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Bone metastases in midgut neuroendocrine tumors: imaging characteristics, distribution, and risk factors

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Abstract

Purpose

Bone metastases (BM) affect 10–30% of patients with small intestine neuroendocrine tumors (siNET), but little descriptive data are available regarding their distribution throughout the skeleton or potential risk factors. Aim of the study is to better describe the imaging characteristics, distribution, and risk factors of siNET bone metastases using 18F-FDOPA PET/CT.

Methods

All patients with well-differentiated siNET who underwent an 18F-DOPA PET/CT examination in our institution were retrospectively screened between October 2017 and February 2020. Location, SUVmax and CT density of each BM were collected. Sex, metabolic tumor volume (MTV) excluding bone, and metastatic sites other than bone were studied to determine risk factors of BM.

Results

Among the 69 patients included, 11 patients (15.9%) presented BM on 18F-FDOPA (65 metastases). The most frequently involved sites were: thoracic spine, pelvic bones and ribs. About 64% of patients presented multiple BM. On coupled CT scan, 63% of BM were not visible. Using an optimal threshold of 19.2 ml, MTV was an independent predictor of BM (p = 0.004) with a derived sensitivity of 100% [65.0–100.0] and a specificity of 70.9% [57.7–81.2]. Hepatic metastatic involvement was also a significant predictor of BM (p = 0.044).

Conclusion

The development of BM in siNETs appears to be a late event, occurring in patients with a high tumor burden and hepatic involvement. They are often multiple and predominate in the axial skeleton.

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Authors and Affiliations

  1. Service de Médecine Nucléaire, Institut Godinot, Reims, France

    Maxime Lelièvre & David Morland

  2. Unità di Medicina Nucleare, TracerGLab, Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italia

    Elizabeth Katherine Anna Triumbari & David Morland

  3. Hépato-Gastroentérologie et Cancérologie digestive, Centre Hospitalier Universitaire de Reims, Reims, France

    Hedia Brixi, Marine Perrier & Guillaume Cadiot

  4. Chirurgie Générale, Digestive et Endocrinienne, Centre Hospitalier Universitaire de Reims, Reims, France

    Sophie Deguelte

  5. Laboratoire de Biophysique, UFR de médecine, Université de Reims Champagne-Ardenne, Reims, France

    David Morland

  6. CReSTIC (Centre de Recherche en Sciences et Technologies de l’Information et de la Communication), EA 3804, Université de Reims Champagne-Ardenne, Reims, France

    David Morland

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  1. Maxime Lelièvre
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by ML and DM. The first draft of the manuscript was written by ML and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to David Morland.

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The authors declare no competing interests.

Ethics approval

This retrospective study was conducted in accordance with the Declaration of Helsinki and was declared on the Health Data Hub (N°F20220506115447) in conformity with the reference methodology MR004 of the “Commission Nationale de l’Informatique et des Libertés”, allowing the computerized management of medical data.

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Lelièvre, M., Triumbari, E.K.A., Brixi, H. et al. Bone metastases in midgut neuroendocrine tumors: imaging characteristics, distribution, and risk factors. Endocrine 78, 380–386 (2022). https://doi.org/10.1007/s12020-022-03160-2

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  • DOI: https://doi.org/10.1007/s12020-022-03160-2

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