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Research ArticleOncology

Tumor-to-Blood Ratio for Assessment of Somatostatin Receptor Density in Neuroendocrine Tumors Using 68Ga-DOTATOC and 68Ga-DOTATATE

Ezgi Ilan, Irina Velikyan, Mattias Sandström, Anders Sundin and Mark Lubberink
Journal of Nuclear Medicine February 2020, 61 (2) 217-221; DOI: https://doi.org/10.2967/jnumed.119.228072
Ezgi Ilan
1Section of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
2Medical Physics, Uppsala University Hospital, Uppsala, Sweden; and
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Irina Velikyan
1Section of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
3PET Centre, Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
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Mattias Sandström
1Section of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
2Medical Physics, Uppsala University Hospital, Uppsala, Sweden; and
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Anders Sundin
1Section of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
3PET Centre, Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
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Mark Lubberink
1Section of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
2Medical Physics, Uppsala University Hospital, Uppsala, Sweden; and
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  • FIGURE 1.
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    FIGURE 1.

    (A and B) Box plots of SUV in blood at 40–45 min after injection for 68Ga-DOTATOC (A) and 68Ga-DOTATATE (B) for high and low Ki values. One tumor per patient is included in plots. Boxes are median and interquartile range, and whiskers are full range of data. Significant differences (P < 0.05) were found in SUVblood between high and low Ki for 68Ga-DOTATOC, however, not for 68Ga-DOTATATE (P > 0.05). (C and D) Relation between Ki and SUV in blood for 68Ga-DOTATOC (C) and 68Ga-DOTATATE (D). Solid line represents exponential fit (y = a/x) for visual illustration.

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    FIGURE 2.

    Correlation between Ki and TBR for 68Ga-DOTATOC (A) and 68Ga-DOTATATE (B) and between Ki and SUV in tumors for 68Ga-DOTATOC (C) and 68Ga-DOTATATE (D). Solid lines represent linear regression fits (A and B) and fits to hyperbolic line (C and D), and dashed lines are 95% confidence band of these fits.

  • FIGURE 3.
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    FIGURE 3.

    Comparison of Ki, SUVtumor, and TBR between 68Ga-DOTATOC and 68Ga-DOTATATE. Significant difference was found between 68Ga-DOTATOC and 68Ga-DOTATATE for TBR (P = 0.019, Wilcoxon matched-pairs test) but not for Ki or SUVtumor (P = 0.083 and 0.413, respectively).

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    TABLE 1

    Demographics and Clinical Characteristics of Study Patients

    SexAge (y)NET typeTracerPeptide (μg)Ki-67 indexPrevious surgeryHistory and previous therapyMetastasesOngoing therapy
    F67pNET/NEC (glucagonoma)TOC/TATE23/233%—SSA, streptozotocin-fluorouracil, PRRT, transformation to NEC and carboplatine-etopsideLiver—
    F63SI NETTOC/TATE17/291%Primary tumorLiver trpl 1999 because of cyst diseaseLiver, mesenteric lgl—
    M67SI NETTOC/TATE18/301%Primary tumor—Liver, mesenteric lglSSA
    M50SI NETTOC/TATE20/3318%Primary tumor mesenteric lgll—Liver, mesenteric lgl, retroperitoneal lgllSSA
    M64pNECTOC/TATE26/2530%—Avastin, temozolomideLiver—
    F73pNETTOC/TATE22/223%—Streptozotocin-fluorouracilLiver, abdominal lgllSSA
    M57SI NETTOC253%—SSAAbdominal lgll, mesenteric lglSSA
    M53pNET (malignant insulinoma)TOC183%Primary tumorStreptozotocin-fluorouracil, SirtexLiver, mesenteric lglEverolimus
    F72pNET (MEN-1, gastrin-producing)TOC15No biopsy——Retroperitoneal lgll—
    M51pNETTOC223%Primary tumor—Retroperitoneal lgll—
    M74SI NETTOC231%——Mesenteric lgll—
    F67pNETTOC252%—Streptozotocin-fluorouracilLiver—
    M50SI NETTOC474%——Liver, mesenteric lgl, peritoneal carcinomatosisSSA
    F*52SI NETTOC255%——Liver, mesenteric thoracic neck lgll, bone, breast, ovarySSA
    F69SI NETTOC279%——Liver, boneSSA
    F47SI NETTOC419%——Liver, mesenteric lgl, abdominal and retroperitoneal lgllSSA
    M72Rectal NETTATE1330%——Liver, pararectal lgll—
    F69SI NETTATE2212%——Liver, peritoneal carcinomatosisSSA
    M67pNETTATE817%——Liver, abdominal lgll, boneSSA
    M75Rectal NETTATE1410%——Liver, abdominal lgll, peritoneal carcinomatosis—
    F*53SI NETTATE165%Primary tumor—Liver, abdominal lgll, bone, breast, lungSSA
    F58Duodenal NET (gastrinoma)TATE223%Primary tumor liver resection, RF—LiverSSA
    F75Atypical lung NETTATE396%SSA
    • ↵* Same patient.

    • pNET = pancreatic NET; NEC = neuroendocrine carcinoma; TOC = 68Ga-DOTATOC; TATE = 68Ga-DOTATATE; SSA = long acting somatostatin analog; PRRT = peptide receptor radionuclide therapy; SI = small intestine; trpl = transplantation; lgl = single lymph node; lgll = multiple lymph nodes; Sirtex = transarterial liver embolization with 90Y-spheres; MEN-1 = multiple endocrine neoplasia type 1; RF = radiofrequency ablation.

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    TABLE 2

    Reconstruction Settings for the 3 Different Scanners

    Reconstruction settingDiscovery STDiscovery IQDiscovery MI
    Reconstruction algorithmOSEMOSEM with PSF modelingToF OSEM with PSF modeling
    Iterations/subsets2/284/123/16
    Postprocessing filter (mm)545
    Matrix size128 × 128256 × 256256 × 256
    Pixel size (mm)3.91 × 3.91 × 3.271.95 × 1.95 × 3.261.95 × 1.95 × 2.79
    • OSEM = ordered-subset expectation maximization; PSF = point-spread function; ToF = time of flight.

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Journal of Nuclear Medicine: 61 (2)
Journal of Nuclear Medicine
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February 1, 2020
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Tumor-to-Blood Ratio for Assessment of Somatostatin Receptor Density in Neuroendocrine Tumors Using 68Ga-DOTATOC and 68Ga-DOTATATE
Ezgi Ilan, Irina Velikyan, Mattias Sandström, Anders Sundin, Mark Lubberink
Journal of Nuclear Medicine Feb 2020, 61 (2) 217-221; DOI: 10.2967/jnumed.119.228072

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Tumor-to-Blood Ratio for Assessment of Somatostatin Receptor Density in Neuroendocrine Tumors Using 68Ga-DOTATOC and 68Ga-DOTATATE
Ezgi Ilan, Irina Velikyan, Mattias Sandström, Anders Sundin, Mark Lubberink
Journal of Nuclear Medicine Feb 2020, 61 (2) 217-221; DOI: 10.2967/jnumed.119.228072
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Keywords

  • 68Ga-DOTATOC
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  • neuroendocrine tumors, tumor-to-blood ratio
  • SUV
  • net influx rate
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