F-FDG. Cancer. 2008 Jun;112(11):2447-55. 
  10. Subramaniam RM, Bradshaw ML, Lewis K, Pinho D, Shah C, Walker RC. ACR practice parameter for the performance of gallium-68 DOTATATE PET/CT for neuroendocrine tumors. Clin Nucl Med. Dec 2018;43(12): 899-908.
  11. Oh S, Prasad V, Lee DS, Baum RP. Effect of Peptide Receptor Radionuclide Therapy on Somatostatin Receptor Status and Glucose Metabolism in Neuroendocrine Tumors: Intraindividual Comparison of Ga-68 DOTANOC PET/CT and F-18 FDG PET/CT. Int J Mol Imaging. 2011;2011:524130.
  12. Adams S, Baum R, Rink T, Schumm-Dräger PM, Usadel KH, Hör G. Limited value of fluorine-18 fluorodeoxyglucose positron emission tomography for the imaging of neuroendocrine tumours. Eur J Nucl Med. 1998 Jan;25(1):79-83.
  13. Kowalski J, Henze M, Schuhmacher J, Maecke HR, Hofmann M, Haberkorn U. Evaluation of positron emission tomography imaging using [68Ga]-DOTA-DPhe1-Tyr3- octreotide in comparison to [111In]-DTPAOC SPECT: first results in patients with neuroendocine tumors. Mol Imaging Biol. Jan-Feb 2003;5(1):42–8.
  14. Naswa N, Sharma P, Gupta SK, Karunanithi S, Reddy RM, Patnecha M, Lata S, Kumar R, Malhotra A, Bal C.Dual tracer functional imaging of gastroenteropancreatic neuroendocrine tumors using 68Ga-DOTA-NOC PET-CT and 18F-FDG PET-CT: competitive or complimentary? Clin Nucl Med. Jan 2014;39(1): e27–e34.
  15. Koukouraki S, Strauss LG, Georgoulias V, Eisenhut M, Haberkorn U, Dimitrakopoulou-Strauss A. Comparison of the pharmacokinetics of 68Ga-DOTATOC and [18F]FDG in patients with metastatic neuroendocrine tumors scheduled for 90Y-DOTATOC therapy. Eur J Nucl Med Mol Imaging. 2006 Apr;33(4):1115–22.
  16. Panagiotidis E, Alshammari A, Michopoulou S, Skoura E, Naik K, Maragkoudakis E, Mohmaduvesh M, Al-Harbi M, Belda M, Caplin ME, Toumpanakis C, Bomanji J. Comparison of the impact of 68Ga-DOTATATE and 18F-FDG PET/CT on clinical management in patients with neuroendocrine tumors. J Nucl Med. Jan 2017;58(1):91-6.
  17. Sampathirao N, Basu S. MIB-1 index-stratified assessment of dual-tracer PET/CT with 68Ga-DOTATATE and 18F-FDG and multimodality anatomic imaging in metastatic neuroendocrine tumors of unknown primary in a PRRT workup setting. J Nucl Med Technol. 2017 Mar;45(1):34-41.
  18. You H, Kandathil A, Beg M, De Blanche L, Kazmi S, Subramaniam RM. Ga-68 DOTATATE PET/CT and F-18 FDG PET/CT in the evaluation of low and intermediate versus high-grade neuroendocrine tumors. Nucl Med Commun. 2020 Oct;41(10):1060-5.
  19. Sanli Y, Garg I, Kandathil A, Kendi T, Zanetti MJB, Kuyumcu S, Subramaniam RM () Neuroendocrine tumor diagnosis and management: 68Ga-DOTATATE PET/CT. Am J Roentgeno. 2018 Aug;211(2):227–67.
  20. Strosberg J, El-Haddad G, Wolin E, Hendifar A, Yao J, Chasen B, Mittra E, Kunz PL, Kulke MH, Jacene H, Bushnell D, O'Dorisio TM, Baum RP, Kulkarni HR, Caplin M, Lebtahi R, Hobday T, Delpassand E, Van Cutsem E, Benson A, Srirajaskanthan R, Pavel M, Mora J, Berlin J, Grande E, Reed N, Seregni E, Öberg K, Lopera Sierra M, Santoro P, Thevenet T, Erion JL, Ruszniewski P, Kwekkeboom D, Krenning E; NETTER-1 Trial Investigators. Phase 3 Trial of 177Lu-Dotatate for Midgut Neuroendocrine Tumors. N Engl J Med. 2017 Jan 12;376(2):125-35.
  21. Wild D, Bomanji JB, Benkert P, Maecke H, Ell PJ, Reubi JC, Caplin ME. Comparison of 68Ga-DOTANOC and 68Ga-DOTATATE PET/CT within patients with gastroenteropancreatic neuroendocrine tumors. J Nucl Med. 2013 Mar;54(3):364-72.
  22. Demirci E, Ocak M, Kabasakal L, Araman A, Ozsoy Y, Kanmaz B. Comparison of Ga-68 DOTA-TATE and Ga-68 DOTA-LAN PET/CT imaging in the same patient group with neuroendocrine tumours: preliminary results. Nucl Med Commun. 2013 Aug;34(8):727-32.

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