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.
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.
(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.
(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.
ABSTRACTMetastatic paraganglioma treatment options are limited. Peptide receptor radionuclide therapy (PRRT) has been introduced as a novel management option for metastatic neuroendocrine tumors ...demonstrating safety, efficacy, and increased quality of life. We present two cases of marked progression of metastatic paraganglioma following initial partial response to PRRT. Given their positivity on 68Ga-DOTATATE PET/CT and 111In-octreotide SPECT, they underwent PRRT. Imaging following treatment revealed significant improvement in size and intensity, with some foci nearly completely resolved in one patient, and disease regression with a decrease in the number and size of bone and liver lesions in the second patient. Within months, repeat imaging in both patients revealed extensive metastatic disease with new lesions, which eventually lead to their deaths. The mechanism for rapid disease progression after partial response is not well understood, although it could be related to initially high Ki-67 levels or 18F-FDG PET/CT SUVmax values. However, naturally rapid disease progression despite PRRT response cannot be excluded. This finding warrants the importance of proper patient counseling along with early and accurate pre-PRRT assessment, taking into consideration the above potential risk factors for therapy response in order to personalize treatment regimens and achieve maximum patient benefit. CLINICALTRIALSGOV IDENTIFIERNCT00004847.
The study identifies the importance of positron emission tomographic (PET) and anatomic imaging modalities and their individual performances in detecting succinate dehydrogenase A (SDHA)-related ...metastatic pheochromocytoma and paraganglioma (PPGL). The detection rates of PET modalities—68Ga-DOTATATE, 18F-FDG, and 18F-FDOPA—along with the combination of computed tomography (CT) and magnetic resonance imaging (MRI) are compared in a cohort of 11 patients with metastatic PPGL in the setting of a germline SDHA mutation. The imaging detection performances were evaluated at three levels: overall lesions, anatomic regions, and a patient-by-patient basis. 68Ga-DOTATATE PET demonstrated a lesion-based detection rate of 88.6% 95% confidence interval (CI), 84.3–92.5%, while 18F-FDG, 18F-FDOPA, and CT/MRI showed detection rates of 82.9% (CI, 78.0–87.1%), 39.8% (CI, 30.2–50.2%), and 58.2% (CI, 52.0–64.1%), respectively. The study found that 68Ga-DOTATATE best detects lesions in a subset of patients with SDHA-related metastatic PPGL. However, 18F-FDG did detect more lesions in the liver, mediastinum, and abdomen/pelvis anatomic regions, showing the importance of a combined approach using both PET modalities in evaluating SDHA-related PPGL.
To compare the diagnostic performance of 68GaDOTATATE PET/CT, 18FFDG PET/CT, MRI of the spine, and whole-body CT and MRI for the detection of pheochromocytoma/paraganglioma (PPGL)-related spinal bone ...metastases.OBJECTIVETo compare the diagnostic performance of 68GaDOTATATE PET/CT, 18FFDG PET/CT, MRI of the spine, and whole-body CT and MRI for the detection of pheochromocytoma/paraganglioma (PPGL)-related spinal bone metastases.Between 2014 and 2020, PPGL participants with spinal bone metastases prospectively underwent 68GaDOTATATE PET/CT, 18FFDG PET/CT, MRI of the cervical-thoracolumbar spine (MRIspine), contrast-enhanced MRI of the neck and thoraco-abdominopelvic regions (MRIWB), and contrast-enhanced CT of the neck and thoraco-abdominopelvic regions (CTWB). Per-patient and per-lesion detection rates were calculated. Counting of spinal bone metastases was limited to a maximum of one lesion per vertebrae. A composite of all functional and anatomic imaging served as an imaging comparator. The McNemar test compared detection rates between the scans. Two-sided p values were reported.MATERIALS AND METHODSBetween 2014 and 2020, PPGL participants with spinal bone metastases prospectively underwent 68GaDOTATATE PET/CT, 18FFDG PET/CT, MRI of the cervical-thoracolumbar spine (MRIspine), contrast-enhanced