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Initial Direct Comparison of ^99mTc-TOC and ^99mTc-TATE in Identifying Sites of Disease in Patients with Proven GEP NETs

¹ Department of Radiology and Diagnostic Imaging, Postgraduate Medical Centre and Central Clinical Hospital of Ministry of Internal Affairs and Administration, Warsaw, Poland; ² Radioisotope Centre POLATOM, Otwock-Swierk, Poland; ³ Department of Nuclear Medicine, Royal Free Hospital, London, United Kingdom; ⁴ Department of Pathology, Central Clinical Hospital of Ministry of Internal Affairs and Administration, Warsaw, Poland; ⁵ Department of Radiology and Diagnostic Imaging, Central Clinical Hospital of Ministry of Internal Affairs and Administration, Warsaw, Poland; and ⁶ Radiological Chemistry Unit, University Hospital, Basel, Switzerland

Correspondence: For correspondence contact: Jaroslaw B. Cwikla, Department of Radiology and Diagnostic Imaging, Hospital Ministry of Internal Affairs and Administration, 137 Woloska, 02-507 Warsaw, Poland. E-mail: jaroslaw.cwikla{at}cskmswia.pl

The imaging of neuroendocrine tumors has become one of the most significant areas in nuclear oncology. In an attempt to provide high-quality imaging and possible sensitivity at a reduced cost, time, and radiation dose, several ^99mTc agents have been proposed. The aim of this initial study was to compare the tumor uptake and biodistribution of 2 new 6-hydrazinopyridine-3-carboxylic acid (HYNIC)–derivatized Tyr³-octreotide analogs, ^99mTc-[HYNIC,Tyr³]octreotide (^99mTc-TOC) and ^99mTc-[HYNIC,Tyr³,Thr⁸]octreotide (^99mTc-TATE), in patients with somatostatin receptor–expressing tumors. Methods: Each of 12 patients with proven gastrointestinal pancreatic neuroendocrine tumors received a mean activity of 520 MBq of ^99mTc-TOC and ^99mTc-TATE. Scintigraphy with both tracers was performed 3–4 h after their injection using standard whole-body and SPECT imaging. The images were reviewed subjectively by 2 readers, who reported tumor uptake lesion by lesion. Results: Both radiotracers demonstrated concordance between the results in 7 patients (58%). In total, 110 sites of disease were identified with ^99mTc-TOC, compared with 115 with ^99mTc-TATE. There was 1 case in which ^99mTc-TOC identified sites of disease not seen on ^99mTc-TATE imaging but 4 cases in which some sites of disease were seen with ^99mTc-TATE and not ^99mTc-TOC. Conclusion: In this initial study, both tracers seem to show similar sites of tumor, with ^99mTc-TATE having a slight edge in the total number of lesions seen, especially in lymph node metastases.

Key Words: ^99mTc-TOC • ^99mTc-TATE • somatostatin receptor scintigraphy • GEP NET

COPYRIGHT © 2008 by the Society of Nuclear Medicine, Inc.

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