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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
[Theranostics and hybrid imaging for somatostatin receptor-expressing tumors]
Rudolf A Werner1, Frank M Bengel2, Thorsten Derlin2
1Klinik für Nuklearmedizin, Medizinische Hochschule Hannover (MHH), OE 8250, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland. werner.rudolf@mh-hannover.de.
Clinical/Methodical Issue:
Conventional imaging tests like computed tomography (CT) cannot visualize somatostatin receptor (SSTR) expression on the tumor cell surface.
Standard Radiological Methods:
For imaging of SSTR-expressing tumors conventional morphological imaging tests such as CT or magnetic resonance imaging (MRI) are employed.
Methodical Innovations:
Molecular imaging of SSTR expression on the tumor cell surface, in particular by using (whole body) single photon emission computed tomography (SPECT) and positron emission tomography (PET), are considered the current standard of care. Only the use of CT enables for exact localization of putative sites of disease (hybrid imaging).
Performance:
Hybrid SPECT/CT and PET/CT are of utmost importance for staging and monitoring of treatment efficacy. SSTR-PET is superior to SPECT and the PET radiotracer 68Ga-DOTATATE has been approved in multiple countries. In addition, SSTR positivity revealed by SPECT or PET pave the way for a peptide receptor radionuclide therapy (PRRT). Such a theranostic approach enables for systemic or locoregional radiation with β‑emitting radionuclides, which are linked to the identical amino acid peptide used for PET or SPECT imaging. The prospective, randomized Netter‑1 trial has shown significant benefit for patients receiving PRRT.
Achievements:
A combined use of conventional and functional imaging tests is superior to conventional imaging alone and allows for identification of suitable candidates for a theranostic approach.
Practical Recommendations:
In case of clinical suspicion or after having obtained histological evidence, hybrid SSTR-SPECT/CT or -PET/CT should be performed, preferably in a dedicated molecular imaging center.
Insights
Hybrid molecular imaging, such as somatostatin receptor (SSTR) PET/CT, is superior to conventional methods for identifying tumors and guiding theranostic approaches. This approach aids in staging and monitoring treatment efficacy for SSTR-expressing tumors.
Area of Science:
- Oncology
- Nuclear Medicine
- Radiology
Background:
- Conventional imaging (CT, MRI) cannot visualize somatostatin receptor (SSTR) expression on tumor cells.
- Molecular imaging, specifically SPECT and PET, is the standard for assessing SSTR expression.
- Hybrid imaging (SPECT/CT, PET/CT) combines functional and anatomical information for precise disease localization.
Purpose of the Study:
- To evaluate the efficacy of hybrid molecular imaging for SSTR-expressing tumors.
- To highlight the role of SSTR-PET/CT in patient selection for theranostic approaches.
- To emphasize the importance of hybrid imaging in staging and treatment monitoring.
Main Methods:
- Utilized hybrid SPECT/CT and PET/CT for molecular imaging of SSTR expression.
- Compared the diagnostic performance of conventional imaging versus hybrid imaging.
- Investigated the role of SSTR-PET/CT in identifying candidates for peptide receptor radionuclide therapy (PRRT).
Main Results:
- Combined conventional and functional imaging is superior to conventional imaging alone.
- Hybrid SSTR-PET/CT enables accurate identification of suitable candidates for theranostic treatment.
- SSTR-PET/CT facilitates staging and monitoring of treatment efficacy.
Conclusions:
- Hybrid SSTR-SPECT/CT or SSTR-PET/CT is recommended for patients with suspected or histologically confirmed SSTR-expressing tumors.
- Molecular imaging centers are preferred for performing these hybrid imaging procedures.
- This approach supports theranostic strategies, including PRRT, for improved patient outcomes.
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