MRI of the neck and thoraco-abdominopelvic regions (MRIWB), and contrast-enhanced CT of the neck and thoraco-abdominopelvic regions (CTWB). Per-patient and per-lesion detection rates were calculated. Counting of spinal bone metastases was limited to a maximum of one lesion per vertebrae. A composite of all functional and anatomic imaging served as an imaging comparator. The McNemar test compared detection rates between the scans. Two-sided p values were reported.Forty-three consecutive participants (mean age, 41.7 ± 15.7 years; females, 22) with MRIspine were included who also underwent 68GaDOTATATE PET/CT (n = 43), 18FFDG PET/CT (n = 43), MRIWB (n = 24), and CTWB (n = 33). Forty-one of 43 participants were positive for spinal bone metastases, with 382 lesions on the imaging comparator. 68GaDOTATATE PET/CT demonstrated a per-lesion detection rate of 377/382 (98.7%) which was superior compared to 18FFDG (72.0%, 275/382, p < 0.001), MRIspine (80.6%, 308/382, p < 0.001), MRIWB (55.3%, 136/246, p < 0.001), and CTWB (44.8%, 132/295, p < 0.001). The per-patient detection rate of 68GaDOTATATE PET/CT was 41/41 (100%) which was higher compared to 18FFDG PET/CT (90.2%, 37/41, p = 0.13), MRIspine (97.6%, 40/41, p = 1.00), MRIWB (95.7%, 22/23, p = 1.00), and CTWB (81.8%, 27/33, p = 0.03).RESULTSForty-three consecutive participants (mean age, 41.7 ± 15.7 years; females, 22) with MRIspine were included who also underwent 68GaDOTATATE PET/CT (n = 43), 18FFDG PET/CT (n = 43), MRIWB (n = 24), and CTWB (n = 33). Forty-one of 43 participants were positive for spinal bone metastases, with 382 lesions on the imaging comparator. 68GaDOTATATE PET/CT demonstrated a per-lesion detection rate of 377/382 (98.7%) which was superior compared to 18FFDG (72.0%, 275/382, p < 0.001), MRIspine (80.6%, 308/382, p < 0.001), MRIWB (55.3%, 136/246, p < 0.001), and CTWB (44.8%, 132/295, p < 0.001). The per-patient detection rate of 68GaDOTATATE PET/CT was 41/41 (100%) which was higher compared to 18FFDG PET/CT (90.2%, 37/41, p = 0.13), MRIspine (97.6%, 40/41, p = 1.00), MRIWB (95.7%, 22/23, p = 1.00), and CTWB (81.8%, 27/33, p = 0.03).68GaDOTATATE PET/CT should be the modality of choice in PPGL-related spinal bone metastases due to its superior detection rate.CONCLUSIONS68GaDOTATATE PET/CT should be the modality of choice in PPGL-related spinal bone metastases due to its superior detection rate.In a prospective study of 43 pheochromocytoma/paraganglioma participants with spinal bone metastases, 68GaDOTATATE PET/CT had a superior per-lesion detection rate of 98.7% (377/382), compared to 18FFDG PET/CT (p < 0.001), MRI of the spine (p < 0.001), whole-body CT (p < 0.001), and whole-body MRI (p < 0.001).CLINICAL RELEVANCE STATEMENTIn a prospective study of 43 pheochromocytoma/paraganglioma participants with spinal bone metastases, 68GaDOTATATE PET/CT had a superior per-lesion detection rate of 98.7% (377/382), compared to 18FFDG PET/CT (p < 0.001), MRI of the spine (p < 0.001), whole-body CT (p < 0.001), and whole-body MRI (p < 0.001).• Data regarding head-to-head comparison between functional and anatomic imaging modalities to detect spinal bone metastases in pheochromocytoma/paraganglioma are limited. • 68GaDOTATATE PET/CT had a superior per-lesion detection rate of 98.7% in the detection of spinal bone metastases associated with pheochromocytoma/paraganglioma compared to other imaging modalities: 18F-FDG PET/CT, MRI of the spine, whole-body CT, and whole-body MRI. • 68GaDOTATATE PET/CT should be the modality of choice in the evaluation of spinal bone metastases associated with pheochromocytoma/paraganglioma.KEY POINTS• Data regarding head-to-head comparison between functional and anatomic imaging modalities to detect spinal bone metastases in pheochromocytoma/paraganglioma are limited. • 68GaDOTATATE PET/CT had a superior per-lesion detection rate of 98.7% in the detection of spinal bone metastases associated with pheochromocytoma/paraganglioma compared to other imaging modalities: 18F-FDG PET/CT, MRI of the spine, whole-body CT, and whole-body MRI. • 68GaDOTATATE PET/CT should be the modality of choice in the evaluation of spinal bone metastases associated with pheochromocytoma/paraganglioma.
