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A Comparison of 68 Ga-DOTATATE and 18 F-FDG PET/CT in Pulmonary Neuroendocrine Tumors

2009; Society of Nuclear Medicine and Molecular Imaging; Volume: 50; Issue: 12 Linguagem: Inglês

10.2967/jnumed.109.066639

1535-5667

Irfan Kayani, B G Conry, Ashley M. Groves, Thida Win, John Dickson, Martyn Caplin, Jamshed Bomanji,

Neuroblastoma Research and Treatments

Our purpose was to compare the performance of 68 Ga-1,4,7,10-tetraazacyclododecane- N,N′,N″,N‴ -tetraacetic acid-d-Phe 1 ,Tyr 3 -octreotate (DOTATATE), a novel selective somatostatin receptor 2 PET ligand, and 18 F-FDG in the detection of pulmonary neuroendocrine tumors using PET/CT, with correlation of uptake and tumor grade on histology. Methods: The imaging findings of the first 18 consecutive patients (8 men and 10 women) with pulmonary neuroendocrine tumors (11 typical carcinoids, 2 atypical carcinoids, 1 large cell neuroendocrine tumor, 1 small cell neuroendocrine carcinoma, 1 non–small cell lung cancer with neuroendocrine differentiation, and 2 cases of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia) who underwent 68 Ga-DOTATATE and 18 F-FDG PET/CT were reviewed. In all cases, the diagnosis was established on histology. Results: Of 18 patients, 15 had primary tumors (median size, 2.7 cm; range, 0.5–8 cm) and 3 had recurrent tumors. All typical carcinoids showed high uptake of 68 Ga-DOTATATE (maximum standardized uptake value [SUV max ] ≥ 8.2), but 4 of 11 showed negative or minimal 18 F-FDG uptake (SUV max = 1.7–2.9). All tumors of higher grade showed high uptake of 18 F-FDG (SUV max ≥ 11.7), but 3 of 5 showed only minimal accumulation of 68 Ga-DOTATATE (SUV max = 2.2–2.8). Neither case of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia showed uptake of 68 Ga-DOTATATE or 18 F-FDG. Typical carcinoids showed significantly higher uptake of 68 Ga-DOTATATE and significantly less uptake of 18 F-FDG than did tumors of higher grade ( P = 0.002 and 0.005). There was no instance of false-positive uptake of 68 Ga-DOTATATE, but there were 3 sites of 18 F-FDG uptake secondary to inflammation. 68 Ga-DOTATATE was superior to 18 F-FDG in discriminating endobronchial tumor from distal collapsed lung ( P = 0.02). Conclusion: Typical bronchial carcinoids showed higher and more selective uptake of 68 Ga-DOTATATE than of 18 F-FDG. Atypical carcinoids and higher grades had less 68 Ga-DOTATATE avidity but were 18 F-FDG–avid.