Imaging of Advanced Neuroendocrine Tumors with 18F-FDOPA PET

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FIGURE 1.
¹⁸F-FDOPA PET (A), SRS (B), and multislice CT (C) in patient with metastasizing glucagonoma of pancreas. Note extensive liver metastasis with massive enlargement of both liver lobes, particularly the left lobe (patient had splenectomy); lymph node metastasis in left supraclavicular region and in epigastrium; and bone metastasis in lumbar spine. Also note better resolution of PET images compared with SRS. Involved lumbar vertebra is clearly shown by ¹⁸F-FDOPA PET but has only weak uptake in SRS (arrowhead). CT could not differentiate between vital tumor in lumbar spine and changes after irradiation.
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FIGURE 2.
(A) Visualization of multiple rib lesions and one sternal lesion by ¹⁸F-FDOPA PET in addition to carcinosis in liver capsule and multiple abdominal nodes of ileocecal carcinoid. (B) SRS shows rib lesions less clearly and misses sternal lesion and some of abdominal nodes. (C) CT of thorax failed to reveal any of the bone lesions. (D) Abdominal CT shows subcapsular liver metastases and lymph node metastases (arrowheads). Note obvious contrast-enhancing liver capsule indicative of diffuse infiltrative metastatic tumor spread. Left-sided pleural effusion is evident (D).

TABLE 1

Patient Characteristics

Patient no.	Age (y)	Sex	Location of primary	Tumor differentiation	Tumor sites*	Therapy before PET^†
1	70	M	Mediastinum	Carcinoid	b, m, lu, li	irrad, cht, oct-h
2	42	M	Pancreas	Carcinoid	p	None
3	52	F	Unknown	Carcinoid	b, o	None
4	74	F	Unknown	Carcinoid	m, li, o	surg, cht
5	67	M	Ileocecal	Carcinoid	b, li, o	surg, emb
6	72	F	Pancreas	Carcinoid	b, li	surg, irrad, cht, oct-h
7	67	F	Unknown	Carcinoid	o	surg
8	56	M	Ileocecal	Carcinoid	b, m, li, o	surg, emb, oct-c, IFN
9	45	F	Pancreas	Glucagonoma	b, li, o	surg, irrad, IFN, oct-c, oct-h
10	60	M	Pancreas	Somatostatinoma	b, li, o	surg, IFN, cht, oct-h
11	46	M	Pancreas	Carcinoid	li, p	surg, emb
12	61	M	Unknown	Carcinoid	b, m, lu, li	cht
13	45	M	Ileocecal	Carcinoid	b, li	cht, emb
14	70	M	Unknown	Carcinoid	li	surg
15	53	M	Unknown	Gastrinoma	li	surg, oct-h
16	61	F	Ileocecal	Carcinoid	m, lu, li, o	surg, emb, oct-h
17	72	F	Unknown	Carcinoid	b, m, li, o	None
18	47	F	Pancreas	Gastrinoma	li, o	surg
19	57	M	Pancreas	Carcinoid	li, p, o	cht, IFN, oct-c
20	63	F	Lung	Carcinoid	b, m, lu	surg, cht
21	69	F	Stomach	Gastrinoma	o	surg
22	81	M	Rectum	Carcinoid	b, o	irrad
23	59	M	Unknown	Carcinoid	lu, li,	surg, cht, oct-h

↵* Tumor sites: b = bone; m = mediastinal; lu = lung; li = liver; p = pancreatic; o = others.
↵^† Therapies: irrad = irradiation; cht = chemotherapy; oct-h = ⁹⁰Y-labeled octreotide; surg = surgery; emb = embolization; oct-c = inactive octreotide; IFN = interferon-α.

TABLE 3

Sensitivity and Specificity of SRS and PET in Different Organs and Regions

Parameter	Bone			Mediastinum			Lungs			Liver			Pancreas	Lymph nodes
Parameter		SRS	PET	SRS	PET	SRS	PET	SRS	PET	SRS	PET	SRS	PET
True-negative	11	10	16	16	17	17	7	6	20	20	12	12
True-positive	6	12	3	7	0	1	12	13	2	3	9	10
False-negative	6	0	4	0	5	4	4	3	1	0	2	1
False-positive	0	1	0	0	1	1	0	1	0	0	0	0
Prevalence	52.2			30.3			21.7			69.7			13.0	47.8
Sensitivity (%)	50.0 (21–87)	100.0 (73–100)	42.9 (9–85)	100.0 (59–100)	0.0 (0–87)	20.0 (0–89)	75.0 (47–93)	81.3 (54–98)	66.7 (9–91)	100.0 (29–100)	81.8 (48–95)	90.9 (58–97)
Specificity (%)	100.0 (71–100)	90.9 (56–99)	100.0 (79–100)	100.0 (79–100)	94.4 (72–99)	94.4 (72–99)	100.0 (59–100)	85.7 (42–99)	100.0 (83–100)	100.0 (83–100)	100.0 (73–100)	100.0 (73–100)
PPV	100.0 (54–100)	92.3 (63–99)	100.0 (29–100)	100.0 (59–100)	0.0 (0–99)	50.0 (1–99)	100.0 (73–100)	92.9 (66–99)	100.0 (15–100)	100.0 (29–100)	100.0 (66–100)	100.0 (69–100)
NPV	64.7 (38–85)	100.0 (69–100)	80.0 (56–94)	100.0 (79–100)	77.3 (54–92)	81.0 (58–94)	63.7 (30–89)	66.7 (29–92)	95.2 (47–99)	100.0 (83–100)	85.7 (51–97)	90.9 (63–99)