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Review
. 2014 Jan;29(1):2-12.
doi: 10.4103/0972-3919.125760.

PET/CT imaging of neuroendocrine tumors with (68)Gallium-labeled somatostatin analogues: An overview and single institutional experience from India

Punit Sharma  1 , Harmandeep Singh  1 , Chandrasekhar Bal  1 , Rakesh Kumar  1
Affiliations
Review

PET/CT imaging of neuroendocrine tumors with (68)Gallium-labeled somatostatin analogues: An overview and single institutional experience from India

Punit Sharma et al. Indian J Nucl Med. 2014 Jan.

Abstract

Neuroendocrine tumors (NETs) are rare neoplasms characterized by overexpression of somatostatin receptors (SSTRs). Functional imaging plays a crucial role in management of NETs. Recently, positron emission tomography/computed tomography (PET/CT) with (68)Gallium ((68)Ga)-labeled somatostatin analogues has shown excellent results for imaging of NETs and better results than conventional SSTR scintigraphy. In this review we have discussed the utility of (68)Ga-labeled somatostatin analogue PET/CT in NETs for various established and potential indications. In addition we have also shared our own experience from a tertiary care center in India.

Keywords: 68Gallium-labeled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-NaI3-octreotide; 68Gallium-labeled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-Phe1-Tyr3-Octreotide; 68Gallium-labeled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-Tyr3-Octreotate; Neuroendocrine tumor; PET/CT; somatostatin receptor.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Maximum intensity projection image of 68Gallium-labeled-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-NaI3-octreotide (68Ga-DOTANOC) positron emission tomography (PET) done in a 45-year-old male after resection of an ileal carcinoid reveals normal radiotracer distribution in pituitary gland, spleen, liver, bilateral adrenal glands, kidneys, ureters, and urinary bladder
Figure 2
Figure 2
A 60-year-old man, diagnosed case of duodenal carcinoid underwent 68Ga-DOTANOC PET/computed tomography (CT) for evaluation of suspected liver metastasis. Maximum intensity projection PET image (a) shows intense tracer uptake in right upper part of abdomen (bold arrow) and focal areas of tracer uptake in liver (arrow). Transaxial images show circumferential duodenal thickening (b and c, bold arrow) with increased tracer uptake. Also noted small foci of increased tracer uptake in liver in PET-CT (E, arrow), with no corresponding lesion on noncontrast CT (d), suspicious for metastasis. This liver lesion was confirmed to be metastatic on contrast CT
Figure 3
Figure 3
A 50-year-old male, operated case of gastrinoma of stomach, presented with recurrent abdominal pain and raised serum gastrin levels. CT findings were suspicious for recurrence in thickened gastric folds. 68Ga-DOTANOC PET/CT was done for restaging. Maximum intensity projection PET image (a) shows a focal area of increased radiotracer uptake in abdomen near midline (arrow), confirmed as positive portal lymph node on PET/CT (b-d, arrow). No abnormal radiotracer uptake was noted in region of stomach
Figure 4
Figure 4
A 35-year-old female presenting with recurrent pain abdomen and multiple hepatic space occupying lesions on ultrasound. Fine needle aspiration cytology from liver lesions demonstrated metastatic neuroendocrine tumor (NET). 68Ga-DOTANOC PET/CT was done to localize the primary. Maximum intensity projections PET image (a) showed multiple liver lesions (broken arrows) along with two discrete foci in abdomen (arrow and arrowhead). Axial CT (b) and PET/CT (c) images of the abdomen revealed focal tracer uptake in ileum with minimal wall thickening (arrow). Also noted are 68Ga-DOTANOC avid retroperitoneal lymph node metastasis (d, arrowhead) and multiple liver metastases (e, broken arrows). The ileal lesion was proven to be carcinoid at histopathology
Figure 5
Figure 5
A 31-year-old male with medullary carcinoma thyroid post total thyroidectomy, central neck dissection, and right side radical neck dissection. He presented with rising calcitonin level. 68Ga-DOTANOC PET/CT was done for restaging. Maximum intensity projection PET image (a) revealed presence of multiple focal areas of increased radiotracer uptake (arrows) in cervical and high mediastinal region, confirmed as SSTR positive cervical and high mediastinal lymph nodes on PET/CT (b, arrows). Resurgery confirmed the diagnosis. In addition, horseshoe kidney was incidentally detected on PET/CT
Figure 6
Figure 6
A 28-year-old male with uncontrolled hypertension and left adrenal mass. Urinary metanephrine was mildly elevated. He underwent 68Ga-DOTANOC PET/CT for characterization of the adrenal mass. MIP PET image (a) show intense tracer uptake in left suprarenal region (arrow). Transaxial CT (b) and PET/CT (c) images showed increased tracer uptake in the large left suprarenal mass with central necrosis (arrow) suggesting pheochromocytoma. Postoperative histopathology confirmed pheochromocytoma
Figure 7
Figure 7
A 35-year-old man, suspected case of MEN 2A syndrome, with known bilateral adrenal masses and cervical lymphadenopathy underwent 68Ga-DOTANOC PET/CT for characterization of the lesions. MIP PET (a) image shows intense tracer uptake in bilateral cervical (arrows) and adrenal regions (bold arrows). Transaxial CT (b) and PET/CT (c) images showed increased tracer uptake in the bilateral calcified thyroid masses (bold arrows). Also noted were bilateral adrenal masses with increased tracer uptake (d and e, arrows). The diagnosis of MEN 2A was confirmed on genetic analysis
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