Nuclear medicine imaging of neuroendocrine tumours

Al‐Nahhas, Adil

doi:10.7861/clinmedicine.12-4-377

Cited by 12 publications

(14 citation statements)

References 17 publications

(15 reference statements)

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“…The expression of SSTRs has been found in neuroendocrine tumours, small cell lung cancer, renal cell carcinoma, malignant lymphoma, breast cancer, and prostate cancer. PET-CT using somatostatin ligand analogues labelled with 68 Ga has become a new golden standard in imaging of NETs with specificity and sensitivity well above 90% and advantages over conventional radiologic and scintigraphic imaging 14 , 146 - 149 . It is the most pronounced example of theranostics 6 , 7 , 150 .…”

Section: Imaging Of G-protein Coupled Receptor Familymentioning

confidence: 99%

Prospective of ⁶⁸Ga-Radiopharmaceutical Development

Velikyan¹

2014

Theranostics

260

249

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Positron Emission Tomography (PET) experienced accelerated development and has become an established method for medical research and clinical routine diagnostics on patient individualized basis. Development and availability of new radiopharmaceuticals specific for particular diseases is one of the driving forces of the expansion of clinical PET. The future development of the 68Ga-radiopharmaceuticals must be put in the context of several aspects such as role of PET in nuclear medicine, unmet medical needs, identification of new biomarkers, targets and corresponding ligands, production and availability of 68Ga, automation of the radiopharmaceutical production, progress of positron emission tomography technologies and image analysis methodologies for improved quantitation accuracy, PET radiopharmaceutical regulations as well as advances in radiopharmaceutical chemistry. The review presents the prospects of the 68Ga-based radiopharmaceutical development on the basis of the current status of these aspects as well as wide range and variety of imaging agents.

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Section: Imaging Of G-protein Coupled Receptor Familymentioning

confidence: 99%

Prospective of ⁶⁸Ga-Radiopharmaceutical Development

Velikyan¹

2014

Theranostics

260

249

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“…However, PET using 68 Ga-labeled SSAs, such as 68 Ga-DOTATOC, 68 Ga-DOTANOC, and 68 Ga-DOTATATE, is gradually replacing SSTR scintigraphy and is expected to become the future gold standard for SSTR imaging of NETs (5). PET/CT with 68 Ga-SSA shows a specificity and sensitivity well above 90%, exceeding that of OctreoScan and CT (6)(7)(8)(9)(10)(11).…”

mentioning

confidence: 99%

Parametric Net Influx Rate Images of ⁶⁸Ga-DOTATOC and ⁶⁸Ga-DOTATATE: Quantitative Accuracy and Improved Image Contrast

et al. 2016

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Ga-DOTATOC and Ga-DOTATATE are radiolabeled somatostatin analogs used for the diagnosis of somatostatin receptor-expressing neuroendocrine tumors (NETs), and SUV measurements are suggested for treatment monitoring. However, changes in net influx rate () may better reflect treatment effects than those of the SUV, and accordingly there is a need to compute parametric images showing at the voxel level. The aim of this study was to evaluate parametric methods for computation of parametric images by comparison to volume of interest (VOI)-based methods and to assess image contrast in terms of tumor-to-liver ratio. Ten patients with metastatic NETs underwent a 45-min dynamic PET examination followed by whole-body PET/CT at 1 h after injection ofGa-DOTATOC and Ga-DOTATATE on consecutive days. Parametric images were computed using a basis function method (BFM) implementation of the 2-tissue-irreversible-compartment model and the Patlak method using a descending aorta image-derived input function, and mean tumor values were determined for 50% isocontour VOIs and compared with values based on nonlinear regression (NLR) of the whole-VOI time-activity curve. A subsample of healthy liver was delineated in the whole-body and images, and tumor-to-liver ratios were calculated to evaluate image contrast. Correlation () and agreement between VOI-based and parametric values were assessed using regression and Bland-Altman analysis. The between NLR-based and parametric image-based (BFM) tumor values was 0.98 (slope, 0.81) and 0.97 (slope, 0.88) for Ga-DOTATOC andGa-DOTATATE, respectively. For Patlak analysis, the between NLR-based and parametric-based (Patlak) tumor was 0.95 (slope, 0.71) and 0.92 (slope, 0.74) for Ga-DOTATOC andGa-DOTATATE, respectively. There was no bias between NLR and parametric-based values. Tumor-to-liver contrast was 1.6 and 2.0 times higher in the parametric BFM images and 2.3 and 3.0 times in the Patlak images than in the whole-body images for Ga-DOTATOC andGa-DOTATATE, respectively. A high and agreement between NLR- and parametric-based values was found, showing that images are quantitatively accurate. In addition, tumor-to-liver contrast was superior in the parametric images compared with whole-body images for bothGa-DOTATOC and Ga DOTATATE.

