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⁶⁸Ga-DOTA-Tyr³-Octreotide PET in Neuroendocrine Tumors: Comparison with Somatostatin Receptor Scintigraphy and CT

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

View larger version (27K): [in this window] [in a new window]   FIGURE 1.  A 28-y-old female was referred for primary diagnosis of a NET because of elevated tumor markers in serum. PET (A) clearly depicted an abnormal focus in upper abdomen (arrow). This lesion could be delineated in the pancreas after image fusion with CT (B). There was also increased contrast medium enhancement in the margin when using helical CT (C). SPECT with 99mTc-HYNIC-TOC was also positive for this tumor in upper abdomen (D). This positive finding was confirmed by histopathology revealing a NET with 1 cm in diameter. (Top) Coronal views; (bottom) axial views.

View larger version (58K): [in this window] [in a new window]   FIGURE 2.  A 56-y-old woman with multiple liver and lymph node metastases was referred for restaging after surgery and chemotherapy. CT presented these tumor lesions; however, it was negative for bone lesions. Beside the visceral metastases, some additional osteoblastic and osteolytic bone metastases were clearly depicted with 68Ga-DOTA-TOC (A). Only some of these bone metastases were delineated by conventional scintigraphy (B, anterior view; C, posterior view). Osteoblastic bone lesions were confirmed by 18F-Na-fluoride PET (D). Retrospective CT analysis after image fusion revealed some of these bone metastases.

View larger version (37K): [in this window] [in a new window]   FIGURE 3.  A 47-y-old female patient was referred for scanning after resection of a carcinoid of the ileum. Multiple liver metastases were known (A). Additionally, 68Ga-DOTA-TOC showed a small lesion in right breast (arrows) (B). This finding was initially not detected with CT or scintigraphy (C). Ultrasound-guided fine-needle biopsy confirmed a metastasis in soft tissue derived from the NET with 7- to 4-mm diameter (D). This tumor lesion and 3 liver metastases were consecutively surgically removed.

View larger version (98K): [in this window] [in a new window]   FIGURE 4.  A 62-y-old male patient was investigated after resection of a small bowel carcinoid. 68Ga-DOTA-TOC PET displayed multiple small liver metastases (A). These liver lesions were negative with the other 2 modalities, CT and scintigraphy (B) including SPECT (C). Ultrasonography (D) and further follow-up controls confirmed these lesions. Diameters of metastases were in the range of 1 cm. Positive PET finding initiated treatment with [177Lu-DOTA0,Tyr3,Thr8]octreotide (177Lu-DOTA-TATE).