[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

  • Alexis VrachimisEmail author
  • Lars Stegger
  • Christian Wenning
  • Benjamin Noto
  • Matthias Christian Burg
  • Julia Renate Konnert
  • Thomas Allkemper
  • Walter Heindel
  • Burkhard Riemann
  • Michael Schäfers
  • Matthias Weckesser
Original Article



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).


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.


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.


[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.


DWI DTC Extrapulmonary metastases Pulmonary metastases 



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.

Compliance with ethical standards



Conflicts of interest


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.

Supplementary material

259_2016_3378_MOESM1_ESM.pptx (830 kb)
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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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Alexis Vrachimis
    • 1
    • 2
    Email author
  • Lars Stegger
    • 1
  • Christian Wenning
    • 1
  • Benjamin Noto
    • 1
  • Matthias Christian Burg
    • 3
  • Julia Renate Konnert
    • 1
  • Thomas Allkemper
    • 3
  • Walter Heindel
    • 3
  • Burkhard Riemann
    • 1
  • Michael Schäfers
    • 1
    • 2
    • 4
    • 5
  • Matthias Weckesser
    • 1
  1. 1.Department of Nuclear MedicineUniversity Hospital MünsterMünsterGermany
  2. 2.DFG CRC 656 ‘Molecular Cardiovascular Imaging’Westfälische Wilhelms University MünsterMünsterGermany
  3. 3.Institute for Clinical RadiologyUniversity Hospital MünsterMünsterGermany
  4. 4.European Institute of Molecular ImagingWestfälische Wilhelms University MünsterMünsterGermany
  5. 5.DFG EXC 1003 ‘Cells in Motion’ Cluster of ExcellenceWestfälische Wilhelms University MünsterMünsterGermany

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