Doing Great With DOTATATE

Abstract

Sinonasal tumors are relatively rare and radiographically challenging to evaluate due to their wide variety of pathologies and imaging features. However, sinonasal tumors possessing somatostatin receptor overexpression have the benefit of utilizing a multimodality anatomic and functional imaging for a more comprehensive evaluation. This is particularly evident with esthesioneuroblastoma, with computed tomography and magnetic resonance imaging defining the anatomic extent of the tumor, whereas somatostatin receptor imaging, particularly with gallium-68 DOTATATE positron emission tomography/computed tomography, is used to assess the presence of metastatic disease for staging purposes as well as in the surveillance for tumor recurrence. In addition, areas which accumulate gallium-68 DOTATATE are potentially amenable to treatment with peptide receptor radionuclide therapy. In this manner, a combined approach of anatomic and functional imaging is critical for optimal imaging evaluation and treatment strategy of patients with sinonasal tumors.

International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors

“…Gallium‐69 Dotatate PET/CT imaging is another functional imaging modality in somatostatin receptor overexpressing sinonasal tumors, such as ONB and SNEC 224 . It has the potential to be very useful in detecting small tumors and metastasis that may not have been identified with traditional imaging methods due to its strong affinity to the receptor.…”

“…It has the potential to be very useful in detecting small tumors and metastasis that may not have been identified with traditional imaging methods due to its strong affinity to the receptor. However, one must be aware that meningiomas, reactive lymph nodes, and other inflammatory processes, as well as some organs (liver, spleen, adrenal glands, pancreas, thyroid, and salivary glands), may also present with uptake despite being benign processes 224 …”

Skull Base Tumors

“…Alternatively, as esthesioneuroblastomas express somatostatin receptors, there is an emerging interest in the role of 68 gallium-dodecanetetraacetic acid tyrosine-3-octreotate PET in identifying metastatic foci. 87 Two systems for esthesioneuroblastoma staging, which may inform prognosis, have been proposed: the Kadish system and the Dulguerov system. The modified Kadish system is used most frequently and includes four stages (A-D), ranging from tumors confined to the nasal cavity (stage A) to those with regional lymph node involvement or distant metastases (stage D).…”

“…The role of systemic imaging in evaluating for the rare occurrence of distant metastases is less well-established, but some advocate for obtaining fludeoxyglucose positron emission tomography (FDG-PET) or CT scans of the body. Alternatively, as esthesioneuroblastomas express somatostatin receptors, there is an emerging interest in the role of 68 gallium-dodecanetetraacetic acid tyrosine-3-octreotate PET in identifying metastatic foci 87 . Two systems for esthesioneuroblastoma staging, which may inform prognosis, have been proposed: the Kadish system and the Dulguerov system.…”