Skip to main content
SpringerLink
Log in

Evaluation of the potential of PET-MRI fusion for detection of liver metastases in patients with neuroendocrine tumours

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

This study was performed to assess the role of retrospective PET-MRI fusion with Ga-68-DOTA(0)-Phe(1)-Tyr(3)-octreotide (Ga-68-DOTATOC) PET and Gd-EOB-DTPA MRI in the detection of hepatic metastases from neuroendocrine tumours (NET).

Methods

Twenty-two consecutive patients with suspected liver metastases from histopathologically proven NET were examined with Gd-EOB-DTPA MRI and multiphase contrast-enhanced Ga-68-DOTATOC PET/CT. PET and MRI images were retrospectively fused using commercially available software. Two physicians experienced in nuclear medicine and radiology analysed the images to assess diagnostic confidence and characterise liver lesions.

Results

A total of 181 lesions were detected. PET-MRI showed a sensitivity of 91.2% (significantly superior to PET/CT; P < 0.05) and a specificity of 95.6% (significantly superior to MRI; P < 0.05). PET/CT had a sensitivity of 73.5% and a specificity of 88.2%. MRI had a sensitivity of 87.6% and a specificity of 86.8%. The area under the curve was 0.98 for PET-MRI, 0.96 for MRI, and 0.89 for PET/CT (P < 0.05).

Conclusions

Retrospectively fused PET-MRI was superior to multiphase contrast-enhanced Ga-68-DOTATOC PET/CT and Gd-EOB-DTPA MRI in the detection of NET liver metastases. It was more sensitive than PET/CT and more specific than MRI. Fused PET-MRI therefore seems well suited for surgical and interventional treatment planning of NET liver metastases.

Key Points

• Ga-68-DOTATOC PET–Gd-EOB-DTPA MRI fusion can improve imaging of liver metastases of neuroendocrine tumours.

• This technique appears more sensitive than PET/CT for staging NET hepatic metastases.

• Ga-68-DOTATOC PET–Gd-EOB-DTPA MRI fusion is more specific than MRI alone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Steinmuller T, Kianmanesh R, Falconi M et al (2008) Consensus guidelines for the management of patients with liver metastases from digestive (neuro)endocrine tumors: foregut, midgut, hindgut, and unknown primary. Neuroendocrinology 87:47–62

    Article  PubMed  Google Scholar 

  2. Maithel SK, Fong Y (2009) Hepatic ablation for neuroendocrine tumor metastases. J Surg Oncol 100:635–638

    Article  PubMed  Google Scholar 

  3. Frilling A, Li J, Malamutmann E, Schmid KW, Bockisch A, Broelsch CE (2009) Treatment of liver metastases from neuroendocrine tumours in relation to the extent of hepatic disease. Br J Surg 96:175–184

    Article  PubMed  CAS  Google Scholar 

  4. Berge T, Linell F (1976) Carcinoid tumours. Frequency in a defined population during a 12-year period. Acta Pathol Microbiol Scand A 84:322–330

    PubMed  CAS  Google Scholar 

  5. Panzuto F, Nasoni S, Falconi M et al (2005) Prognostic factors and survival in endocrine tumor patients: comparison between gastrointestinal and pancreatic localization. Endocr Relat Cancer 12:1083–1092

    Article  PubMed  Google Scholar 

  6. Madeira I, Terris B, Voss M et al (1998) Prognostic factors in patients with endocrine tumours of the duodenopancreatic area. Gut 43:422–427

    Article  PubMed  CAS  Google Scholar 

  7. Tomassetti P, Campana D, Piscitelli L et al (2005) Endocrine pancreatic tumors: factors correlated with survival. Ann Oncol 16:1806–1810

    Article  PubMed  CAS  Google Scholar 

  8. Sarmiento JM, Heywood G, Rubin J, Ilstrup DM, Nagorney DM, Que FG (2003) Surgical treatment of neuroendocrine metastases to the liver: a plea for resection to increase survival. J Am Coll Surg 197:29–37