Context:The reliable localization of insulinoma is critical for the successful surgical treatment.Objective:This study compared the accuracy of 68Gallium (Ga)-DOTATATE PET/CT to anatomic imaging ...modalities, selective arterial secretagogue injection (SASI), and intraoperative ultrasound (IOUS) and palpation for localizing insulinoma in patients who were biochemically cured.Design, Setting, and Patients:We conducted a retrospective analysis of 31 patients who had an insulinoma confirmed on histology and were biochemically cured. The results of CT, MRI, transabdominal US, IOUS, 68Ga-DOTATATE PET/CT, SASI, and operative findings were analyzed.Intervention, Main Outcome Measures, Results:The insulinomas were correctly localized in 17 out of 31 (55%) of patients by CT, in 17 out of 28 (61%) by MRI, in 6 out of 28 (21%) by US, and in 9 out of 10 (90%) by 68Ga-DOTATATE. IOUS was performed in 31 patients, and 29 of them had an insulinoma successfully localized (93.5%). Thirty patients underwent SASI, and the insulinoma was regionalized in 28 out of 30 patients (93%). In 19 out of 23 patients (83%), manual palpation identified insulinoma. In patients who had all four noninvasive imaging studies, CT was concordant with 68Ga-DOTATATE in 6 out of 9 patients (67%); MRI in 8 out of 9 (78%); US in 0 out of 9; and in 1 out of 9 patients (11%) the lesion was only seen by 68Ga-DOTATATE.Conclusions:68Ga-DOTATATE PET/CT identifies most insulinomas and may be considered as an adjunct imaging study when all imaging studies are negative and when a minimally invasive surgical approach is planned.
Gallium-68 (Ga-68) DOTATATE is a radiolabeled peptide-imaging modality that targets the somatostatin receptor (SSTR), especially subtype 2 (SSTR2). Benign and malignant thyroid tumors have been ...observed to express SSTR. The aim of this study was to evaluate the frequency and clinical significance of incidental atypical thyroid uptake as detected by Ga-68 DOTATATE positron emission tomography/computed tomography (PET/CT).
A retrospective analysis was conducted of a prospective study in which 237 patients underwent Ga-68 DOTATATE PET/CT as part of a work-up for metastatic and unknown primary neuroendocrine tumors. The types of uptake in the thyroid gland (focal/diffuse) and maximum standardized uptake value (SUVmax) levels were evaluated and compared with the background uptake in the liver and salivary glands.
Of 237 patients, 26 (11%) had atypical thyroid uptake as detected by Ga-68 DOTATATE PET/CT. There were no significant clinical or biochemical variables associated with atypical thyroid uptake. Fourteen (54%) patients had positive focal uptake, and 12 (46%) patients had diffuse uptake. Of the 14 patients with atypical focal uptake, 10 (71%) had thyroid nodules on the corresponding side, as detected by anatomic imaging. Three of 10 patients (21%) were found to have papillary thyroid cancer, and seven (70%) had adenomatoid nodules. Of the 12 patients with diffuse increased uptake, six (50%) had a history of hypothyroidism, five (42%) had chronic lymphocytic thyroiditis, and one (8%) had nontoxic multinodular goiter.
Patients with an incidental focal abnormal thyroid uptake on Ga-68 DOTATATE PET/CT scan should have further clinical evaluation to exclude a diagnosis of thyroid cancer.
Context:
Phosphaturic mesenchymal tumors (PMTs) are small, typically difficult to localize, and express somatostatin receptors. Recent work suggests imaging studies using 68Gallium (68Ga)-conjugated ...somatostatin peptide analogues, such as 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)TATE, which enables somatostatin receptor imaging with positron emission tomography (PET), may be useful at identifying these tumors.
Objective:
Our objective was to evaluate the use of 68Ga-DOTATATE PET/computed tomography (CT) for tumor localization in tumor-induced osteomalacia (TIO).
Design:
This was a single-center prospective study of patients with TIO.
Setting:
The study was conducted at the National Institutes of Health Clinical Center between February 2014 and February 2015.
Subjects:
Eleven subjects (six females, five males) with TIO were included.
Intervention:
Subjects underwent 68Ga-DOTATATE PET/CT in addition to 111In-pentetreotide single-photon emission CT (Octreoscan- SPECT/CT) and fluorodeoxyglucose-PET/CT (18F FDG-PET/CT) scan.
Main Outcome Measures:
Localization of PMTs on the previously described imaging modalities were determined.
Results:
The tumor was successfully localized in 6/11 (54.5%) subjects (one was metastatic). The tumor was identified by 68Ga-DOTATATE in all six cases. Both Octreoscan-SPECT/CT and 18F FDG-PET each identified the tumor in 4/6. In no cases was 68Ga-DOTATATE the only imaging study to identify the tumor.
Conclusions:
In this first prospective study comparing 68Ga-DOTATATE PET/CT to Octreoscan-SPECT/CT and 18F FDG-PET in TIO localization, 68Ga-DOTATATE PET/CT demonstrated the greatest sensitivity and specificity, suggesting that it may be the best single study for localization of PMTs in TIO.
Tumor-induced osteomalacia is caused by FGF23-secreting tumors that are notoriously difficult to localize. In this first, prospective study of patients with TIO, we have found that 68Ga-DOTATATE as a single study is superior to Octreoscan or FDGPET/ CT.
