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Comparison of the pharmacokinetics of 68Ga-DOTATOC and [18F]FDG in patients with metastatic neuroendocrine tumours scheduled for 90Y-DOTATOC therapy

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Abstract

Purpose

The purpose of this study was to evaluate and compare, by means of dynamic PET, the pharmacokinetics of 68Ga-DOTATOC, a tracer which reflects the expression of somatostatin receptors (SSTRs), and of [18F]FDG, a marker of tumour viability, in patients with metastatic neuroendocrine tumours (NETs) in whom 90Y-DOTATOC therapy was planned.

Materials and methods

Fifteen patients (63 lesions) with confirmed metastatic NETs were enrolled in this study. Dynamic [18F]FDG and 68Ga-DOTATOC PET scans were performed on two different days in the same week. The data analysis was based on qualitative and quantitative analysis using a two-tissue compartment model with a blood compartment and a non-compartment model based on the fractal dimension (FD). Multivariate analysis was used for evaluation of the kinetic data.

Results

Enhanced [18F]FDG uptake was observed in 43/63 lesions. 68Ga-DOTATOC showed pathologically enhanced uptake in all evaluated patients and in 57/63 lesions. Discordant scintigraphic results for [18F]FDG and 68Ga-DOTATOC were observed in 6/15 patients. Global SUV was defined as the SUV measured in the last frame (55–60 min p.i.) of the dynamic series, for each tracer. The median global SUV uptake was 7.9 for 68Ga-DOTATOC and 4.6 for [18F]FDG. The selection of patients for 90Y-DOTATOC therapy was based on the uptake of 68Ga-DOTATOC. Multiple linear regression analysis was applied to determine the effect of each kinetic parameter (K 1–k 4, V B) on the global SUV of both tracers. The highest positive t-ratio was found for K 1 (receptor binding), followed by k 3 (cellular internalisation) and V B (fractional blood volume), when using the global 68Ga-DOTATOC uptake (SUV) as a target variable. Analysis of the [18F]FDG data revealed the highest positive t-ratio for V B, followed by k 3 (phosphorylation) and K 1 (influx). The comparison of global SUV, K 1–k 4 and the FD for [18F]FDG and 68Ga-DOTATOC did not show any statistically significant correlation. The only parameter that demonstrated a significant linear correlation between the tracers was V B.

Conclusion

68Ga-DOTATOC is a promising tool for evaluation of the expression of SSTR2 in NETs. The combination of [18F]FDG and 68Ga-DOTATOC dynamic PET studies provides different information regarding the biological properties of lesions in patients with metastatic NETs in whom 90Y-DOTATOC therapy is planned. While the global 68Ga-DOTATOC uptake is influenced mostly by K 1, the global [18F]FDG uptake is mostly influenced by V B. Only patients with enhanced 68Ga-DOTATOC uptake (SUV >5.0) were referred to 90Y-DOTATOC therapy.

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Acknowledgement

We thank Prof. Dr. Helmut R. Mäcke (University Hospital Basel, Switzerland) for providing sample material of DOTATOC.

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Authors and Affiliations

  1. Medical PET Group–Biological Imaging (E0601), Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Sophia Koukouraki, Ludwig G. Strauss, Uwe Haberkorn & Antonia Dimitrakopoulou-Strauss

  2. Department of Nuclear Medicine, University of Crete, Iraklion, Greece

    Sophia Koukouraki

  3. Department of Medical Oncology, University of Crete, Iraklion, Greece

    Vassilios Georgoulias

  4. Department of Radiopharmaceutical Chemistry, German Cancer Research Center, Heidelberg, Germany

    Michael Eisenhut

  5. Department of Nuclear Medicine, University of Heidelberg, Heidelberg, Germany

    Uwe Haberkorn

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  1. Sophia Koukouraki
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  2. Ludwig G. Strauss
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  3. Vassilios Georgoulias
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  4. Michael Eisenhut
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Correspondence to Antonia Dimitrakopoulou-Strauss.

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Koukouraki, S., Strauss, L.G., Georgoulias, V. et al. Comparison of the pharmacokinetics of 68Ga-DOTATOC and [18F]FDG in patients with metastatic neuroendocrine tumours scheduled for 90Y-DOTATOC therapy. Eur J Nucl Med Mol Imaging 33, 1115–1122 (2006). https://doi.org/10.1007/s00259-006-0110-x

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  • DOI: https://doi.org/10.1007/s00259-006-0110-x

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