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“…This was, for many years, the gold standard in the diagnostic workup of GEP NENs following a study in a cohort of over 1000 patients which demonstrated high sensitivities: over 90% for carcinoids and 60-90% for pancreatic NENs depending on tumor type or lesion size [22]. Developments in gamma camera apparatus and a widespread increase in availability of single-photon emission computed tomography (SPECT) contributed to its ongoing use but limited spatial resolution for the detection of small tumors or those adjacent to sites of physiological uptake (e.g., spleen and kidneys), and the fact that 111 In-DTPA had a relatively limited receptor affinity profile to SSTR2 predominantly, meant that further advances were deemed necessary [23].…”

Section: Somatostatin Receptor Imagingmentioning

confidence: 99%

Treatment of Neuroendocrine Neoplasms with Radiolabeled Peptides—Where Are We Now

Naik¹,

Al-Nahhas²,

Khan³

2022

Cancers

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Peptide receptor radionuclide therapy (PRRT) has been one of the most successful and exciting examples of theranostics in nuclear medicine in recent decades and is now firmly embedded in many treatment algorithms for unresectable or metastatic neuroendocrine neoplasms (NENs) worldwide. It is widely considered to be an effective treatment for well- or moderately differentiated neoplasms, which express high levels of somatostatin receptors that can be selectively targeted. This review article outlines the scientific basis of PRRT in treatment of NENs and describes its discovery dating back to the early 1990s. Early treatments utilizing Indium-111, a γ-emitter, showed promise in reduction in tumor size and improvement in biochemistry, but were also met with high radiation doses and myelotoxic and nephrotoxic effects. Subsequently, stable conjugation of DOTA-peptides with β-emitting radionuclides, such as Yttrium-90 and Lutetium-177, served as a breakthrough for PRRT and studies highlighted their potential in eliciting progression-free survival and quality of life benefits. This article will also elaborate on the key trials which paved the way for its approval and will discuss therapeutic considerations, such as patient selection and administration technique, to optimize its use.

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Nuclear medicine imaging of neuroendocrine tumours

Cited by 12 publications

References 17 publications

Prospective of ⁶⁸Ga-Radiopharmaceutical Development

Prospective of ⁶⁸Ga-Radiopharmaceutical Development

Parametric Net Influx Rate Images of ⁶⁸Ga-DOTATOC and ⁶⁸Ga-DOTATATE: Quantitative Accuracy and Improved Image Contrast

Treatment of Neuroendocrine Neoplasms with Radiolabeled Peptides—Where Are We Now

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Nuclear medicine imaging of neuroendocrine tumours

Cited by 12 publications

References 17 publications

Prospective of 68Ga-Radiopharmaceutical Development

Prospective of 68Ga-Radiopharmaceutical Development

Parametric Net Influx Rate Images of 68Ga-DOTATOC and 68Ga-DOTATATE: Quantitative Accuracy and Improved Image Contrast

Treatment of Neuroendocrine Neoplasms with Radiolabeled Peptides—Where Are We Now

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Prospective of ⁶⁸Ga-Radiopharmaceutical Development

Prospective of ⁶⁸Ga-Radiopharmaceutical Development

Parametric Net Influx Rate Images of ⁶⁸Ga-DOTATOC and ⁶⁸Ga-DOTATATE: Quantitative Accuracy and Improved Image Contrast