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Evaluation of 68Ga-DOTA-TOC PET/CT for the detection of duodenopancreatic neuroendocrine tumors in patients with MEN1

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Context

Somatostatin receptor scintigraphy with 111In-pentetreotide (SRS) is used to detect duodenopancreatic neuroendocrine tumors (dpNETs) in multiple endocrine neoplasia type 1 (MEN1). However, SRS has limited sensitivity for this purpose. Positron emission tomography/computed tomography (PET/CT) with 68Ga-DOTA-TOC has a higher rate of sporadic dpNETs detection than SRS but there is little data for dpNETs detection in MEN1.

Purpose

To compare the performances of 68Ga-DOTA-TOC PET/CT, SRS and contrast-enhanced computed tomography (CE-CT) to diagnose dpNETs in MEN1.

Design and setting

Single-institution prospective comparative study

Patients and methods

Nineteen consecutive MEN1 patients (aged 47 ± 13 years) underwent 68Ga-DOTA-TOC PET/CT, SRS, and CE-CT within 2 months in random order. Blinded readings of images were performed separately by experienced physicians. Unblinded analysis of CE-CT, combined with additional magnetic resonance imaging, endoscopic-ultrasound, 18F-2-fluoro-deoxy-d-glucose (18F-FDG) PET/CT or histopathology results served as reference standard for dpNETs diagnosis.

Results

The sensitivity of 68Ga-DOTA-TOC PET/CT, SRS, and CE-CT was 76, 20, and 60 %, respectively (p < 0.0001). All the true-positive lesions detected by SRS were also depicted on 68Ga-DOTA-TOC PET/CT. 68Ga-DOTA-TOC PET/CT detected lesions of smaller size than SRS (10.7 ± 7.6 and 15.2 ± 5.9 mm, respectively, p < 0.03). False negatives of 68Ga-DOTA-TOC PET/CT included small dpNETs (<10 mm) and 18F-FDG PET/CT positive aggressive dpNETs. No false positives were recorded. In addition, whole-body mapping with 68Ga-DOTA-TOC PET/CT identified extra-abdominal MEN1-related tumors including one neuroendocrine thymic carcinoma identified by the three imaging procedures, one bronchial carcinoid undetected by CE-CT and three meningiomas undetected by SRS.

Conclusions

Owing to higher diagnostic performance, 68Ga-DOTA-TOC PET/CT (or alternative 68Ga-labeled somatostatin analogues) should replace 111In-pentetreotide in the investigation of MEN1 patients.

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Acknowledgments

We thank Dr. F Debordeaux for participation in quality controls and preparation of 111In-pentetreotide and Mrs. C. Blair for grammatical revision of the manuscript. This study has been funded by “La Ligue contre le Cancer” and was achieved within the context of the Laboratory of Excellence TRAIL ANR-10-LABX-57. The authors declare that they have no conflicts of interest.

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    Authors and Affiliations

    1. CNRS, INCIA, UMR 5287, 33000, Bordeaux, France

      Clément Morgat, Delphine Vimont, Jürgen Schulz, Joachim Mazère, Elif Hindié & Philippe Fernandez

    2. University of Bordeaux, INCIA, UMR 5287, 33000, Bordeaux, France

      Clément Morgat, Delphine Vimont, Jürgen Schulz, Joachim Mazère, Elif Hindié & Philippe Fernandez

    3. Department of Nuclear Medicine, University Hospital of Bordeaux, 33000, Bordeaux, France

      Clément Morgat, Paul Schwartz, Martine Guyot, Joachim Mazère, Elif Hindié & Philippe Fernandez

    4. Department of Endocrinology, USN Haut-Lévêque, 33604, Pessac, France

      Fritz-Line Vélayoudom-Céphise, Marie-Laure Nunes & Antoine Tabarin

    5. Department of Radiology, University Hospital of Bordeaux, 33604, Pessac, France

      Delphine Gaye

    6. Department of Oncology, University Hospital of Bordeaux, 33000, Bordeaux, France

      Denis Smith

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    1. Clément Morgat
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    Correspondence to Clément Morgat.

    Ethics declarations

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

    Financial support

    This work was funded by La Ligue contre le Cancer and was achieved within the context of the Laboratory of Excellence TRAIL ANR-10-LABX-57.

    Additional information

    Clément Morgat and Fritz-Line Vélayoudom-Céphise are both first co-authors.

    Philippe Fernandez and Antoine Tabarin contributed equally to this work.

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    Morgat, C., Vélayoudom-Céphise, FL., Schwartz, P. et al. Evaluation of 68Ga-DOTA-TOC PET/CT for the detection of duodenopancreatic neuroendocrine tumors in patients with MEN1. Eur J Nucl Med Mol Imaging 43, 1258–1266 (2016). https://doi.org/10.1007/s00259-016-3319-3

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