RT Journal Article SR Electronic T1 Heterogeneity of SSTR2 expression assessed by 68Ga-DOTATOC PET/CT using coefficient of variation in patients with neuroendocrine tumors JF Journal of Nuclear Medicine JO J Nucl Med FD Society of Nuclear Medicine SP jnumed.121.262928 DO 10.2967/jnumed.121.262928 A1 Rosa Fonti A1 Mariarosaria Panico A1 Sara Pellegrino A1 Alessandro Pulcrano A1 Luisa Alessia Vastarella A1 Armin Hakkak A1 Mario Giuliano A1 Giovannella Palmieri A1 Sabino De Placido A1 Silvana Del Vecchio YR 2022 UL http://jnm.snmjournals.org/content/early/2022/03/10/jnumed.121.262928.abstract AB High levels of somatostatin receptor type 2 (SSTR2) is a prerequisite for therapy with unlabeled or labeled somatostatin analogues. However, it is still unclear how the heterogeneity of SSTR2 expression could affect tumor response to therapy. The aim of our study was to test the ability of an imaging parameter such as coefficient of variation (CoV) derived from PET/CT with 68Ga-peptides in the evaluation and quantification of the heterogeneity of SSTR2 expression within primary and metastatic lesions of patients with neuroendocrine tumors. Methods: Thirty-eight patients with pathologically proven neuroendocrine tumors who underwent 68Ga-DOTATOC-PET/CT were studied. Primary tumors were localized in the gastroenteropancreatic, bronchopulmonary and other anatomical districts in 25, 7 and 6 patients, respectively. Malignant lesions were segmented using an automated contouring program and a threshold of SUV> 2.5 or in the case of liver lesions a threshold of 30% of the SUVmax. The imaging parameters SUVmean, CoV, SUVmax, RETV (receptor expressing tumor volume) and TLRE (total lesion receptor expression) of each lesion were obtained. SUVmean, CoV, SUVmax were also obtained in representative volumes of normal liver, spleen as well as in the whole pituitary gland. Results: A total of 107 lesions were analyzed including 35 primary tumors, 32 metastatic lymph nodes and 40 distant metastases. Average CoV values were 0.49±0.20 in primary tumors, 0.57±0.26 in lymph node metastases and 0.44±0.20 in distant metastases. CoV values in malignant lesions were up to 4-fold higher than those of normal tissues (p≤0.0001). Among malignant lesions the highest CoV value was found in bone metastases (0.68±0.20) and was significantly greater than that of primary lesions (P = 0.01) and liver metastases (0<0.0001). On the other hand, the lowest CoV value was found in liver lesions (0.32±0.07) probably due to the high background. Conclusion: Our findings indicate that the heterogeneity of tracer uptake, reflecting that of SSTR2, varies depending on type and site of malignant lesions as assessed by CoV values obtained from 68Ga-DOTATOC-PET/CT scans. These observations may be related to different biological characteristics of tumor lesions in the same patient that may affect their response to treatment with both labeled and unlabeled somatostatin analogues.