Skip to main content
SpringerLink
Log in

Nuclear Medicine Imaging Techniques of the Neuroendocrine System

  • Chapter
  • First Online:
Clinical Nuclear Medicine

  • 1382 Accesses

Abstract

Nuclear medicine plays a major role in well-differentiated neuroendocrine tumors (NETs). Due to the unique characteristics of NETs, such as very high expression of somatostatin receptors, somatostatin receptor positron emission tomography (SSTR PET) is considered the gold standard in imaging. SSTR PET has proven its unsurpassed diagnostic accuracy in prospective trials and has a major influence on the choice of the right treatment. Its use is well established, and it is recommended for initial staging, treatment monitoring, and the follow-up of patients with NET. In other tumors of the neuroendocrine system, such as pheochromocytoma and paraganglioma, nuclear medicine offers several diagnostic approaches for enhanced diagnosis. [123I]-MIBG scintigraphy, including single-photon emission computed tomography (SPECT), is of great value, especially in hormone-active tumors. PET tracers such as fluorodeoxyglucose (FDG), [18F]-DOPA, and SSTR analogs have been introduced recently and offer similar diagnostic accuracy. In neuroblastoma, [123I]-MIBG scintigraphy is the imaging of choice for staging and treatment monitoring. In medullary thyroid cancer, FDG, SSTR, and [18F]-DOPA PET/CT can be considered as modalities with equal diagnostic accuracy.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Yao JC, Hassan M, Phan A, et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008;26:3063–72.

    Google Scholar 

  2. Binderup T, Knigge U, Loft A, Federspiel B, Kjaer A. 18F-fluorodeoxyglucose positron emission tomography predicts survival of patients with neuroendocrine tumors. Clin Cancer Res. 2010;16:978–85.

    CAS  PubMed  Google Scholar 

  3. Schillaci O. Somatostatin receptor imaging in patients with neuroendocrine tumors: not only SPECT? J Nucl Med. 2007;48:498–500.

    PubMed  Google Scholar 

  4. Kabasakal L, Demirci E, Ocak M, et al. Comparison of (6)(8)Ga-DOTATATE and (6)(8)Ga-DOTANOC PET/CT imaging in the same patient group with neuroendocrine tumours. Eur J Nucl Med Mol Imaging. 2012;39:1271–7.

    PubMed  Google Scholar 

  5. Poeppel TD, Binse I, Petersenn S, et al. 68Ga-DOTATOC versus 68Ga-DOTATATE PET/CT in functional imaging of neuroendocrine tumors. J Nucl Med. 2011;52:1864–70.

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  7. Srirajaskanthan R, Kayani I, Quigley AM, Soh J, Caplin ME, Bomanji J. The role of 68Ga-DOTATATE PET in patients with neuroendocrine tumors and negative or equivocal findings on 111In-DTPA-octreotide scintigraphy. J Nucl Med. 2010;51:875–82.

    CAS  PubMed  Google Scholar 

  8. Sadowski SM, Neychev V, Millo C, et al. Prospective study of 68Ga-DOTATATE positron emission tomography/computed tomography for detecting gastro-entero-pancreatic neuroendocrine tumors and unknown primary sites. J Clin Oncol. 2016;34:588–96.

    CAS  PubMed  Google Scholar 

  9. Bozkurt MF, Virgolini I, Balogova S, et al. Guideline for PET/CT imaging of neuroendocrine neoplasms with (68)Ga-DOTA-conjugated somatostatin receptor targeting peptides and (18)F-DOPA. Eur J Nucl Med Mol Imaging. 2017;44:1588–601.

    CAS  PubMed  Google Scholar 

  10. Boy C, Poeppel T, Kotzerke J, et al. Somatostatin receptor PET/CT (SSTR-PET/CT). Nuklearmedizin. 2018;57:4–17.

    CAS  PubMed  Google Scholar 

  11. Haug AR, Rominger A, Mustafa M, et al. Treatment with octreotide does not reduce tumor uptake of (68)Ga-DOTATATE as measured by PET/CT in patients with neuroendocrine tumors. J Nucl Med. 2011;52:1679–83.

    CAS  PubMed  Google Scholar 

  12. Haug AR, Cindea-Drimus R, Auernhammer CJ, et al. The role of 68Ga-DOTATATE PET/CT in suspected neuroendocrine tumors. J Nucl Med. 2012;53:1686–92.

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  14. Barrio M, Czernin J, Fanti S, et al. The impact of somatostatin receptor-directed PET/CT on the management of patients with neuroendocrine tumor: a systematic review and meta-analysis. J Nucl Med. 2017;58:756–61.

