Research ArticleTheranostics

Quantitative 3D Assessment of 68Ga-DOTATOC PET/MRI with Diffusion-Weighted Imaging to Assess Imaging Markers for Gastroenteropancreatic Neuroendocrine Tumors: Preliminary Results

Lisa C. Adams, Keno K. Bressem, Julia Brangsch, Carolin Reimann, Kristin Nowak, Winfried Brenner and Marcus R. Makowski
Journal of Nuclear Medicine July 2020, 61 (7) 1021-1027; DOI: https://doi.org/10.2967/jnumed.119.234062

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Study flowchart.

  • FIGURE 2.
    FIGURE 2.

    Example of 3D VOI lesion analysis in 50-y-old patient with grade 1 pancreas NET (SUVmean of 15 and ADCmin of 900 mm2/s; combined SUVmean/ADCmin ratio, 0.02). Shown are fusion of enhanced T1-weighted VIBE (volumetric interpolated breath-hold sequence) MRI with 68Ga-DOTATOC PET (A), 68Ga-DOTATOC PET (B), ADC map (C), and 3D lesion model (D).

  • FIGURE 3.
    FIGURE 3.

    Example of 3D VOI lesion analysis in 64-y-old patient with grade 2 pancreas NET (SUVmean of 45 and ADCmin of 490 mm2/s; combined SUVmean/ADCmin ratio, 0.09). Shown are fusion of enhanced T1-weighted VIBE (volumetric interpolated breath-hold sequence) MRI with 68Ga-DOTATOC PET (A), 68Ga-DOTATOC PET (B), ADC map (C), and 3D lesion model (D).

  • FIGURE 4.
    FIGURE 4.

    Receiver-operating-characteristic curves from 68Ga-DOTATOC PET and MRI ADC parameters. SUVmean demonstrates poor to moderate discriminative test performance (A), whereas ADCmin shows fair discriminative ability (B). Of combined ratios and parameters, SUVmean/ADCmin (D) demonstrates better discriminative test performance than SUVmax/ADCmean (C), with AUC of 0.90, sensitivity of 86%, and specificity of 100%. AUC = area under the curve.

Tables

  • TABLE 1

    Patient- and Tumor-Related Characteristics

    CharacteristicData
    Age (y)61 (43–81)
    Sex
     Male15 (68.2%)
     Female7 (31.8%)
    Histologic tumor grade (24 lesions)
     Grade 112 (50%)
     Grade 212 (50%)
    Tumor location
     Stomach1 (4.2%)
     Small bowel9 (37.5%)
     Rectum1 (4.2%)
     Pancreas13 (54.2%)
    Presence of metastases20 (80.0%)

    • Qualitative data are expressed as numbers followed by percentages in parentheses; continuous data are expressed as mean ± SD followed by range in parentheses.

  • TABLE 2

    MRI Sequence Parameters

    SequenceOrientationBandwidth (Hz/Px)TR/TE (ms)MatrixFOV (mm)Voxel size (mm3)TA (s)
    T2-weighted HASTEAxial7101,400/953204001.3 × 1.3 × 5.068
    T2-weighted TIRMCoronal3004,390/532564501.8 × 1.8 × 4.0142
    T1-weighted fs VIBEAxial4503.9/1.863204001.3 × 1.3 × 3.017
    T2-weighted fs TSEAxial2432,200/1004484000.9 × 0.9 × 5.0230
    EPI DWIAxial2,2325,600/551343801.4 × 1.4 × 5.0204
    T1-weighted fs VIBE (dynamic)Axial4503.95/1.923203601.1 × 1.1 × 3.017 (per phase)
    T1-weighted fs STARVIBE (Siemens)Axial8703.05/1.4432038012.x1.2 × 1.2278

    • TR = repetition time; TE = echo time; FOV = field of view; TA = time of acquisition; HASTE = half-Fourier acquisition single-shot turbo spin echo; TIRM = turbo inversion recovery magnitude; fs = fat saturation; VIBE = volumetric interpolated breath-hold sequence; EPI = echo planar imaging.

  • TABLE 3

    Comparison of Imaging Parameters Between Different World Health Organization Grade GEP NETs

    ParameterGrade 1 (n = 12)Grade 2 (n = 12)
    Diameter (mm)19.7 ± 9.6 (12.0–95.0)40.7 ± 30.4 (11.0–40.0)
    TFTV (cm3)6.4 ± 9.9 (1.2–34.2)70.6 ± 112.2 (1.5–351.1)
    Ki-67 proliferation index (%)1.6 ± 0.6 (0.9–2.0)5.3 ± 2.6 (2.3–10)
    TBR6.6 ± 1.9 (3.1–10.1)12.7 ± 9.3 (3.9–33.2)
    SUVmean14.7 ± 7.0 (4.0–23.2)23.1 ± 12.3 (8.0–45.0)
    SUVmax34.9 ± 16.9 (14.5–62.5)42.3 ± 26.6 (14.8–89.5)
    ADCmean (×10−3 mm2/s)1.24 ± 0.18 (1.05–1.49)0.96 ± 0.26 (0.50–1.22)
    ADCmin (×10−3 mm2/s)0.67 ± 0.14 (0.51–0.87)0.49 ± 0.24 (0.23–0.85)
    Enhancement ratio1.2 ± 0.8 (0.6–2.9)1.0 ± 0.4 (0.4 to 1.6)

    • Data are mean ± SD followed by range in parentheses.

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