Article Figures & Data
Figures
- 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.
- 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.
- 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.
- 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).
Tables
Patient no. Sex Age (y) Pathology Indication Clinical symptoms* Confirmation† 1 M 49 Paraganglioma Follow-up No Histology 2 F 57 Carcinoid of pancreas Follow-up No CT 3 F 47 Carcinoid of pancreas Follow-up Diarrhea CT 4 M 59 Carcinoid of pancreas Follow-up No CT 5 M 79 Carcinoid of pancreas Follow-up No CT 6 M 48 Carcinoid of pancreas Follow-up No CT 7 M 61 Broncogenic carcinoid Follow-up No CT, NaF 8 M 59 Small bowel carcinoid (gastrinoma) Staging Gastritis CT 9 M 62 Small bowel carcinoid Staging Flush CT, MRI 10 F 66 Small bowel carcinoid Staging Diarrhea CT 11 M 39 Elevation of CgA and NSE Detection No CT, MRI 12 F 28 Elevation of ACTH Detection Cushing Histology, CT 13 F 62 Carcinoid of pancreas Staging Flush Histology, CT 14 F 75 NET unknown primary Follow-up No CT 15 M 45 Carcinoid of pancreas Staging Diarrhea CT 16 F 50 NET unknown primary Follow-up No CT 17 F 70 Carcinoid of pancreas Follow-up Diarrhea CT 18 F 61 Elevation of CgA and NSE Detection No Histology 19 F 68 NET unknown primary (gastrinoma) Staging Flush CT 20 M 55 Small bowel carcinoid Follow-up No CT, MRI 21 F 40 NET of hypophysis Staging No MRI 22 M 61 NET unknown primary Staging No MRI, NaF 23 M 61 Carcinoid of pancreas Staging No CT 24 F 54 Carcinoid of pancreas Follow-up No CT 25 M 55 Carcinoid of pancreas (gastrinoma) Staging Gastritis CT 26 F 64 NET unknown primary Staging No CT 27 F 56 NET unknown primary Follow-up No CT, MRI 28 F 57 Hypoglycemia Detection NGP and CCR Histology 29 F 41 Carcinoid of pancreas Staging No CT 30 M 73 Elevation of CgA and NSE Detection Diarrhea MRI, histology 31 M 75 Hypoglycemia Detection NGP and CCR MRI 32 M 51 Carcinoid of stomach Staging No CT 33 F 58 NET unknown primary Follow-up Flush, diarrhea CT 34 M 63 Elevation of CgA and NSE Detection Diarrhea CT, MRI 35 M 62 Small bowel carcinoid Staging No CT 36 F 47 NET unknown primary Staging No CT, histology 37 F 28 Elevation of CgA and NSE Detection No Histology 38 F 41 Broncogenic carcinoid Follow-up No CT 39 M 51 Carcinoid of pancreas Staging Diarrhea CT 40 F 40 Elevation of CgA and NSE Detection No Histology 41 M 77 NET of prostate gland Staging No CT, NaF 42 M 54 Hypoglycemia Detection NGP and CCR CT, MRI 43 M 69 Carcinoid of stomach Staging No CT 44 M 64 Carcinoid of pancreas Staging No CT 45 M 84 Carcinoid of pancreas Staging Flush CT, MRI 46 M 74 NET unknown primary Staging No CT 47 M 74 Broncogenic carcinoid Staging No CT 48 F 43 Carcinoid of pancreas Staging No CT, MRI 49 M 56 Small bowel carcinoid Staging No CT 50 F 57 Small bowel carcinoid Staging No CT, NaF 51 F 58 Small bowel carcinoid Staging Flush CT 52 M 55 Elevation of CgA and NSE Detection No Histology 53 F 51 Elevation of gastrin Detection Gastritis CT, MRI, biopsy 54 M 62 Broncogenic carcinoid Follow-up No CT, MRI 55 M 40 Carcinoid of pancreas (VIPoma) Staging