Molecular Imaging and Therapy for Neuroendocrine Tumors

  • Hemant Desai
  • Salvador Borges-Neto
  • Terence Z. WongEmail author
Lower Gastrointestinal Cancers (AB Benson, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Lower Gastrointestinal Cancers

Opinion statement

Neuroendocrine tumors (NETs) are relatively rare, with 12,000–15,000 new cases diagnosed annually in the USA. Although NETs are a diverse group of neoplasms, they share common molecular targets that can be exploited using nuclear medicine techniques for both imaging and therapy. NETs have traditionally been imaged with SPECT imaging using 111In-labeled octreotide analogs to detect neoplasms with somatostatin receptors. In addition, certain NETs (pheochromocytomas, paragangliomas, and neuroblastomas) are also effectively imaged using 123I- or 131I-labeled metaiodobenzylguanidine (MIBG), an analog of guanethidine. More recently, PET imaging with 68Ga-labeled somatostatin receptor (SSR) analogs allows neuroendocrine tumors to be imaged with much higher sensitivity. 68Ga-DOTATATE was approved as a PET tracer by the FDA in June 2016. In addition to imaging, both MIBG and DOTATATE can be labeled with therapeutic radionuclides to deliver targeted radiation selectively to macroscopic and microscopic tumor sites. The incorporation of the same molecular probe for imaging and therapy provides a radio-theranostic approach to identifying, targeting, and treating tumors. Over the years, several centers have experience treating NETs with high-dose 131I-MIBG. 177Lu-DOTATATE was approved by the FDA in 2018 for treatment of gastroenteropancreatic NETs and constitutes a major advancement in the treatment of these diseases. In this paper, we provide an overview of imaging and treating neuroendocrine tumors using MIBG and SSR probes. Although uncommon, neuroendocrine tumors have provided the largest experience for targeted radionuclide imaging and therapy (with the exception of radioiodine treatment for thyroid disease). In addition to benefitting patients with these rare tumors, the knowledge gained provides a blueprint for the development of future paired diagnostic/therapeutic probes for treating other diseases, such as prostate cancer.


Somatostatin receptor PET/CT Peptide receptor radionuclide therapy (PRRT) DOTATATE MIBG Theranostic 


Compliance with Ethical Standards

Conflict of Interest

The authors declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Hemant Desai
    • 1
  • Salvador Borges-Neto
    • 2
  • Terence Z. Wong
    • 3
    Email author
  1. 1.Department of RadiologyDuke University Medical CenterDurhamUSA
  2. 2.Division of Nuclear Medicine, Department of RadiologyDuke University Medical CenterDurhamUSA
  3. 3.Division of Nuclear Medicine, Department of Radiology, Duke Cancer InstituteDuke University Medical CenterDurhamUSA

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