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Somatostatin receptor PET/CT in restaging of typical and atypical lung carcinoids.

AbstractBACKGROUND:
To assess the role of somatostatin receptor (SR) PET/CT using Ga-68 DOTATOC or DOTATATE in staging and restaging of typical (TC) and atypical (AC) lung carcinoids.
METHODS:
Clinical and PET/CT data were retrospectively analyzed in 27 patients referred for staging (N = 5; TC, N = 4; AC, N = 1) or restaging (N = 22; TC, N = 8; AC, N = 14). Maximum standardized uptake value (SUVmax) of SR-positive lesions was normalized to the SUVmax of the liver to generate SUVratio; SR PET was compared to contrast-enhanced (ce) CT. The classification system proposed by Rindi et al. (Endocr Relat Cancer. 2014;21(1):1-16, 2014) was used for classification of patients in TC and AC groups.
RESULTS:
Only 18/27 patients were found to have metastases on PET/CT. Of the 186 lesions, 101 (54.3 %) were depicted on both PET and CT, 53 (28.5 %) lesions only on CT, and 32 (17.2 %) only on PET. SUVratio of lesions was significantly higher in AC as compared to TC (p < 0.001). In patients referred for restaging, additional findings on PET lead to upstaging with change in management strategy in 5/22 (22.7 %) patients (AC, N = 5; TC, N = 1). In four patients (all AC) referred for restaging and in one patient (TC) referred for staging, additional findings on CT missed on PET lead to correct staging.
CONCLUSIONS:
Typical and atypical carcinoid patients have complex patterns of metastases which make it necessary to combine functional SR PET and contrast-enhanced CT for appropriate restaging. In patients referred for restaging SR, PET may have a relevant impact on treatment strategy in up to 22.7 of patients with typical and atypical lung carcinoids.
AuthorsVikas Prasad, Ingo G Steffen, Marianne Pavel, Timm Denecke, Elisabeth Tischer, Konstantina Apostolopoulou, Andreas Pascher, Ruza Arsenic, Winfried Brenner
JournalEJNMMI research (EJNMMI Res) Vol. 5 Issue 1 Pg. 53 (Dec 2015) ISSN: 2191-219X [Electronic] Germany
PMID26458908 (Publication Type: Journal Article)

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