Diarrhea CT, NaF 56 F 67 Small bowel carcinoid Follow-up No CT 57 F 76 Carcinoid of stomach Staging Diarrhea CT, NaF 58 M 34 Carcinoid of pancreas Follow-up No CT, NaF 59 M 66 Small bowel carcinoid Staging No CT 60 M 64 Small bowel carcinoid Follow-up No CT 61 M 58 Small bowel carcinoid Follow-up Flush, diarrhea CT 62 M 59 Small bowel carcinoid Staging No CT 63 F 75 Small bowel carcinoid Staging No CT, MRI 64 M 47 Small bowel carcinoid Follow-up No CT 65 F 61 Broncogenic carcinoid Follow-up No CT, MRI 66 M 62 Small bowel carcinoid Staging No CT 67 M 35 Carcinoid of middle ear Follow-up No CT, MRI 68 M 65 Carcinoid of cecum Follow-up Flush CT 69 M 62 Small bowel carcinoid Follow-up Diarrhea CT 70 M 50 Small bowel carcinoid Staging No CT 71 F 78 Small bowel carcinoid Follow-up No CT, NaF 72 F 37 Hypoglycemia Detection NGP and CCR CT, MRI 73 M 73 Paraganglioma Follow-up No CT, MRI 74 M 79 Carcinoid of rectum Staging No CT 75 F 64 Carcinoid of stomach Follow-up No CT 76 F 66 Broncogenic carcinoid Follow-up No CT 77 F 60 Small bowel carcinoid Follow-up Diarrhea CT 78 M 67 Carcinoid of rectum Follow-up No CT 79 M 69 Paraganglioma Staging No MRI, histology 80 F 47 Small bowel carcinoid Follow-up No CT, MRI, histology 81 F 59 Carcinoid of pancreas Follow-up No CT, NaF 82 M 59 Carcinoid of pancreas Staging No CT, MRI, NaF 83 M 65 Small bowel carcinoid Follow-up No CT 84 M 54 Small bowel carcinoid Follow-up No CT Uptake Features of tracer accumulation Nonmalignant Linear, nonfocal limited intestinal uptake with moderate intensity Tracer uptake less intense than liver uptake Pancreatic head (PET): small sickle-shaped findings in right upper abdomen just below left liver lobe; diffuse nature of uptake Malignant Clearly demarked findings with higher tracer uptake compared with liver uptake Tracer accumulation in structures that did not take up tracer physiologically or was higher than background activity Pancreatic head: irregular or protrusive shape of finding; clear delineation from adjacent tissue with higher uptake than liver uptake Parameter 20 min 1 h 1 h 40 min Liver 6.2 ± 1.7 5.9 ± 2.1 5.5 ± 2.4 Background 0.8 ± 0.5 0.6 ± 0.4 0.6 ± 0.4 Tumor in liver 12.9 ± 4.9 14.6 ± 5.9 15.8 ± 6.9 Tumor in abdomen 9.0 ± 6.7 10.6 ± 7.5 11.6 ± 7.2 SUVbw is for selected tissue from 8 patients. SD gives interpatient variability.
PET SPECT CT Group n TP TN FP FN TP TN FP FN TP TN FP FN Detection 13 4 8 1 0 2 8 1 2 3 8 1 1 Staging 36 32 3 0 1 14 3 0 19 16 3 2 15 Follow-up 34 33 1 0 1 21 1 0 13 22 1 2 10 Overall 84 69 12 1 2 37 12 1 34 41 12 5 26 Parameter PET (%) SPECT (%) CT (%) Sensitivity 97 (69/71) 52 (37/71) 61 (41/67) Specificity 92 (12/13) 92 (12/13) 71 (12/17) Accuracy 96 (81/84) 58 (49/84) 63 (53/84) Number of patients is in parentheses.
Site PET SPECT CT Cranium 5 5 5 Neck/chest 35 30 31 Liver 56 46 56 Pancreas 23 21 19 Lymph nodes 90 68 87 Other 50 48 39 Bone 116 84 58 Overall 375 302 295 Other sites include, but are not mentioned, locations of tumor deposits—for example, peritoneal carcinosis.
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