68Ga-DOTATATE PET/CT, 99mTc-HYNIC-octreotide SPECT/CT, and whole-body MR imaging in detection of neuroendocrine tumors: a prospective trial.

Abstract

UNLABELLED:

There are different metabolic imaging methods, various tracers, and emerging anatomic modalities to stage neuroendocrine tumor (NET). We aimed to compare NET lesion detectability among (99m)Tc-hydrazinonicotinamide (HYNIC)-octreotide (somatostatin receptor scintigraphy [SSRS]) SPECT/CT, (68)Ga-DOTATATE PET/CT, and whole-body diffusion-weighted MR imaging (WB DWI).

METHODS:

Nineteen consecutive patients (34-77 y old; mean, 54.3 ± 10.4 y old; 10 men and 9 women) underwent SSRS SPECT/CT, (68)Ga-DOTATATE PET/CT, and WB DWI. Images were acquired with a maximum interval of 3 mo between them and were analyzed with masking by separate teams. Planar whole-body imaging and SPECT/CT were performed from thorax to pelvis using a double-head 16-slice SPECT/CT scanner 4 h after injection of 111-185 MBq of (99m)Tc-HYNIC-octreotide. (68)Ga-DOTATATE PET/CT was performed from head to feet using a 16-slice PET/CT scanner 45 min after injection of 185 MBq of tracer. WB DWI was performed in the coronal plane using a 1.5-T scanner and a body coil. The standard method of reference for evaluation of image performance was undertaken: consensus among investigators at the end of the study, clinical and imaging follow-up, and biopsy of suggestive lesions.

RESULTS:

McNemar testing was applied to evaluate the detectability of lesions using (68)Ga-DOTATATE PET/CT in comparison to SSRS SPECT/CT and WB DWI: a significant difference in detectability was noted for pancreas (P = 0.0455 and P = 0.0455, respectively), gastrointestinal tract (P = 0.0455 and P = 0.0455), and bones (P = 0.0082 and P = 0.0082). Two unknown primary lesions were identified solely by (68)Ga-DOTATATE PET/CT. (68)Ga-DOTATATE PET/CT, SSRS SPECT/CT, and WB DWI demonstrated, respectively, sensitivities of 0.96, 0.60, and 0.72; specificities of 0.97, 0.99, and 1.00; positive predictive values of 0.94, 0.96, and 1.00; negative predictive values of 0.98, 0.83, and 0.88; and accuracies of 0.97, 0.86, and 0.91.

CONCLUSION:

(68)Ga PET/CT seems to be more sensitive for detection of well-differentiated NET lesions, especially for bone and unknown primary lesions. NET can be staged with (68)Ga-DOTATATE PET/CT. WB DWI is an efficient new method with high accuracy and without ionizing radiation exposure. SSRS SPECT/CT should be used only when (68)Ga-DOTATATE PET/CT and WB DWI are not available.

• Authors: Elba Cristina Sá de Camargo Etchebehere, Allan de Oliveira Santos, Brenda Gumz, Andreia Vicente, Paulo Ghem Hoff, Gustavo Corradi, Wilson André Ichiki, José Geraldo de Almeida Filho, Saulo Cantoni, Edwaldo Eduardo Camargo, Frederico Perego Costa
• Journal: Journal of nuclear medicine : official publication, Society of Nuclear Medicine (J Nucl Med) Vol. 55 Issue 10 Pg. 1598-604 (Oct 2014) ISSN: 1535-5667 [Electronic] United States
• PMID: 25168627 (Publication Type: Journal Article)
• Copyright: © 2014 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

Chemical References

• 6-hydrazinopyridine-3-carboxylic acid
• Hydrazines
• Nicotinic Acids
• Organometallic Compounds
• Technetium
• gallium Ga 68 dotatate
• Octreotide

Topics

• Adult
• Aged
• Algorithms
• Biopsy
• Female
• Humans
• Hydrazines
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Neuroendocrine Tumors (diagnostic imaging, pathology)
• Nicotinic Acids
• Octreotide
• Organometallic Compounds
• Positron-Emission Tomography (methods)
• Prospective Studies
• Technetium
• Tomography, Emission-Computed, Single-Photon (methods)
• Tomography, X-Ray Computed (methods)
• Whole Body Imaging (methods)