Abstract
Neuroendocrine (NE) cancers are usually suspected on clinical symptoms related to their metabolically active peptide secretion into the circulatory system. The most effective treatment is surgery and a preoperative accurate localization of these slow growing tumors is needed. Combined anatomical (CT) and molecular imaging modalities using single-photon emission computed tomography (SPET) with radiolabeled pentetreotide have been developed in routine, and we report here the potential of SPECT/CT image fusion for diagnosis, staging, and evaluation of treatment efficacy of NE cancers.
Patients: Sixty-four consecutive patients were included: 2 patients with MEN 2b, thoracic lesions (n = 5), bowel lesions (n = 28), pancreatic lesions (n = 17), and unknown primary endocrine tumors (n=12). Age ranged from 31 to 64 years.
Imaging Protocol: Hybrid images of functional SPET and anatomical CT data were acquired using a SPET/CT system combining a dual-detector gamma camera with a low-dose CT (Millennium VG & Hawkeye GE Healthcare), 24 hours after intravenous injection of 200 MBq 111In-pentetreotide and compared with additional whole-body and planar conventional scintigraphies obtained, respectively, at 4 and 24 hours. All images were reviewed without knowledge of clinical data and the results correlated with the follow-up.
Results: Thirty-four were true positives, twenty-one true negatives, and nine remained equivocal. Eighty-eight uptake sites in the neck, thorax, liver, abdomen, and skeleton were detected. Sensitivity and specificity raised, respectively, from 81 and 22 without fusion to 92 and 80% with fusion (p = 0.005). Equivocal foci decreased from 17% without CT to 5.7% with CT. Site-by-site interobserver performances were also improved from 60 to 88% when using CT fusion (p < 0.005).
Conclusion: Molecular imaging of NE cancer by fusion SPECT/CT is an accurate modality to precise tumor site location and has a significant impact in the management of endocrine tumor patients.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Adams S, Baum R, Rink T, et al. Limited value of fluorine-18 fluorodeoxyglucose positron emission tomography for the imaging of neuroendocrine tumours. Eur J Nucl Med 1998;25:79–83.
Becherer A, Szabo M, Karanikas G, et al. Imaging of advanced neuroendocrine tumors with 18F-FDOPA PET. J Nucl Med 2004;45:1161–1167.
Belhocine T, Foidart J, Rigo P, et al. Fluorodeoxyglucose positron emission tomography and somatostatin receptor scintigraphy for diagnosing and staging carcinoid tumours: correlations with the pathological indexes p53 and Ki-67. Nucl Med Com 2002;23:727–734.
Caplin ME, Buscombe JR, Hilson AJ, et al. Carcinoid tumor. Lancet 1998;352:799–805.
DeLellis RA, Tischler AS. The dispersed neuroendocrine cell system. Functional Endocrine Pathology. Boston: Blackwell, 1991, pp. 493–508.
Fahey FH, Harkness BA, Keyes JW Jr, et al. Sensitivity, resolution and image quality with a multi-head SPECT camera. J Nucl Med 1992;33:1859–1863.
Hoegerle S, Altehoefer C, Ghanem N, et al. Whole-body 18F dopa PET for detection of gastrointestinal carcinoid tumors. Radiology 2001;220:373–380.
Kaltsas G, Rockall A, Papadogias D, et al. Recent advances in radiological and radionuclide imaging and therapy of neuroendocrine tumours. Eur J Endocrinol 2004;151:15–27.
Koopmans KP, de Vries EGE, Kema IP, et al. Staging of carcinoid tumours with 18F-DOPA PET. A prospective, diagnostic accuracy study. Lancet Oncol 2006;7:728–734.
Krausz Y, Keidar Z, Kogan I, et al. SPECT/CT hybrid imaging with 111In-pentetreotide in assessment of neuroendocrine tumours. Clin Endocrinol 2003;59:565–573.
Krenning EP, Kwekkeboom DJ, Reubi JC, et al. 111In-Octreotide scintigraphy in oncology. Metabolism 1992;41:83–86.
Kumbasar B, Kamel IR, Tekes A, et al. Imaging of neuroendocrine tumors: accuracy of helical CT versus SRS. Abdom Imaging 2004;29:696–702.
Kwekkeboom DJ, Krenning EP. Somatostatin receptor imaging. Semin Nucl Med 2002;32:133–140.
Lebtahi R, Cadiot G, Sarda L, et al. Clinical impact of somatostatin receptor scintigraphy in the management of patients with neuroendocrine gastroenteropancreatic tumors. J Nucl Med 1997;38:853–858.
Modlin IM, Kidd M, Latich I, et al. Current status of gastrointestinal carcinoids. Gastroenterology 2005;128:1717–1751.
Moertel CG, Lefkopoulo M, Lipsitz S, et al. Streptozocin-doxorubicin, streptozocin-fluorouracil or chlorozotocin in the treatment of advanced islet-cell carcinoma. N Engl J Med 1992;326:519–523.
Montravers F, Grahek D, Kerrou K, et al. Can fluorodihydroxy phenylalanine PET replace somatostatin receptor scintigraphy in patients with digestive endocrine tumors? J Nucl Med 2006;47:1455–1462.
Oberg K, Kvols L, Caplin M, et al. Consensus report on the use of somatostatin analogs for the management of neuroendocrine tumors of the gastroenteropancreatic system. Ann Oncol 2004;15:966–973.
Pearse AG. The APUD cell concept and its implications in pathology. Pathol Ann 1974; 9:27–41.
Perault C, Schvartz C, Wampach H, et al. Thoracic and abdominal SPECT-CT image fusion without external markers in endocrine carcinomas. J Nucl Med 1997;38:1234–1242.
Plockinger U, Rindi G, Arnold R, et al. Guidelines for the diagnosis and treatment of neuroendocrine gastrointestinal tumours: a consensus statement on behalf of the European Neuroendocrine Tumour Society. Neuroendocrinology 2004;80:394–424.
Weber DA, Ivanovic M. Correlative image registration. Semin Nucl Med 1994;24:311–323.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2009 Humana Press, a part of Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Alberini, J.L. et al. (2009). Molecular Imaging of Neuroendocrine Cancer by Fusion SPET/CT. In: Leong, S. (eds) From Local Invasion to Metastatic Cancer. Current Clinical Oncology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-087-8_15
Download citation
DOI: https://doi.org/10.1007/978-1-60327-087-8_15
Published:
Publisher Name: Humana Press, Totowa, NJ
Print ISBN: 978-1-60327-086-1
Online ISBN: 978-1-60327-087-8
eBook Packages: MedicineMedicine (R0)