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Bone Metastases in Patients with Neuroendocrine Tumor: ⁶⁸Ga-DOTA-Tyr³-Octreotide PET in Comparison to CT and Bone Scintigraphy

¹ Department of Nuclear Medicine, Innsbruck Medical University, Innsbruck, Austria; and ² Department of Radiology, Innsbruck Medical University, Innsbruck, Austria

Correspondence: For correspondence or reprints contact: Daniel Putzer, Department of Nuclear Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. E-mail: daniel.putzer{at}i-med.ac.at

Somatostatin receptor scintigraphy is an accurate imaging modality for the diagnosis of neuroendocrine tumor. Because detection of distant metastases has a major impact on treatment, early diagnosis of metastatic spread is of great importance. So far, no standard procedure has become established for the early diagnosis of bone metastases from neuroendocrine tumor. We compared the diagnostic value of CT with that of the novel somatostatin analog ⁶⁸Ga-1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetic acid-D-Phe¹-Tyr³-octreotide (⁶⁸Ga-DOTATOC) in the detection of such metastases. Methods: Fifty-one patients (22 women and 29 men; age range, 32–87 y) with histologically verified neuroendocrine tumor were included in this study. PET scans were fused with CT scans using a vacuum fixation device. ¹⁸F-NaF or ^99mTc-dicarboxypropane diphosphonate bone scans or clinical follow-up served as the reference standard. Results: Twelve of the 51 patients had no evidence of bone metastases on any of the available imaging modalities, and 37 patients had ⁶⁸Ga-DOTATOC PET results true-positive for bone metastases. ⁶⁸Ga-DOTATOC PET results were true-negative for 12 patients, false-positive for one, and false-negative for another, resulting in a sensitivity of 97% and a specificity of 92%. ⁶⁸Ga-DOTATOC PET detected bone metastases at a significantly higher rate than did CT (P < 0.001). Furthermore, conventional bone scans confirmed the results of somatostatin receptor PET but did not reveal additional tumors in any patients. Conclusion: ⁶⁸Ga-DOTATOC PET is a reliable, novel method for the early detection of bone metastases in patients with neuroendocrine tumor. Our results show that CT and conventional bone scintigraphy are less accurate than ⁶⁸Ga-DOTATOC PET in the primary staging or restaging of neuroendocrine tumor.

Key Words: neuroendocrine tumors • somatostatin receptor scintigraphy • ⁶⁸Ga-DOTATOC • PET • bone metastases

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.

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