PT - JOURNAL ARTICLE AU - Long, Tingting AU - Yang, Nengan AU - Li, Zibo AU - Hu, Shuo TI - A primitive study for clinical application of <sup>18</sup>F-AlF-NOTA-octreotide PET/CT in combination with <sup>18</sup>F-FDG PET/CT for imaging neuroendocrine neoplasms DP - 2018 May 01 TA - Journal of Nuclear Medicine PG - 48--48 VI - 59 IP - supplement 1 4099 - http://jnm.snmjournals.org/content/59/supplement_1/48.short 4100 - http://jnm.snmjournals.org/content/59/supplement_1/48.full SO - J Nucl Med2018 May 01; 59 AB - 48Objectives: 18F is the most widely used radionuclide in PET examination and has shown excellent performance during peptide-based imaging. Compared with the 68Ga-somatostatin analogs, 18F analogs can be a promising radioligand candidate for detecting neuroendocrine neoplasms (NENs). The aim of this study was to document the preliminary data on the first humanly application of 18F-AlF-NOTA-octreotide in volunteers and patients with NENs and to evaluate its safety, biodistribution, and radiation dosimetry, as well as to assess the clinical value of 18F-AlF-NOTA-octreotide in combination with 18F-FDG PET/CT for detecting NENs. Methods: The study was approved by the institutional review board. Three healthy volunteers (three women) were enrolled to evaluate the safety of 18F-AlF-NOTA-octreotide and saved as a normal radiotracer distribution baseline reference. Regions of interest (ROIs) were drawn manually to determine the radiotracer uptake in different organs. Dosimetry was calculated using the OLINDA/EXM software. Twelve patients with pathological confirmed NENs (three grade 1 (G1) patients, four grade 2 (G2) patients and five grade 3 (G3) patients) were participated in the study. All patients underwent PET/CT scans at 60 min after intravenous injection of 3.7-4.44MBq (0.10-0.12mCi) per kilogram of body weight of 18F-AlF-NOTA-octreotide and also accepted 18F-FDG PET/CT within 2 weeks. Results: All healthy volunteers and patients tolerated 18F-AlF-NOTA-octreotide well without any adverse events. Physiologic distribution was seen in the pituitary, thyroid, liver, spleen, adrenals, pancreatic uncinate process, stomach, small and large bowel. 18F-AlF-NOTA-octreotide was excreted mainly through the kidneys and urinary tract, and partly through the bile duct. The calculated effective dose was 0.023±0.002 (mSv/MBq). In twelve patients with NENs, 11 patients (3 G1, 4 G2, 4 G3) detected by 18F-AlF-NOTA-octreotide PET/CT with an average maximum standard uptake value (SUVmax) of 29.25±30.96 (range, 4.77 to 107.75), and 8 patients (2 G1, 1 G2, 5 G3) detected by 18F-FDG. There were 99 lesions not sequentially detected by both types of tracer, the discordant rate was 41.4%, and the remain 140 lesions were agree with each other in two types of tracer, the concordant rate was 58.6%, and an interesting “flip-flop” phenomenon was displayed in a patient with pancreatic neuroendocrine tumor. There were greater uptakes of 18F-AlF-NOTA-octreotide than that of 18F-FDG in G1 and G2 patients (SUVmax 41.71±33.73 vs 5.53±8.66, P&lt;0.05), whereas the uptakes of 18F-FDG were little higher than that of 18F-AlF-NOTA-octreotide in G3 patients (SUVmax 16.72±11.24 vs 5.97±3.83, P=0.09) ,. Conclusions: 18F-AlF-NOTA-octreotide is a PET radiotracer with favorable safety and dosimetric profile, and is superior to 18F-FDG for imaging G1 and G2 NENs. Combination of 18F-FDG PET/CT and 18F-AlF-NOTA-octreotide has the promising potential for staging and management of NENs. Clinical studies with much more patients are ongoing to qualify this tracer.