To compare the diagnostic performance of
GaDOTATATE PET/CT,
FFDG PET/CT, MRI of the spine, and whole-body CT and MRI for the detection of pheochromocytoma/paraganglioma (PPGL)-related spinal bone ...metastases.
Between 2014 and 2020, PPGL participants with spinal bone metastases prospectively underwent
GaDOTATATE PET/CT,
FFDG PET/CT, MRI of the cervical-thoracolumbar spine (MRI
), contrast-enhanced MRI of the neck and thoraco-abdominopelvic regions (MRI
), and contrast-enhanced CT of the neck and thoraco-abdominopelvic regions (CT
). Per-patient and per-lesion detection rates were calculated. Counting of spinal bone metastases was limited to a maximum of one lesion per vertebrae. A composite of all functional and anatomic imaging served as an imaging comparator. The McNemar test compared detection rates between the scans. Two-sided p values were reported.
Forty-three consecutive participants (mean age, 41.7 ± 15.7 years; females, 22) with MRI
were included who also underwent
GaDOTATATE PET/CT (n = 43),
FFDG PET/CT (n = 43), MRI
(n = 24), and CT
(n = 33). Forty-one of 43 participants were positive for spinal bone metastases, with 382 lesions on the imaging comparator.
GaDOTATATE PET/CT demonstrated a per-lesion detection rate of 377/382 (98.7%) which was superior compared to
FFDG (72.0%, 275/382, p < 0.001), MRI
(80.6%, 308/382, p < 0.001), MRI
(55.3%, 136/246, p < 0.001), and CT
(44.8%, 132/295, p < 0.001). The per-patient detection rate of
GaDOTATATE PET/CT was 41/41 (100%) which was higher compared to
FFDG PET/CT (90.2%, 37/41, p = 0.13), MRI
(97.6%, 40/41, p = 1.00), MRI
(95.7%, 22/23, p = 1.00), and CT
(81.8%, 27/33, p = 0.03).
GaDOTATATE PET/CT should be the modality of choice in PPGL-related spinal bone metastases due to its superior detection rate.
In a prospective study of 43 pheochromocytoma/paraganglioma participants with spinal bone metastases,
GaDOTATATE PET/CT had a superior per-lesion detection rate of 98.7% (377/382), compared to
FFDG PET/CT (p < 0.001), MRI of the spine (p < 0.001), whole-body CT (p < 0.001), and whole-body MRI (p < 0.001).
• Data regarding head-to-head comparison between functional and anatomic imaging modalities to detect spinal bone metastases in pheochromocytoma/paraganglioma are limited. •
GaDOTATATE PET/CT had a superior per-lesion detection rate of 98.7% in the detection of spinal bone metastases associated with pheochromocytoma/paraganglioma compared to other imaging modalities:
F-FDG PET/CT, MRI of the spine, whole-body CT, and whole-body MRI. •
GaDOTATATE PET/CT should be the modality of choice in the evaluation of spinal bone metastases associated with pheochromocytoma/paraganglioma.
Background. Kaposi sarcoma herpesvirus (KSHV)-associated multicentric Castleman disease (MCD) is a lymphoproliferative inflammatory disorder commonly associated with human immunodeficiency virus ...(HIV). Its presentation may be difficult to distinguish from HIV and its complications, including lymphoma. Novel imaging strategies could address these problems. Methods. We prospectively characterized ¹⁸F-fluorodeoxyglucose positron emission tomography (PET) findings in 27 patients with KSHV-MCD. Patients were imaged with disease activity and at remission with scans evaluated blind to clinical status. Symptoms, C-reactive protein level, and HIV and KSHV loads were assessed in relation to imaging findings. Results. KSHV-MCD activity was associated with hypermetabolic symmetric lymphadenopathy (median maximal standardized uptake value SUVmax, 6.0; range, 2.0-8.0) and splenomegaly (3.4; 1.2-11.0), with increased metabolism also noted in the marrow (2.1; range, 1.0-3.5) and salivary glands (3.0; range, 2.0-6.0). The ¹⁸F-fluorodeoxyglucose PET abnormalities improved at remission, with significant SUVmax decreases in the lymph nodes (P = .004), spleen (P = .008), marrow (P = .004), and salivary glands (P = .004). Nodal SUVmax correlated with symptom severity (P = .005), C-reactive protein level (R = 0.62; P = .004), and KSHV load (R = 0.54; P = .02) but not HIV load (P = .52). Conclusions. KSHV-MCD activity is associated with ¹⁸F-FDG PET abnormalities of the lymph nodes, spleen, marrow, and salivary glands. These findings have clinical implications for the diagnosis and monitoring of KSHV-MCD and shed light on its pathobiologic mechanism.
PDF
