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Vertebral metastases from neuroendocrine tumours: How to avoid false positives on 68Ga-DOTA-TOC PET using CT pattern analysis?

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To develop criteria to improve discrimination between vertebral metastases from neuroendocrine tumours (NETs) and benign bone lesions on PET combined with CT using DOTA-D-Phe1-Tyr3-octreotide labelled with gallium-68 (68Ga-DOTA-TOC).

Methods

In 535 NET patients, 68Ga-DOTA-TOC PET/CT examinations were reviewed retrospectively for vertebral CT lesions and/or PET foci. For each vertebral PET abnormality, appearance on CT, biological volume (BV), standardized uptake value (SUVmax) and ratios to those of reference organs were determined. All vertebral abnormalities were characterized as a metastasis, a typical vertebral haemangioma (VH) or other benign lesion.

Results

In 79 patients (14.8 %), we found 107 metastases, 34 VHs and 31 other benign lesions in the spine. The optimal cut-off values to differentiate metastases from benign lesions were BV ≥0.72 cm3, SUVmax ≥2, SUVmax ratio to a reference vertebra ≥2.1, to liver ≥0.28 and to spleen ≥0.14. They corresponded to lesion-based 68Ga-DOTA-TOC PET/CT sensitivity of 87 %, 98 %, 97 %, 99 % and 94 %, and specificity of 55 %, 100 %, 90 %, 97 %, 100 %, respectively.

Conclusions

The high sensitivity of 68Ga-DOTA-TOC-PET/CT in detecting NET vertebral metastases was confirmed; this study showed that specificity could be improved by combining CT features and quantifying 68Ga-DOTA-TOC uptake.

Key Points

• Bone metastases in neuroendocrine tumours correlate with prognosis.

• Benign bone lesions may mimic metastases on 68 Ga-DOTA-TOC PET/CT imaging.

• The specific polka-dot CT pattern may be missing in some vertebral haemangiomas.

• Lesion atypical for haemangiomas can be better characterized by quantifying 68 Ga-DOTA-TOC uptake.

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Abbreviations

AUC:

Area under the curve

BV:

Biological volume

CT:

Computed tomography

DOTA:

1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid

DOTA-TOC:

Edotreotide

FDG:

18F-fluorodeoxyglucose

68Ga:

Gallium-68

MRI:

Magnetic resonance imaging

NET:

Neuroendocrine tumour

NPV:

Negative predictive value

OSEM:

Ordered Subsets Expectation-Maximization

PET:

Positron emission tomography

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

RV:

Reference vertebra

Se:

Sensitivity

SOT:

Standard of truth

Sp:

Specificity

SR:

Somatostatin receptor

SR-2:

Somatostatin receptors subtype 2

SUV:

Standardized uptake value

TOC:

Tyr3-octreotide

VH:

Vertebral haemangioma

VOI:

Volume of interest

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Acknowledgements

This study includes the data of a ‘Projet de recherche clinique’ PHRC P040303 sponsored by Assistance Publique-Hôpitaux de Paris monitored by Mrs Zakia Idir. We acknowledge the help of the Cancer Est Clinical Research Assistants during the clinical trial. We thank the referring physicians for their confidence and the medical technologists of our department for their commitment to PET/CT imaging. We thank Professor Ralph McCready for his assistance with editing the manuscript.

Funding

The authors state that this retrospective analysis of data of a prospective series has not received any funding.

Author information

Authors and Affiliations

  1. Médecine Nucléaire, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France

    Mathieu Gauthé, Jessica Ohnona, Valérie Nataf, Françoise Montravers & Jean-Noël Talbot

  2. Université P&M Curie, Paris, France

    Mathieu Gauthé, Jessica Ohnona, Valérie Nataf, Françoise Montravers & Jean-Noël Talbot

  3. Nuclear Medicine, CHU de Granada, Granada, Spain

    Nathalie Testart Dardel

  4. Radiology Department, CHU de Granada, Granada, Spain

    Fernando Ruiz Santiago

Authors
  1. Mathieu Gauthé
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  2. Nathalie Testart Dardel
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  3. Fernando Ruiz Santiago
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  4. Jessica Ohnona
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  5. Valérie Nataf
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  7. Jean-Noël Talbot
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Corresponding author

Correspondence to Mathieu Gauthé.

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Guarantor

The scientific guarantor of this publication is Prof. J.N. Talbot.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic study

• performed at one institution

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Gauthé, M., Testart Dardel, N., Ruiz Santiago, F. et al. Vertebral metastases from neuroendocrine tumours: How to avoid false positives on 68Ga-DOTA-TOC PET using CT pattern analysis?. Eur Radiol 28, 3943–3952 (2018). https://doi.org/10.1007/s00330-017-5294-x

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  • DOI: https://doi.org/10.1007/s00330-017-5294-x

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