    PubMed  Google Scholar 

  15. Ilhan H, Fendler WP, Cyran CC, et al. Impact of (68)Ga-DOTATATE PET/CT on the surgical management of primary neuroendocrine tumors of the pancreas or ileum. Ann Surg Oncol. 2015;22:164–71.

    PubMed  Google Scholar 

  16. Koch W, Auernhammer CJ, Geisler J, et al. Treatment with octreotide in patients with well-differentiated neuroendocrine tumors of the ileum: prognostic stratification with Ga-68-DOTA-TATE positron emission tomography. Mol Imaging. 2014;13:1–10.

    CAS  PubMed  Google Scholar 

  17. Haug AR, Auernhammer CJ, Wangler B, et al. 68Ga-DOTATATE PET/CT for the early prediction of response to somatostatin receptor-mediated radionuclide therapy in patients with well-differentiated neuroendocrine tumors. J Nucl Med. 2010;51:1349–56.

    CAS  PubMed  Google Scholar 

  18. Kratochwil C, Stefanova M, Mavriopoulou E, et al. SUV of [68Ga]DOTATOC-PET/CT predicts response probability of PRRT in neuroendocrine tumors. Mol Imaging Biol. 2015;17(3):313–8.

    Google Scholar 

  19. Ruf J, Schiefer J, Furth C, et al. 68Ga-DOTATOC PET/CT of neuroendocrine tumors: spotlight on the CT phases of a triple-phase protocol. J Nucl Med. 2011;52:697–704.

    PubMed  Google Scholar 

  20. Kwekkeboom DJ, de Herder WW, Kam BL, et al. Treatment with the radiolabeled somatostatin analog [177 Lu-DOTA 0,Tyr3]octreotate: toxicity, efficacy, and survival. J Clin Oncol. 2008;26:2124–30.

    CAS  PubMed  Google Scholar 

  21. Boninsegna L, Panzuto F, Partelli S, et al. Malignant pancreatic neuroendocrine tumour: lymph node ratio and Ki67 are predictors of recurrence after curative resections. Eur J Cancer. 2012;48:1608–15.

    Google Scholar 

  22. Haug AR, Cindea-Drimus R, Auernhammer CJ, et al. Neuroendocrine tumor recurrence: diagnosis with 68Ga-DOTATATE PET/CT. Radiology. 2013;270(2):517–25.

    PubMed  Google Scholar 

  23. Berzaczy D, Giraudo C, Haug AR, et al. Whole-body 68Ga-DOTANOC PET/MRI versus 68Ga-DOTANOC PET/CT in patients with neuroendocrine tumors: a prospective study in 28 patients. Clin Nucl Med. 2017;42:669–74.

    PubMed  PubMed Central  Google Scholar 

  24. Sawicki LM, Deuschl C, Beiderwellen K, et al. Evaluation of (68)Ga-DOTATOC PET/MRI for whole-body staging of neuroendocrine tumours in comparison with (68)Ga-DOTATOC PET/CT. Eur Radiol. 2017;27:4091–9.

    PubMed  Google Scholar 

  25. Wang X, Fani M, Schulz S, Rivier J, Reubi JC, Maecke HR. Comprehensive evaluation of a somatostatin-based radiolabelled antagonist for diagnostic imaging and radionuclide therapy. Eur J Nucl Med Mol Imaging. 2012;39(12):1876–85.

    CAS  PubMed  Google Scholar 

  26. Nicolas GP, Schreiter N, Kaul F, et al. Sensitivity comparison of (68)Ga-OPS202 and (68)Ga-DOTATOC PET/CT in patients with gastroenteropancreatic neuroendocrine tumors: a prospective phase II imaging study. J Nucl Med. 2018;59:915–21.

    CAS  PubMed  Google Scholar 

  27. Bombardieri E, Aktolun C, Baum RP, et al. 131I/123I-metaiodobenzylguanidine (MIBG) scintigraphy: procedure guidelines for tumour imaging. Eur J Nucl Med Mol Imaging. 2003;30:BP132–9.

    PubMed  Google Scholar 

  28. Rufini V, Treglia G, Castaldi P, Perotti G, Giordano A. Comparison of metaiodobenzylguanidine scintigraphy with positron emission tomography in the diagnostic work-up of pheochromocytoma and paraganglioma: a systematic review. Q J Nucl Med Mol Imaging. 2013;57:122–33.

