title: Role of PET/CT in the functional imaging of endocrine pancreatic tumors.
abstract: Endocrine pancreatic tumors (EPTs) are a heterogeneous group of neoplasms with variable clinical and biological features and prognosis, ranging from very slow-growing tumors to highly aggressive and very malignant ones. As other neuroendocrine tumors, EPTs are characterized by the presence of neuroamine uptake mechanisms and/or peptide receptors at the cell membrane and these features constitute the basis of the clinical use of specific radiolabeled ligands, both for imaging and therapy. The more widespread use of hybrid machines, i.e., positron emission tomography/computed tomography (PET/CT), allows to perform imaging with high resolution and high diagnostic accuracy especially for small lesions, and to correlate anatomic location with function. The recent WHO recommendations for classification and prognostic factors help the selection of tracers likely to show a positive image on PET; therefore, tracers exploiting specific metabolic patterns ((18)F-DOPA and (11)C-5-HTP) or specific receptor expression ((68)Ga-DOTA-peptides) are suited to well-differentiated tumors, while the use of (18)F-FDG is preferred for poorly-differentiated neoplasms with high proliferative activity and loss of neuroendocrine features. In differentiated EPTs, (11)C-5-HTP performs better than (18)F-DOPA even though its use is hampered by its complex production and limited availability and experience; (68)Ga-peptides are indicated for all type of gastroenteropancreatic (GEP) neuroendocrine tumors, regardless of their functional activity. In addition, (68)Ga-DOTA-peptides play a distinctive role in planning peptide receptor radionuclide therapy.
authors.affiliation: Department of Bioimaging and Radiological Sciences, Institute of Nuclear Medicine, Agostino Gemelli Hospital, Università Cattolica del Sacro Cuore, Roma, Italy. v.rufini@rm.unicatt.it
authors.forename: Vittoria
authors.initials: V
authors.lastname: Rufini
authors.forename: Richard P
authors.initials: RP
authors.lastname: Baum
authors.forename: Paola
authors.initials: P
authors.lastname: Castaldi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Treglia
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: De Gaetano
authors.forename: Cecilia
authors.initials: C
authors.lastname: Carreras
authors.forename: Daniel
authors.initials: D
authors.lastname: Kaemmerer
authors.forename: Merten
authors.initials: M
authors.lastname: Hommann
authors.forename: Dieter
authors.initials: D
authors.lastname: Hörsch
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bonomo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giordano
mesh_terms: D002454:Cell Differentiation; D003287:Contrast Media; D015259:Dopamine Agents / Q000378:metabolism; D006571:Heterocyclic Compounds; D006801:Humans; D007980:Levodopa / Q000378:metabolism; D064847:Multimodal Imaging; D009362:Neoplasm Metastasis / Q000000981:diagnostic imaging; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000145:classification / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D009942:Organometallic Compounds; D010190:Pancreatic Neoplasms / Q000145:classification / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D036361:Peptide Hormones / Q000378:metabolism; D049268:Positron-Emission Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D015259:Dopamine Agents; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; D036361:Peptide Hormones; D019275:Radiopharmaceuticals; D007980:Levodopa; C050823:gadolinium 1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetate