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European Journal of Nuclear Medicine and Molecular Imaging

Erschienen in:

01.06.2015 | Review Article

Nuclear imaging of neuroendocrine tumors with unknown primary: why, when and how?

verfasst von: Prasanna Santhanam, Sangeeta Chandramahanti, Alexander Kroiss, Run Yu, Philippe Ruszniewski, Rakesh Kumar, David Taïeb

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 7/2015

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Abstract

Neuroendocrine tumors (NETs) with unknown primary (CUP-NET) are associated with a poor prognosis (10-year survival 22 %), grade 1 and 2 NETs having a more favorable outcome than grade 3 (also called carcinoma). There is evidence that an effort should be made to localize the primary tumor even in the presence of metastasis because resection of the primary tumor(s) may improve disease-free and overall survival, and because the choice of chemotherapeutic agent depends on the location of the primary tumor. Localization of the tumors remains challenging and often relies on a combination of radiological, endoscopic and functional imaging. The functional imaging protocol for evaluation of these patients has historically relied on somatostatin receptor scintigraphy (SRS). However, the sensitivity and specificity of SRS may be unsatisfactory, especially for NETs of midgut origin. Newer PET radiotracers such as ⁶⁸Ga-labeled somatostatin analogs (⁶⁸Ga-DOTA-SSTa) and ¹⁸F-DOPA have shown promise. In direct comparisons between ⁶⁸Ga-DOTA-SSTa PET/CT and ^99mTc-HYNIC-octreotide/¹¹¹In-pentetreotide SPECT(/CT), ⁶⁸Ga-DOTA-SSTa performed better than other techniques, giving a compelling reason for switching from SPECT/CT to PET/CT imaging. ¹⁸F-DOPA performs better than SRS and CT in well-differentiated NETs of the small intestine. For detecting pancreatic NETs, the high background uptake of ¹⁸F-DOPA by the normal exocrine pancreas can be somewhat overcome by pretreatment with carbidopa. We have suggested a protocol in which SRS is replaced by one of the two agents (preferably with ⁶⁸Ga-DOTA-SSTa, alternatively ¹⁸F-DOPA) as first-line nuclear tracer for detection of CUP-NET in patients with well-differentiated NETs and ¹⁸F-FDG PET/CT may be an additional diagnostic test for poorly differentiated tumors and for prognostication. In the near future, it is expected that patients with CUP-NET will benefit from newly developed PET approaches (radiopharmaceuticals) and intraoperative PET imaging.

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Titel: Nuclear imaging of neuroendocrine tumors with unknown primary: why, when and how?
verfasst von: Prasanna Santhanam
Sangeeta Chandramahanti
Alexander Kroiss
Run Yu
Philippe Ruszniewski
Rakesh Kumar
David Taïeb
Publikationsdatum: 01.06.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 7/2015
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-015-3027-4

Springer Medizin

Abstract

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