    Article  PubMed  Google Scholar 

  9. Sarmiento JM, Que FG (2003) Hepatic surgery for metastases from neuroendocrine tumors. Surg Oncol Clin N Am 12:231–242

    Article  PubMed  Google Scholar 

  10. Elias D, Lasser P, Ducreux M et al (2003) Liver resection (and associated extrahepatic resections) for metastatic well-differentiated endocrine tumors: a 15-year single center prospective study. Surgery 133:375–382

    Article  PubMed  Google Scholar 

  11. Chamberlain RS, Canes D, Brown KT et al (2000) Hepatic neuroendocrine metastases: does intervention alter outcomes? J Am Coll Surg 190:432–445

    Article  PubMed  CAS  Google Scholar 

  12. Chen H, Hardacre JM, Uzar A, Cameron JL, Choti MA (1998) Isolated liver metastases from neuroendocrine tumors: does resection prolong survival? J Am Coll Surg 187:88–92, discussion 92–83

    Article  PubMed  CAS  Google Scholar 

  13. Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO (2007) MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA. Magn Reson Med Sci 6:43–52

    Article  PubMed  Google Scholar 

  14. Vogl TJ, Kummel S, Hammerstingl R et al (1996) Liver tumors: comparison of MR imaging with Gd-EOB-DTPA and Gd-DTPA. Radiology 200:59–67

    PubMed  CAS  Google Scholar 

  15. Huppertz A, Balzer T, Blakeborough A et al (2004) Improved detection of focal liver lesions at MR imaging: multicenter comparison of gadoxetic acid-enhanced MR images with intraoperative findings. Radiology 230:266–275

    Article  PubMed  Google Scholar 

  16. Buchmann I, Henze M, Engelbrecht S et al (2007) Comparison of 68Ga-DOTATOC PET and 111In-DTPAOC (Octreoscan) SPECT in patients with neuroendocrine tumours. Eur J Nucl Med Mol Imaging 34:1617–1626

    Article  PubMed  CAS  Google Scholar 

  17. Kowalski J, Henze M, Schuhmacher J, Macke HR, Hofmann M, Haberkorn U (2003) Evaluation of positron emission tomography imaging using [68Ga]-DOTA-D Phe(1)-Tyr(3)-Octreotide in comparison to [111In]-DTPAOC SPECT. First results in patients with neuroendocrine tumors. Mol Imaging Biol 5:42–48

    Article  PubMed  Google Scholar 

  18. Gabriel M, Decristoforo C, Kendler D et al (2007) 68Ga-DOTA-Tyr3-octreotide PET in neuroendocrine tumors: comparison with somatostatin receptor scintigraphy and CT. J Nucl Med 48:508–518

    Article  PubMed  CAS  Google Scholar 

  19. Antoch G, Bockisch A (2009) Combined PET/MRI: a new dimension in whole-body oncology imaging? Eur J Nucl Med Mol Imaging 36(Suppl 1):S113–120

    Article  PubMed  Google Scholar 

  20. Donati OF, Hany TF, Reiner CS et al (2010) Value of retrospective fusion of PET and MR images in detection of hepatic metastases: comparison with 18F-FDG PET/CT and Gd-EOB-DTPA-enhanced MRI. J Nucl Med 51:692–699

    Article  PubMed  Google Scholar 

  21. Zhernosekov KP, Filosofov DV, Baum RP et al (2007) Processing of generator-produced 68Ga for medical application. J Nucl Med 48:1741–1748

    Article  PubMed  CAS  Google Scholar 

  22. Domingues RC, Carneiro MP, Lopes FC, Domingues RC, da Fonseca LM, Gasparetto EL (2009) Whole-body MRI and FDG PET fused images for evaluation of patients with cancer. AJR Am J Roentgenol 192:1012–1020

    Article  PubMed  Google Scholar 

  23. Kim SK, Choi HJ, Park SY et al (2009) Additional value of MR/PET fusion compared with PET/CT in the detection of lymph node metastases in cervical cancer patients. Eur J Cancer 45:2103–2109

    Article  PubMed  Google Scholar 

  24. DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845

    Article  PubMed  CAS  Google Scholar 

  25. Ward J, Robinson PJ, Guthrie JA et al (2005) Liver metastases in candidates for hepatic resection: comparison of helical CT and gadolinium- and SPIO-enhanced MR imaging. Radiology 237:170–180

    Article  PubMed  Google Scholar 

  26. Niekel MC, Bipat S, Stoker J (2010) Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis of prospective studies including patients who have not previously undergone treatment. Radiology 257:674–684

    Article  PubMed  Google Scholar 

  27. Kong G, Jackson C, Koh DM et al (2008) The use of 18F-FDG PET/CT in colorectal liver metastases–comparison with CT and liver MRI. Eur J Nucl Med Mol Imaging 35:1323–1329

    Article  PubMed  CAS  Google Scholar 

  28. Debray MP, Geoffroy O, Laissy JP et al (2001) Imaging appearances of metastases from neuroendocrine tumours of the pancreas. Br J Radiol 74:1065–1070

    PubMed  CAS  Google Scholar 

  29. Paulson EK, McDermott VG, Keogan MT, DeLong DM, Frederick MG, Nelson RC (1998) Carcinoid metastases to the liver: role of triple-phase helical CT. Radiology 206:143–150

    PubMed  CAS  Google Scholar 

  30. Namasivayam S, Martin DR, Saini S (2007) Imaging of liver metastases: MRI. Cancer Imaging 7:2–9

    Article  PubMed  Google Scholar 

  31. Bader TR, Semelka RC, Chiu VC, Armao DM, Woosley JT (2001) MRI of carcinoid tumors: spectrum of appearances in the gastrointestinal tract and liver. J Magn Reson Imaging 14:261–269

    Article  PubMed  CAS  Google Scholar 

  32. Bluemke DA, Sahani D, Amendola M et al (2005) Efficacy and safety of MR imaging with liver-specific contrast agent: U.S. multicenter phase III study. Radiology 237:89–98

    Article  PubMed  Google Scholar 

  33. Halavaara J, Breuer J, Ayuso C et al (2006) Liver tumor characterization: comparison between liver-specific gadoxetic acid disodium-enhanced MRI and biphasic CT–a multicenter trial. J Comput Assist Tomogr 30:345–354

    Article  PubMed  Google Scholar 

  34. Kele PG, van der Jagt EJ (2010) Diffusion weighted imaging in the liver. World J Gastroenterol 16:1567–1576

    Article  PubMed  Google Scholar 

  35. Holzapfel K, Eiber MJ, Fingerle AA, Bruegel M, Rummeny EJ, Gaa J (2011) Detection, classification, and characterization of focal liver lesions: Value of diffusion-weighted MR imaging, gadoxetic acid-enhanced MR imaging and the combination of both methods Abdom Imaging. 2011 May 20. [Epub ahead of print]PMID: 21597893

  36. Kenis C, Deckers F, De Foer B, Van Mieghem F, Van Laere S, Pouillon M (2011) Diagnosis of liver metastases: Can diffusion-weighted imaging (DWI) be used as a stand alone sequence? Eur J Radiol. 2011 Mar 3. [Epub ahead of print] PMID: 21377305

  37. Ruf J, Heuck F, Schiefer J et al (2010) Impact of Multiphase 68Ga-DOTATOC-PET/CT on therapy management in patients with neuroendocrine tumors. Neuroendocrinology 91:101–109

    Article  PubMed  CAS  Google Scholar 

  38. Frilling A, Sotiropoulos GC, Radtke A et al (2010) The impact of 68Ga-DOTATOC positron emission tomography/computed tomography on the multimodal management of patients with neuroendocrine tumors. Ann Surg 252:850–856

    Article  PubMed  Google Scholar 

  39. Schillaci O, Spanu A, Scopinaro F et al (2003) Somatostatin receptor scintigraphy in liver metastasis detection from gastroenteropancreatic neuroendocrine tumors. J Nucl Med 44:359–368

    PubMed  CAS  Google Scholar 

  40. Baum RP (2009) Molecular imaging of neuroendocrine tumors using 68Ga-labeled peptides (Somatostatin Receptor PET/CT). Nuklearmediziner 32:115–130

    Article  Google Scholar 

  41. Cimitan M, Buonadonna A, Cannizzaro R et al (2003) Somatostatin receptor scintigraphy versus chromogranin A assay in the management of patients with neuroendocrine tumors of different types: clinical role. Ann Oncol 14:1135–1141

    Article  PubMed  CAS  Google Scholar 

  42. Rodrigues M, Gabriel M, Heute D, Putzer D, Griesmacher A, Virgolini I (2008) Concordance between results of somatostatin receptor scintigraphy with 111In-DOTA-DPhe 1-Tyr 3-octreotide and chromogranin A assay in patients with neuroendocrine tumours. Eur J Nucl Med Mol Imaging 35:1796–1802

    Article  PubMed  CAS  Google Scholar 

  43. Mussig K, Oksuz MO, Dudziak K et al (2010) Association of somatostatin receptor 2 immunohistochemical expression with [111In]-DTPA octreotide scintigraphy and [68Ga]-DOTATOC PET/CT in neuroendocrine tumors. Horm Metab Res 42:599–606

    Article  PubMed  CAS  Google Scholar 

  44. Kwekkeboom DJ, Krenning EP, Scheidhauer K et al (2009) ENETS consensus guidelines for the standards of care in neuroendocrine tumors: somatostatin receptor imaging with (111)In-pentetreotide. Neuroendocrinology 90:184–189

    Article  PubMed  CAS  Google Scholar 

  45. Seemann MD (2005) Whole-body PET/MRI: the future in oncological imaging. Technol Cancer Res Treat 4:577–582

    PubMed  Google Scholar 

  46. Hicks RJ, Lau EW (2009) PET/MRI: a different spin from under the rim. Eur J Nucl Med Mol Imaging 36(Suppl 1):S10–14

    Article  PubMed  Google Scholar 

  47. Rockall AG, Reznek RH (2007) Imaging of neuroendocrine tumours (CT/MR/US). Best Pract Res Clin Endocrinol Metab 21:43–68

    Article  PubMed  CAS  Google Scholar 

  48. Lemke AJ, Niehues SM, Hosten N et al (2004) Retrospective digital image fusion of multidetector CT and 18F-FDG PET: clinical value in pancreatic lesions–a prospective study with 104 patients. J Nucl Med 45:1279–1286

    PubMed  Google Scholar 

  49. Amthauer H, Ruf J, Bohmig M et al (2004) Diagnosis of neuroendocrine tumours by retrospective image fusion: is there a benefit? Eur J Nucl Med Mol Imaging 31:342–348

    Article  PubMed  CAS  Google Scholar 

  50. Prasad V, Ambrosini V, Hommann M, Hoersch D, Fanti S, Baum RP (2010) Detection of unknown primary neuroendocrine tumours (CUP-NET) using (68)Ga-DOTA-NOC receptor PET/CT. Eur J Nucl Med Mol Imaging 37:67–77

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Charité, Augustenburger Platz 1, 13353, Berlin, Germany

    Nils F. Schreiter, Ingo Steffen, Winfried Brenner & Rainer Röttgen

  2. Department of Nuclear Medicine, Kochi University, Kochi, Japan

    Munenobu Nogami

  3. Department of Gastroenterology, Charité, Berlin, Germany

    Ulrich-Frank Pape

  4. Department of Radiology, Charité, Berlin, Germany

    Bernd Hamm

Authors
  1. Nils F. Schreiter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Munenobu Nogami
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ingo Steffen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ulrich-Frank Pape
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bernd Hamm
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Winfried Brenner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rainer Röttgen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nils F. Schreiter.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schreiter, N.F., Nogami, M., Steffen, I. et al. Evaluation of the potential of PET-MRI fusion for detection of liver metastases in patients with neuroendocrine tumours. Eur Radiol 22, 458–467 (2012). https://doi.org/10.1007/s00330-011-2266-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-011-2266-4

Keywords

Search

Navigation