Comparison of 68Ga PET/CT to Other Imaging Studies in Medullary Thyroid Cancer: Superiority in Detecting Bone Metastases

Castroneves, Luciana A.; Filho, George Coura; Freitas, Ricardo Miguel Costa de; Salles, Raphael; Moysés, Raquel Ajub; López, Rossana Verónica Mendoza; Pereira, Maria Adelaide Albergaria; Tavares, Marcos Roberto; Jorge, Alexander A L; Buchpiguel, Carlos Alberto; Hoff, Ana O.

doi:10.1210/jc.2018-00193

Cited by 43 publications

(23 citation statements)

References 20 publications

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“…Moreover, their diagnostic role is continually evolving by breakthroughs in new therapies such as Azedra, as these imaging techniques can easily be applied in assessing new sites of disease in patient’s follow-up. Azedra (iobenguane I 131)) is a new FDA-proved drug which targets iobenguane scan-positive, unresectable, locally advanced or metastatic pheochromocytomas and paragangliomas, who require systemic anti-cancer therapy [11]. MRI could not be included in our study since it has only been added in the imaging protocol lately.…”

Section: Discussionmentioning

confidence: 99%

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CT- and ultrasound-characteristics of hepatic lesions in patients with multiple endocrine neoplasia syndrome. A retrospective image review of 25 cases

Fard

Raue²,

Jobke

2019

PLoS ONE

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Introduction Liver metastases from neuroendocrine tumors in multiple endocrine neoplasia syndrome are common (75%) and significantly impairs the prognosis. Characterisation of liver lesions in these patients is challenging, as liver metastases are difficult to differentiate from benign liver lesions such as haemangioma. Methods In this study we aimed to characterize the radiological findings of hepatic metastases in MEN patients. The findings of contrast-enhanced CT were considered for the main diagnosis. We retrospectively evaluated 25 patients with MEN-syndrome (10 MEN1/ 15 MEN2) including 11 men and 14 women between 28–62 years of age. Results Liver metastases (48%, 12/25) and hemangioma (40%, 10/25) were the most common liver lesions among our patients. The most common primary tumors in our MEN1 and MEN2 patients with liver metastases were of pancreatic neuroendocrine tumor (70%, 7/10) und medullary thyroid carcinoma (100%, 15/15) origin, respectively. CT-characteristics were grouped into three main categories, depending on contrast dynamics. The majority of hepatic metastases (75%, 14/25) are presented as multiple lesions with a slow growth in an average 5 years of follow-up-period. We were able to find a common CT pattern and categorise these for each MEN-syndrome. Hepatic metastases in MEN1 presented commonly a blurred arterial enhancement with a low portal venous enhancement and less frequently a prominent enhancement in the arterial phase, which mimics the classical haemangioma. In MEN2 the liver metastases exhibited disseminated mixed hyper- and hypo-enhanced lesions in CT-scans. Moreover, lesion calcifications are pathognomonic in MEN2. The main limitation of this study is the missing histopathological confirmation in the majority of cases. Conclusions In this retrospective imaging study, we were able to categorise and find a common CT pattern for hepatic lesions in patients with MEN-syndrome. In order to differentiate these lesions sufficiently, a combination of a 3-phasic CT-scan with US is required. Other liver specific imaging modalities (MRI, CEUS, SMS-PET/CT) should complement the diagnosis in individual cases.

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Section: Discussionmentioning

confidence: 99%

“…The indications for new treatments (such as systematic therapy with tyrosine kinase inhibitors) are based on RECIST criteria, which cannot be accurately applied to PET. Moreover, its value in MTC is still disputable, for one due to missing correlations between PET positive findings (sensitivity) and calcitonin levels [11–14].…”

Section: Introductionmentioning

confidence: 99%

CT- and ultrasound-characteristics of hepatic lesions in patients with multiple endocrine neoplasia syndrome. A retrospective image review of 25 cases

Fard

Raue²,

Jobke

2019

PLoS ONE

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“…Overall, the diagnostic performance of SST-R analogs PET or PET/CT in recurrent MTC is overall lower compared to 18F-FDOPA PET/CT [32]. Although 68Ga-DOTATATE PET/CT is not an optimal whole-body imaging technique as a single imaging modality in patients with MTC, it detects 100% for bone metastases and it was found to be superior to bone scan that identified 44% of osseous lesions [33].…”

