Contemporary nuclear medicine diagnostics of neuroendocrine tumors
2015
The new positron emission tomography (PET/CT) methods for neuroendocrine
tumors detection are presented and compared with classic, conventional
methods. Conventional methods use a gamma scintillation camera for patients
with neuroendocrine tumor imaging, after intravenous injection of one of the
following radiopharmaceuticals: 1) somatostatin analogues labeled with
indium-111 (111In-pentetreotide) or technetium-99m (99mTc-EDDA/HYNIC-TOC); 2)
noradrenaline analogue labeled with iodine-131 or -123 (131I/123I-MIBG); or
3) 99mTc(V)-DMSA. Contemporary methods use PET/CT equipment for patients with
neuroendocrine tumor imaging, after intravenous injection of pharmaceuticals
labeled with positron emitters [fluorine-18 (18F), galium-68 (68Ga), or
carbon-11 (11C)]: 1) glucose analogue (18FDG); 2) somatostatin analogue
(68Ga-DOTATOC/68Ga-DOTATATE/68Ga-DOTANOC); 3) aminoacid precursors of
bioamines: [a) dopamine precursor 18F-DOPA (6-18F-dihydroxyphenylalanine), b)
serotonin precursor 11C-5HTP (11C-5-hydroxytryptophan)]; or 4) dopamine
analogue 18F-DA (6-18F-fluorodopamine). Conventional and contemporary (PET/
CT) somatostatin receptor detection showed identical high specificity (92%),
but conventional had very low sensitivity (52%) compared to PET/CT (97%). It
means that almost every second neuroendocrine tumor detected by contemporary
method cannot be discovered using conventional (classic) method. In
metastatic pheochromocytoma detection contemporary (PET/ CT) methods
(18F-DOPA and 18F-DA) have higher sensitivity than conventional
(131I/123I-MIBG). In medullary thyroid carcinoma diagnostics contemporary
method (18F-DOPA) is more sensitive than conventional 99mTc(V)-DMSA method,
and is similar to 18FDG, computed tomography and magnetic resonance. In
carcinoid detection contemporary method (18F-DOPA) shows similar results with
contemporary somatostatin receptor detection, while for
gastroenteropancreatic neuroendocrine tumors it is worse. To conclude,
contemporary (PET/CT) methods for somatostatin receptor detection
(68Ga-DOTATOC/-NOC/-TATE) in neuroendocrine tumors are much more sensitive
(almost twice) and more accurate than conventional. Therefore the classical
methods should be urgently replaced by contemporary methods.
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