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. 2023 Oct 24:15:17588359231189133.
doi: 10.1177/17588359231189133. eCollection 2023.

Intra-individual qualitative and quantitative comparison of [68Ga]Ga-DOTATATE PET/CT and PET/MRI

Géraldine Lens  1 , Niloefar Ahmadi Bidakhvidi  2 , Vincent Vandecaveye  3 , Steven Grauwels  4 , Annouschka Laenen  5 , Wies Deckers  1 , Ronald Peeters  3 , Raphaëla C Dresen  3 , Jeroen Dekervel  6 , Chris Verslype  6 , Kristiaan Nackaerts  7 , Paul M Clement  8 , Eric Van Cutsem  6 , Michel Koole  9 , Karolien Goffin  2 , Koen Van Laere  2 , Christophe M Deroose  1   10
Affiliations

Intra-individual qualitative and quantitative comparison of [68Ga]Ga-DOTATATE PET/CT and PET/MRI

Géraldine Lens et al. Ther Adv Med Oncol. .

Abstract

Background: Somatostatin receptor (SSTR) positron emission tomography (PET) is a cornerstone of neuroendocrine tumor (NET) management. Hybrid PET/magnetic resonance imaging (MRI) is now available for NET-imaging, next to PET/computed tomography (CT).

Objectives: To determine whether CT or MRI is the best hybrid partner for [68Ga]Ga-DOTATATE PET.

Design: Monocentric, prospective study.

Methods: Patients received a same-day [68Ga]Ga-DOTATATE PET/CT and subsequent PET/MRI, for suspicion of NET, (re)staging or peptide receptor radionuclide therapy-selection. The union (PETunion) of malignant lesions detected on PETCT and PETMRI was the reference standard. Concordance of detection of malignant lesions in an organ was measured between PETunion and CT and PETunion and MRI. Seven bins were used to categorize the number of malignant lesions, containing following ordinal variables: 0, 1, 2-5, 6-10, 11-20, >20 countable and diffuse/uncountable. The difference in number of malignant lesions was obtained as the difference in bin level ('Δbin') between PETunion and CT and PETunion and MRI with a Δbin closer to zero implying a higher concordance rate.

Results: Twenty-nine patients were included. Primary tumors included 17 gastroenteropancreatic-NETs, 1 colon neuroendocrine carcinoma, 7 lung-NETs and 2 meningiomas. Patient level concordance with PETunion was 96% for MRI and 67% for CT (p = 0.039). Organ level concordance with PETunion was 74% for MRI and 40% for CT (p < 0.0001). In bone, there was a higher concordance rate for MRI compared to CT, 92% and 33%, respectively (p = 0.016). Overall, a mean Δbin of 0.5 ± 1.1 for PETunion/MRI and 1.4 ± 1.2 for PETunion/CT (p < 0.0001) was noted. In liver, a mean Δbin of 0.0 ± 1.1 for PETunion/MRI and 1.7 ± 1.2 for PETunion/CT was observed (p = 0.0078). In bone, a mean Δbin closer to zero was observed for PETunion/MRI compared to PETunion/CT, 0.6 ± 1.4 and 2.0 ± 1.5, respectively (p = 0.0098).

Conclusions: Compared to SSTR PET/CT, SSTR PET/MRI had a higher patient and organ level concordance for malignant tumoral involvement and number of malignant lesions, with a clear added value in bone and liver specifically.

Keywords: Krenning score; PET/CT; PET/MRI; SSTR; [68Ga]Ga-DOTATATE; neuroendocrine tumor.

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Conflict of interest statement

No conflicts of interest relevant to this work exist. CMD has been a consultant for Terumo, Ipsen, Sirtex, Bayer and PSI CRO. KVL has received speaker fees from GE Healthcare.

Figures

Figure 1.
Figure 1.
Qualitative organ level concordance. Malignant tumoral involvement on PETunion and concordance with CT and MRI are displayed per organ. ID, infradiaphragmatic; MRI, magnetic resonance imaging; PET: positron emission tomography; SD, supradiaphragmatic.
Figure 2.
Figure 2.
Hybrid image correlate of organs with malignant tumoral involvement on PETunion. Findings on CT and MRI in organs that showed malignant involvement on PETunion. MRI, magnetic resonance imaging; No., number of; PET: positron emission tomography.
Figure 3.
Figure 3.
Quantitative organ level concordance. The number of organs per bin level are displayed on PETunion and CT (a) or MRI (b). No., number of; PET, positron emission tomography.
Figure 4.
Figure 4.
Scatter plot of tracer uptake on PETCT and PETMRI. (a) Relationship between mean SUVmax of malignant tumoral lesions on PETMRI and PETCT, on a patient level. (b) Relationship between mean TBR of malignant tumoral lesions between PETMRI and PETCT, on a patient level. (c) Relationship between SUVmean of background regions bloodpool, lumbar spine and muscle between PETMRI and PETCT. (d) Relationship between SUVmean of background regions liver and spleen between PETMRI and PETCT. The dotted line on each graph represents the identity line. PET, positron emission tomography; SUV, standardized uptake values; TBR, tumor-to-background ratio.
See this image and copyright information in PMC

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