Section: Modern Imaging Modalities and Techniquesmentioning

confidence: 99%

“…Two early studies showed contradictory results: Mirallié et al (2005) demonstrated a higher sensitivity of MR imaging for detecting bone metastases compared with bone scintigraphy, while Giraudet et al (2007) claimed a better sensitivity of bone scans [27, 84]. In another small study, 68Ga-DOTATATE PET/CT demonstrated a high sensitivity in detecting bone lesions and potentially it may be considered a substitute for a bone scan and MRI [33]. The European Organization for Research and Treatment of Cancer (EORTC) imaging group stresses the superiority of MR imaging over bone scintigraphy for the detection of all bone metastases and suggests the use of whole-body MRI and 18F-FDOPA PET/CT for the detection of MTC bone lesions [85] (Figure 10).…”

Section: Clinical Application Of the Imaging Techniquesmentioning

confidence: 99%

Medullary Thyroid Carcinoma: An Update on Imaging

Kushchayev

Kushchayeva

Tella

et al. 2019

Journal of Thyroid Research

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Medullary thyroid carcinoma (MTC), arising from the parafollicular C cells of the thyroid, accounts for 1–2% of thyroid cancers. MTC is frequently aggressive and metastasizes to cervical and mediastinal lymph nodes, lungs, liver, and bones. Although a number of new imaging modalities for directing the management of oncologic patients evolved over the last two decades, the clinical application of these novel techniques is limited in MTC. In this article, we review the biology and molecular aspects of MTC as an important background for the use of current imaging modalities and approaches for this tumor. We discuss the modern and currently available imaging techniques—advanced magnetic resonance imaging (MRI)-based techniques such as whole-body MRI, dynamic contrast-enhanced (DCE) technique, diffusion-weighted imaging (DWI), positron emission tomography/computed tomography (PET/CT) with 18F-FDOPA and 18F-FDG, and integrated positron emission tomography/magnetic resonance (PET/MR) hybrid imaging—for primary as well as metastatic MTC tumor, including its metastatic spread to lymph nodes and the most common sites of distant metastases: lungs, liver, and bones.

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“…On the imaging side, gallium-68 ( 68 Ga) radiolabelled somatostatin analog peptides in PET/CT have been well established for the diagnosis of neuroendocrine tumors. A study by Castroneves et al showed that 68 Ga PET/CT may also be highly sensitive to identifying bone metastases in thyroid carcinoma ( Castroneves et al, 2018 ).…”

Section: Thyroid Carcinomamentioning

confidence: 99%

Current Standards and Recent Advances in Biomarkers of Major Endocrine Tumors

et al. 2018

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The complexity of endocrine tumor diagnosis stems from its variable symptoms and presentation that may mimic many other disease states, or display asymptomatic properties for a prolonged amount of time. Early and accurate disease identification is needed for better patient prognosis. The key to this may be in using validated biomarkers with enhanced sensitivity and specificity. Several biomarkers are consistently used across various endocrine tumor types, possibly indicating a deeper pathophysiological mechanism behind endocrine cancer genesis and development. For example, carbohydrate antigen (CA) is measured in both pancreatic adenocarcinoma as well as ovarian cancer for diagnosis, surveillance, and risk stratification. The discovery of measuring miRNAs that are highly expressed in malignant tumors is also a novel strategy across multiple endocrine tumor types, and is propelling the future advancement of biomarker development. This review introduces currently utilized biomarkers in some of the commonly known endocrine tumors, including thyroid, adrenal, pituitary, pancreatic, and gonadal carcinoma, as well as future research directions.

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Comparison of 68Ga PET/CT to Other Imaging Studies in Medullary Thyroid Cancer: Superiority in Detecting Bone Metastases

Abstract: 68Ga PET/CT does not provide optimal whole-body imaging as a single procedure in patients with MTC. However, it is highly sensitive in detecting bone lesions and could be a substitute for a bone scan and MRI.

Cited by 43 publications

References 20 publications

CT- and ultrasound-characteristics of hepatic lesions in patients with multiple endocrine neoplasia syndrome. A retrospective image review of 25 cases

CT- and ultrasound-characteristics of hepatic lesions in patients with multiple endocrine neoplasia syndrome. A retrospective image review of 25 cases

Medullary Thyroid Carcinoma: An Update on Imaging

Current Standards and Recent Advances in Biomarkers of Major Endocrine Tumors

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