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Updated: Jan 6, 2026
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
68Ga-DOTATATE PET/CT versus MRI in neuroendocrine liver metastases: a comprehensive per-lesion analysis
Alexander Herold1,2, Azadeh Hajati1, Yihan Cao1
1Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White Building, Room 270, Boston, MA, 02114, USA.
Purpose:
To evaluate the diagnostic performance of 68Ga-DOTATATE PET, contrast-enhanced CT, combined DOTATATE PET/CT, and MRI in detecting neuroendocrine liver metastases on a per-lesion basis and to assess the added value of diagnostic contrast-enhanced CT to PET interpretation as well as influence of lesion size.
Materials And Methods:
This retrospective study evaluated patients with histologically-confirmed gastroenteropancreatic neuroendocrine tumors who underwent both contrast-enhanced MRI and 68Ga-DOTATATE PET/CT within 12 weeks between August 2017 and December 2023. Three readers evaluated in consensus MRI, 68Ga-DOTATATE PET, contrast-enhanced CT, and combined PET/CT in separate sessions. Lesions were stratified by size. Diagnostic performance metrics were calculated using generalized estimating equations with reference standard of imaging follow-up or histopathology.
Results:
The study included 36 patients (mean age 66.4 ± 10.7 years, 55.6% male) with 720 lesions, of which 582 were metastases. MRI demonstrated superior performance (sensitivity 94.0%, specificity 94.2%) compared to all other modalities (all p < .001). Combined PET/CT showed superior sensitivity (68.1%) compared to PET alone (61.1%) (p < .001). The addition of diagnostic contrast-enhanced CT to PET interpretation identified 41 additional metastases. Size-stratified analysis revealed superior detection of subcentimeter lesions by MRI (sensitivity 83.3% for ≤ 5 mm, 99.6% for 6-10 mm) compared to PET/CT (34.8% and 78.6%, respectively; p < .001). For lesions > 10 mm, both MRI and PET/CT achieved 100% sensitivity, while PET alone reached 94.1% (p = .019).
Conclusion:
MRI outperforms 68Ga-DOTATATE PET/CT in detecting individual neuroendocrine liver metastases, particularly for subcentimeter lesions. While diagnostic CT improves PET performance, the combination of MRI with 68Ga-DOTATATE PET/CT provides the most comprehensive assessment.
