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Review
. 2022 Nov 18;11(22):6836.
doi: 10.3390/jcm11226836.

Nuclear Medicine and Radiological Imaging of Pancreatic Neuroendocrine Neoplasms: A Multidisciplinary Update

Daniela Prosperi  1 , Guido Gentiloni Silveri  1 , Francesco Panzuto  2 , Antongiulio Faggiano  3 , Vincenzo Marcello Russo  1 , Damiano Caruso  4 , Michela Polici  4 , Chiara Lauri  1 , Angelina Filice  5 , Andrea Laghi  4 , Alberto Signore  1
Affiliations
Review

Nuclear Medicine and Radiological Imaging of Pancreatic Neuroendocrine Neoplasms: A Multidisciplinary Update

Daniela Prosperi et al. J Clin Med. .

Abstract

Pancreatic neuroendocrine neoplasms (panNENs) are part of a large family of tumors arising from the neuroendocrine system. PanNENs show low-intermediate tumor grade and generally high somatostatin receptor (SSTR) expression. Therefore, panNENs benefit from functional imaging with 68Ga-somatostatin analogues (SSA) for diagnosis, staging, and treatment choice in parallel with morphological imaging. This narrative review aims to present conventional imaging techniques and new perspectives in the management of panNENs, providing the clinicians with useful insight for clinical practice. The 68Ga-SSA PET/CT is the most widely used in panNENs, not only fr diagnosis and staging purpose but also to characterize the biology of the tumor and its responsiveness to SSAs. On the contrary, the 18F-Fluordeoxiglucose (FDG) PET/CT is not employed systematically in all panNEN patients, being generally preferred in G2-G3, to predict aggressiveness and progression rate. The combination of 68Ga-SSA PET/CT and 18F-FDG PET/CT can finally suggest the best therapeutic strategy. Other radiopharmaceuticals are 68Ga-exendin-4 in case of insulinomas and 18F-dopamine (DOPA), which can be helpful in SSTR-negative tumors. New promising but still-under-investigation radiopharmaceuticals include radiolabeled SSTR antagonists and 18F-SSAs. Conventional imaging includes contrast enhanced CT and multiparametric MRI. There are now enriched by radiomics, a new non-invasive imaging approach, very promising to early predict tumor response or progression.

Keywords: 18F-DOPA; 18F-FDG; 68Ga-SSA; 68Ga-exendin-4; PET/CT; neuroendocrine; panNEN; pancreatic; radiomics.

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Conflict of interest statement

A.F. (Angelina Filice): received honoraria for speaker/advisory role from Novartis and Advanced Accelerator Applications; AAA received honoraria as a speaker at scientific events by AstraZeneca and Bayer. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
68Ga-DOTA-TOC PET/CT coronal images. The red arrows show a very common finding: a physiological diffuse uptake in the pancreatic head/uncinate process.
Figure 2
Figure 2
68Ga-DOTA-TOC PET/CT transaxial images. Low-dose CT: (a), PET: (b), image-fused PET/CT: (c), and maximum intensity projection (MIP) (d). The red arrows in images (b,c) show a focal uptake in the pancreatic tail while restaging patient for small bowel NET (G2, Ki67 3%). The morphological imaging was not decisive for the diagnosis. Cytology revealed accessory intrapancreatic spleen.
Figure 3
Figure 3
Combined imaging 68Ga-DOTA-SSAs-PET/CT and 18FDG-PET/CT in G2 small bowel NET showing heterogeneity of the tumor.
Figure 4
Figure 4
A 35-year-old female with atypical metastatic pancreatic neuroendocrine neoplasm of the tail, difficult to identify in contrast-enhanced CT due to the iso-enhancement in arterial ((A), arrow) and portal ((B), arrow) phase. It was detected by MRI by using diffusion-weighted images, showing hyperintensity on the DWI ((C), arrow) and low signal intensity on the ADC map ((D), arrow).
Figure 5
Figure 5
Graphical representation of radiomic workflow from liver segmentation, in panNEN with liver metastases, to build a predictive model.
See this image and copyright information in PMC

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