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[68Ga]DOTATATE PET/MRI and [18F]FDG PET/CT are complementary and superior to diffusion-weighted MR imaging for radioactive-iodine-refractory differentiated thyroid cancer

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

Abstract

Purpose

The purpose of this study was to determine whether [68Ga]DOTATATE PET/MRI with diffusion-weighted imaging (DWI) can replace or complement [18F]FDG PET/CT in patients with radioactive-iodine (RAI)-refractory differentiated thyroid cancer (DTC).

Methods

The study population comprised 12 patients with elevated thyroglobulin and a negative RAI scan after thyroidectomy and RAI remnant ablation who underwent both [18F]FDG PET/CT and [68Ga]DOTATATE PET/MRI within 8 weeks of each other. The presence of recurrent cancer was evaluated on a per-patient, per-organ and per-lesion basis. Histology, and prior and follow-up examinations served as the standard of reference.

Results

Recurrent or metastatic tumour was confirmed in 11 of the 12 patients. [68Ga]DOTATATE PET(/MRI) correctly identified the tumour burden in all 11 patients, whereas in one patient local relapse was missed by [18F]FDG PET/CT. In the lesion-based analysis, overall lesion detection rates were 79/85 (93 %), 69/85 (81 %) and 27/82 (33 %) for [18F]FDG PET/CT, [68Ga]DOTATATE PET/MRI and DWI, respectively. [18F]FDG PET(/CT) was superior to [68Ga]DOTATATE PET(/MRI) in the overall evaluation and in the detection of pulmonary metastases. In the detection of extrapulmonary metastases, [68Ga]DOTATATE PET(/MRI) showed a higher sensitivity than [18F]FDG PET(/CT), at the cost of lower specificity. DWI achieved only poor sensitivity and was significantly inferior to [18F]FDG PET in the lesion-based evaluation in the detection of both extrapulmonary and pulmonary metastases.

Conclusion

[18F]FDG PET/CT was more sensitive than [68Ga]DOTATATE PET/MRI in the evaluation of RAI-refractory DTC, mostly because of its excellent ability to detect lung metastases. In the evaluation of extrapulmonary lesions, [68Ga]DOTATATE PET(/MRI) was more sensitive and [18F]FDG PET(/CT) more specific. Furthermore, DWI did not provide additional information and cannot replace [18F]FDG PET for postoperative monitoring of patients with suspected RAI-refractory DTC.

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Acknowledgments

We are grateful to Florian Büther, PhD, for his help with PET physics and the imaging staff of both our departments, in particular Mrs. Anne Kanzog and Mr. Stan Milachowski.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital Münster, Münster, Germany

    Alexis Vrachimis, Lars Stegger, Christian Wenning, Benjamin Noto, Julia Renate Konnert, Burkhard Riemann, Michael Schäfers & Matthias Weckesser

  2. DFG CRC 656 ‘Molecular Cardiovascular Imaging’, Westfälische Wilhelms University Münster, Münster, Germany

    Alexis Vrachimis & Michael Schäfers

  3. Institute for Clinical Radiology, University Hospital Münster, Münster, Germany

    Matthias Christian Burg, Thomas Allkemper & Walter Heindel

  4. European Institute of Molecular Imaging, Westfälische Wilhelms University Münster, Münster, Germany

    Michael Schäfers

  5. DFG EXC 1003 ‘Cells in Motion’ Cluster of Excellence, Westfälische Wilhelms University Münster, Münster, Germany

    Michael Schäfers

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  1. Alexis Vrachimis
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  2. Lars Stegger
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Correspondence to Alexis Vrachimis.

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Ethical approval

All procedures were in accordance with the ethical standards of the institutional national and committee on human experimentation and the principles of the 1975 Declaration of Helsinki, as revised in 2008. The institutional review board of the Medical Association of Westphalia-Lippe and the Faculty of Medicine, University of Münster, approved this prospective study.

Informed consent

Informed consent was obtained from all individual participants recruited for this study.

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Suppl. Figure 1

A 65-year-old patient with local relapse (confirmed by histology) in the left thyroid bed (arrow) detected by [68Ga]DOTATATE PET/MRI (A) and missed by [18F]FDG PET/CT (B). (PPTX 830 kb)

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Vrachimis, A., Stegger, L., Wenning, C. et al. [68Ga]DOTATATE PET/MRI and [18F]FDG PET/CT are complementary and superior to diffusion-weighted MR imaging for radioactive-iodine-refractory differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 43, 1765–1772 (2016). https://doi.org/10.1007/s00259-016-3378-5

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  • DOI: https://doi.org/10.1007/s00259-016-3378-5

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