    CAS  PubMed  Google Scholar 

  29. Fiebrich HB, Brouwers AH, Kerstens MN, et al. 6-[F-18]Fluoro-L-dihydroxyphenylalanine positron emission tomography is superior to conventional imaging with (123)I-metaiodobenzylguanidine scintigraphy, computer tomography, and magnetic resonance imaging in localizing tumors causing catecholamine excess. J Clin Endocrinol Metab. 2009;94:3922–30.

    CAS  PubMed  Google Scholar 

  30. Timmers HJ, Chen CC, Carrasquillo JA, et al. Comparison of 18F-fluoro-L-DOPA, 18F-fluoro-deoxyglucose, and 18F-fluorodopamine PET and 123I-MIBG scintigraphy in the localization of pheochromocytoma and paraganglioma. J Clin Endocrinol Metab. 2009;94:4757–67.

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Chang CA, Pattison DA, Tothill RW, et al. (68)Ga-DOTATATE and (18)F-FDG PET/CT in paraganglioma and pheochromocytoma: utility, patterns and heterogeneity. Cancer Imaging. 2016;16:22.

    PubMed  PubMed Central  Google Scholar 

  32. Jing H, Li F, Wang L, et al. Comparison of the 68Ga-DOTATATA PET/CT, FDG PET/CT, and MIBG SPECT/CT in the evaluation of suspected primary pheochromocytomas and paragangliomas. Clin Nucl Med. 2017;42:525–9.

    PubMed  Google Scholar 

  33. Howman-Giles R, Shaw PJ, Uren RF, Chung DK. Neuroblastoma and other neuroendocrine tumors. Semin Nucl Med. 2007;37:286–302.

    PubMed  Google Scholar 

  34. Huang SY, Bolch WE, Lee C, et al. Patient-specific dosimetry using pretherapy [(1)(2)(4)I]m-iodobenzylguanidine ([(1)(2)(4)I]mIBG) dynamic PET/CT imaging before [(1)(3)(1)I]mIBG targeted radionuclide therapy for neuroblastoma. Mol Imaging Biol. 2015;17:284–94.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Ishiguchi H, Ito S, Kato K, et al. Diagnostic performance of (18)F-FDG PET/CT and whole-body diffusion-weighted imaging with background body suppression (DWIBS) in detection of lymph node and bone metastases from pediatric neuroblastoma. Ann Nucl Med. 2018;32:348–62.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. Kong G, Hofman MS, Murray WK, et al. Initial experience with Gallium-68 DOTA-octreotate PET/CT and peptide receptor radionuclide therapy for pediatric patients with refractory metastatic neuroblastoma. J Pediatr Hematol Oncol. 2016;38:87–96.

    CAS  PubMed  Google Scholar 

  37. Treglia G, Tamburello A, Giovanella L. Detection rate of somatostatin receptor PET in patients with recurrent medullary thyroid carcinoma: a systematic review and a meta-analysis. Hormones (Athens). 2017;16:362–72.

    Google Scholar 

  38. Conry BG, Papathanasiou ND, Prakash V, et al. Comparison of (68)Ga-DOTATATE and (18)F-fluorodeoxyglucose PET/CT in the detection of recurrent medullary thyroid carcinoma. Eur J Nucl Med Mol Imaging. 2009;37(1):49–57.

    Google Scholar 

  39. Hoegerle S, Altehoefer C, Ghanem N, Brink I, Moser E, Nitzsche E. 18F-DOPA positron emission tomography for tumour detection in patients with medullary thyroid carcinoma and elevated calcitonin levels. Eur J Nucl Med. 2001;28:64–71.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria

    Alexander Haug

Authors
  1. Alexander Haug
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander Haug .

Editor information

Editors and Affiliations

  1. Department of Nuclear Medicine, Klinikum Westfalen - Knappschaftskrankenhaus Academic teaching hospital of the Ruhr University, Dortmund, Nordrhein-Westfalen, Germany

    Hojjat Ahmadzadehfar

  2. Department of Nuclear Medicine, Beta Klinik Bonn, Bonn, Germany

    Hans-Jürgen Biersack

  3. Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Bronx, NY, USA

    Leonard M. Freeman

  4. Albert Einstein College of Medicine, Bronx, NY, USA

    Lionel S. Zuckier

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Haug, A. (2020). Nuclear Medicine Imaging Techniques of the Neuroendocrine System. In: Ahmadzadehfar, H., Biersack, HJ., Freeman, L., Zuckier, L. (eds) Clinical Nuclear Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-39457-8_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-39457-8_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-39455-4

  • Online ISBN: 978-3-030-39457-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation