European Radiology

, Volume 22, Issue 4, pp 938–946 | Cite as

Are contrast media required for (68)Ga-DOTATOC PET/CT in patients with neuroendocrine tumours of the abdomen?

  • Marius E. Mayerhoefer
  • Matthias Schuetz
  • Silvia Magnaldi
  • Michael Weber
  • Siegfried Trattnig
  • Georgios Karanikas
Oncology

Abstract

Objectives

To determine the value of intravenous contrast medium in (68)Ga-DOTA-Phe(1)-Tyr(3)-octreotide – (68)Ga-DOTATOC – PET/CT for the detection of abdominal neuroendocrine tumours (NET).

Methods

In fifty-five patients with known or suspected NETs of the abdomen PET/CT was performed on a 64-row multi-detector hybrid system. For PET, 150 MBq of (68)Ga-DOTATOC were injected intravenously. Full-dose unenhanced, and arterial- and venous-phase contrast-enhanced CT images were obtained. Unenhanced and contrast-enhanced PET/CT images were evaluated separately for the presence of NETs on a per-region basis, by two separate teams with different experience levels.

Results

On unenhanced PET/CT, sensitivity and specificity ranged from 89.3% (junior team) to 92% (senior team), and 99.1% (junior team) to 99.2% (senior team), respectively. On contrast-enhanced PET/CT, sensitivity and specificity ranged from 92.3% (junior team) to 98.5% (senior team), and 99.4% (junior team) to 99.5% (senior team), respectively. These increases in sensitivity and specificity, due to the use of contrast-enhanced images, were statistically significant (P < 0.05).

Conclusions

Intravenous contrast medium only moderately, aleit significantly, improves the sensitivity of (68)Ga-DOTATOC PET/CT for the detection of abdominal NETs, and hardly affects specificity. Thus, while contrast enhancement is justified to achieve maximum sensitivity, unenhanced images may be sufficient for routine PET/CT in NET patients.

Key Points

Contrast media moderately improve the sensitivity of (68)Ga-DOTATOC PET/CT for neuroendocrine tumours.

Contrast media hardly affect the specificity of (68)Ga-DOTATOC PET/CT for neuroendocrine tumours.

Unenhanced PET/CT is sufficient for routine imaging of patients with neuroendocrine tumours.

Keywords

PET/CT (68)Ga-DOTATOC NET Contrast media 

References

  1. 1.
    Joseph S, Wang YZ, Boudreaux JP, Anthony LB, Campeau R, Raines D et al (2011) Neuroendocrine tumors: current recommendations for diagnosis and surgical management. Endocrinol Metab Clin North Am 40:205–231PubMedCrossRefGoogle Scholar
  2. 2.
    Scarpa M, Prando D, Pozza A, Esposti ED, Castoro C, Angriman I (2011) A systematic review of diagnostic procedures to detect midgut neuroendocrine tumors. J Surg Oncol 102:877–888CrossRefGoogle Scholar
  3. 3.
    Lawrence B, Gustafsson BI, Chan A, Svejda B, Kidd M, Modlin IM (2011) The epidemiology of gastroenteropancreatic neuroendocrine tumors. Endocrinol Metab Clin North Am 40:1–18PubMedCrossRefGoogle Scholar
  4. 4.
    Seregni E, Chiti A, Bombardieri E (1998) Radionuclide imaging of neuroendocrine tumours: biological basis and diagnostic results. Eur J Nucl Med 25:639–658PubMedCrossRefGoogle Scholar
  5. 5.
    Reubi JC, Waser B (2003) Concomitant expression of several peptide receptors in neuroendocrine tumors: molecular basis for in vivo multireceptor tumour targeting. Eur J Nucl Med Mol Imaging 30:781–793PubMedCrossRefGoogle Scholar
  6. 6.
    Elsayes KM, Menias CO, Bowerson M, Osman OM, Alkharouby AM, Hillen TJ (2011) Imaging of carcinoid tumors: spectrum of findings with pathologic and clinical correlation. J Comput Assist Tomogr 35:72–80PubMedCrossRefGoogle Scholar
  7. 7.
    Strosberg JR, Cheema A, Kvols LK (2011) A review of systemic and liver-directed therapies for metastatic neuroendocrine tumors of the gastroenteropancreatic tract. Cancer Control 18:127–137PubMedGoogle Scholar
  8. 8.
    Ambrosini V, Campana D, Tomassetti P, Grassetto G, Rubello D, Fanti S (2010) PET/CT with 68Gallium-DOTA-peptides in NET: An overview. Eur J Radiol. doi: 10.1016/j.ejrad.2010.07.022
  9. 9.
    Bushnell DL, Baum RP (2011) Standard imaging techniques for neuroendocrine tumors. Endocrinol Metab Clin North Am 40:153–162PubMedCrossRefGoogle Scholar
  10. 10.
    Paulson EK, McDermott VG, Keogan MT, DeLong DM, Frederick MG, Nelson RC (1998) Carcinoid metastases to the liver: role of triple-phase helical CT. Radiology 206:143–150PubMedGoogle Scholar
  11. 11.
    Gabriel M, Decristoforo C, Kendler D, Dobrozemsky G, Heute D, Uprimny C et al (2007) 68Ga-DOTA-Tyr3-octreotide PET in neuroendocrine tumors: comparison with somatostatin receptor scintigraphy and CT. J Nucl Med 48:508–518PubMedCrossRefGoogle Scholar
  12. 12.
    Ambrosini V, Nanni C, Zompatori M, Campana D, Tomassetti P, Castellucci P (2010) (68)Ga-DOTA-NOC PET/CT in comparison with CT for the detection of bone metastasis in patients with neuroendocrine tumours. Eur J Nucl Med Mol Imaging 37:722–727PubMedCrossRefGoogle Scholar
  13. 13.
    Kumar R, Sharma P, Garg P, Karunanithi S, Naswa N, Sharma R et al (2011) Role of (68)Ga-DOTATOC PET-CT in the diagnosis and staging of pancreatic neuroendocrine tumours. Eur Radiol 21:2408–2416PubMedCrossRefGoogle Scholar
  14. 14.
    Ambrosini V, Campana D, Bodei L, Nanni C, Castellucci P, Allegri V et al (2010) 68Ga-DOTANOC PET/CT clinical impact in patients with neuroendocrine tumors. J Nucl Med 51:669–673PubMedCrossRefGoogle Scholar
  15. 15.
    Ruf J, Heuck F, Schiefer J, Denecke T, Elgeti F, Pascher A et al (2010) Impact of Multiphase 68Ga-DOTATOC-PET/CT on therapy management in patients with neuroendocrine tumors. Neuroendocrinology 91:101–109PubMedCrossRefGoogle Scholar
  16. 16.
    Breeman WA, de Jong M, de Blois E, Bernard BF, Konijnenberg M, Krenning EP (2005) Radiolabelling DOTA-peptides with 68Ga. Eur J Nucl Med Mol Imaging 32:478–485PubMedCrossRefGoogle Scholar
  17. 17.
    Decristoforo C, Knopp R, von Guggenberg E, Rupprich M, Dreger T, Hess A et al (2007) A fully automated synthesis for the preparation of 68Ga-labelled peptides. Nucl Med Commun 28:870–875PubMedCrossRefGoogle Scholar
  18. 18.
    Singh J, Daftary A (2008) Iodinated contrast media and their adverse reactions. J Nucl Med Technol 36:69–74PubMedCrossRefGoogle Scholar
  19. 19.
    Castellucci P, Pou Ucha J, Fuccio C, Rubello D, Ambrosini V, Montini GC et al (2011) Incidence of Increased 68Ga-DOTANOC Uptake in the Pancreatic Head in a Large Series of Extrapancreatic NET Patients Studied with Sequential PET/CT. J Nucl Med 52:886–890PubMedCrossRefGoogle Scholar
  20. 20.
    Nakamoto Y, Nogami M, Sugihara R, Sugimura K, Senda M, Togashi K (2011) Is contrast material needed after treatment of malignant lymphoma in positron emission tomography/computed tomography? Ann Nucl Med 25:93–99PubMedCrossRefGoogle Scholar
  21. 21.
    Pfluger T, Melzer HI, Schneider V, La Fougere C, Coppenrath E, Berking C et al (2011) PET/CT in malignant melanoma: contrast-enhanced CT versus plain low-dose CT. Eur J Nucl Med Mol Imaging 38:822–831PubMedCrossRefGoogle Scholar
  22. 22.
    Ruf J, Schiefer J, Furth C, Kosiek O, Kropf S, Heuck F et al (2011) 68Ga-DOTATOC PET/CT of neuroendocrine tumors: spotlight on the CT Phases of a triple-phase protocol. J Nucl Med 52:697–704PubMedCrossRefGoogle Scholar
  23. 23.
    Veit-Haibach P, Schiesser M, Soyka J, Strobel K, Schaefer NG, Hesselmann R et al (2011) Clinical value of a combined multi-phase contrast enhanced DOPA-PET/CT in neuroendocrine tumours with emphasis on the diagnostic CT component. Eur Radiol 21:256–264PubMedCrossRefGoogle Scholar
  24. 24.
    Kitajima K, Suzuki K, Nakamoto Y, Onishi Y, Sakamoto S, Senda M et al (2010) Low-dose non-enhanced CT versus full-dose contrast-enhanced CT in integrated PET/CT studies for the diagnosis of uterine cancer recurrence. Eur J Nucl Med Mol Imaging 37:1490–1498PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2011

Authors and Affiliations

  • Marius E. Mayerhoefer
    • 1
  • Matthias Schuetz
    • 2
  • Silvia Magnaldi
    • 1
  • Michael Weber
    • 1
  • Siegfried Trattnig
    • 1
  • Georgios Karanikas
    • 2
  1. 1.Department of Radiology, PET/CT CenterMedical University of Vienna, Vienna General HospitalViennaAustria
  2. 2.Department of Nuclear Medicine, PET/CT CenterMedical University of Vienna, Vienna General HospitalViennaAustria

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