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A Practical Guide for the Production and PET/CT Imaging of 68Ga-DOTATATE for Neuroendocrine Tumors in Daily Clinical Practice
Published on: April 17, 2019
Results of (68)Gallium-DOTATATE PET/CT Scanning in Patients with Multiple Endocrine Neoplasia Type 1
Samira M Sadowski1, Corina Millo2, Candice Cottle-Delisle1
1Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Background:
Screening for neuroendocrine tumors (NETs) in patients with multiple endocrine neoplasia type 1 (MEN1) is recommended to detect primary and metastatic tumors, which can result in significant morbidity and mortality. The utility of somatostatin receptor imaging (68)Gallium-DOTATATE PET/CT in patients with MEN1 is not known. The aim of this study was to prospectively determine the accuracy of (68)Gallium-DOTATATE PET/CT vs (111)In- pentetreotide single-photon emission CT (SPECT)/CT and anatomic imaging in patients with MEN1.
Study Design:
We performed a prospective study comparing (68)Gallium-DOTATATE PET/CT, (111)In-pentetreotide SPECT/CT, and triphasic CT scan to clinical, biochemical, and pathologic data in 26 patients with MEN1.
Results:
(68)Gallium-DOTATATE PET/CT detected 107 lesions; (111)In-pentetreotide SPECT/CT detected 33 lesions; and CT scan detected 48 lesions. Lesions detected on (68)Gallium-DOTATATE PET/CT had high standard uptake value (SUV)(max) (median SUV(max) = 72.8 [range 19 to 191]). In 7 of the 26 patients (27%), (68)Gallium-DOTATATE PET/CT was positive, with a negative (111)In-pentetreotide SPECT/CT, and in 10 patients (38.5%), additional metastases were detected (range 0.3 cm to 1.5 cm). In 8 of the 26 patients (31%), there was a change in management recommendations as a result of the findings on (68)Gallium-DOTATATE PET/CT that were not seen on (111)In-pentetreotide SPECT/CT and CT scan.
Conclusions:
(68)Gallium-DOTATATE PET/CT is more sensitive for detecting NETs than (111)In-pentetreotide SPECT/CT and CT scan in patients with MEN1. This imaging technique should be integrated into radiologic screening and surveillance of patients with MEN1 because it can significantly alter management recommendations.
Insights
Gallium-DOTATATE PET/CT is a more sensitive imaging tool for detecting neuroendocrine tumors (NETs) in patients with multiple endocrine neoplasia type 1 (MEN1). This advanced imaging can alter management strategies for MEN1 patients.
Area of Science:
- Radiology
- Nuclear Medicine
- Oncology
Background:
- Screening for neuroendocrine tumors (NETs) is crucial in multiple endocrine neoplasia type 1 (MEN1) due to associated morbidity and mortality.
- The diagnostic utility of Gallium-DOTATATE PET/CT in MEN1 patients remains under investigation.
Purpose of the Study:
- To prospectively evaluate the accuracy of Gallium-DOTATATE PET/CT compared to Indium-pentetreotide SPECT/CT and CT scan for NET detection in MEN1.
- To assess the impact of Gallium-DOTATATE PET/CT on clinical management decisions in MEN1 patients.
Main Methods:
- A prospective study involving 26 MEN1 patients.
- Comparison of Gallium-DOTATATE PET/CT, Indium-pentetreotide SPECT/CT, and triphasic CT scan against clinical, biochemical, and pathological data.
Main Results:
- Gallium-DOTATATE PET/CT detected significantly more lesions (107) compared to Indium-pentetreotide SPECT/CT (33) and CT scan (48).
- In 27% of patients, Gallium-DOTATATE PET/CT was positive while Indium-pentetreotide SPECT/CT was negative, revealing additional metastases in 38.5% of cases.
- Management recommendations changed in 31% of patients based on Gallium-DOTATATE PET/CT findings not visible on other imaging modalities.
Conclusions:
- Gallium-DOTATATE PET/CT demonstrates superior sensitivity for detecting NETs in MEN1 patients compared to Indium-pentetreotide SPECT/CT and CT scan.
- Integration of Gallium-DOTATATE PET/CT into radiologic screening and surveillance protocols for MEN1 is recommended due to its potential to significantly alter patient management.
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