title: 64Cu-DOTATATE PET for Neuroendocrine Tumors: A Prospective Head-to-Head Comparison with 111In-DTPA-Octreotide in 112 Patients.
abstract: Neuroendocrine tumors (NETs) can be visualized using radiolabeled somatostatin analogs. We have previously shown the clinical potential of (64)Cu-DOTATATE in a small first-in-human feasibility study. The aim of the present study was, in a larger prospective design, to compare on a head-to-head basis the performance of (64)Cu-DOTATATE and (111)In-diethylenetriaminepentaacetic acid (DTPA)-octreotide ((111)In-DTPA-OC) as a basis for implementing (64)Cu-DOTATATE as a routine.
  
  
  METHODS
  We prospectively enrolled 112 patients with pathologically confirmed NETs of gastroenteropancreatic or pulmonary origin. All patients underwent both PET/CT with (64)Cu-DOTATATE and SPECT/CT with (111)In-DTPA-OC within 60 d. PET scans were acquired 1 h after injection of 202 MBq (range, 183-232 MBq) of (64)Cu-DOTATATE after a diagnostic contrast-enhanced CT scan. Patients were followed for 42-60 mo for evaluation of discrepant imaging findings. The McNemar test was used to compare the diagnostic performance.
  
  
  RESULTS
  Eighty-seven patients were congruently PET- and SPECT-positive. No SPECT-positive cases were PET-negative, whereas 10 false-negative SPECT cases were identified using PET. The diagnostic sensitivity and accuracy of (64)Cu-DOTATATE (97% for both) were significantly better than those of (111)In-DTPA-OC (87% and 88%, respectively, P = 0.017). In 84 patients (75%), (64)Cu-DOTATATE identified more lesions than (111)In-DTPA-OC and always at least as many. In total, twice as many lesions were detected with (64)Cu-DOTATATE than with (111)In-DTPA-OC. Moreover, in 40 of 112 cases (36%) lesions were detected by (64)Cu-DOTATATE in organs not identified as disease-involved by (111)In-DTPA-OC.
  
  
  CONCLUSIONS
  With these results, we demonstrate that (64)Cu-DOTATATE is far superior to (111)In-DTPA-OC in diagnostic performance in NET patients. Therefore, we do not hesitate to recommend implementation of (64)Cu-DOTATATE as a replacement for (111)In-DTPA-OC.
authors.affiliation: Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark Department of Nuclear Medicine, Helios-Klinikum Berlin-Buch, Berlin, Germany ENETS Center of Excellence for Neuroendocrine Tumors, Copenhagen, Denmark.
authors.forename: Andreas
authors.initials: A
authors.lastname: Pfeifer
authors.affiliation: Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark ENETS Center of Excellence for Neuroendocrine Tumors, Copenhagen, Denmark Departments of Surgical Gastroenterology C and Medical Endocrinology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Knigge
authors.affiliation: Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark ENETS Center of Excellence for Neuroendocrine Tumors, Copenhagen, Denmark.
authors.forename: Tina
authors.initials: T
authors.lastname: Binderup
authors.affiliation: Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark ENETS Center of Excellence for Neuroendocrine Tumors, Copenhagen, Denmark.
authors.forename: Jann
authors.initials: J
authors.lastname: Mortensen
authors.affiliation: Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark ENETS Center of Excellence for Neuroendocrine Tumors, Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Oturai
authors.affiliation: Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark ENETS Center of Excellence for Neuroendocrine Tumors, Copenhagen, Denmark.
authors.forename: Annika
authors.initials: A
authors.lastname: Loft
authors.affiliation: Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark ENETS Center of Excellence for Neuroendocrine Tumors, Copenhagen, Denmark.
authors.forename: Anne Kiil
authors.initials: AK
authors.lastname: Berthelsen
authors.affiliation: ENETS Center of Excellence for Neuroendocrine Tumors, Copenhagen, Denmark Department of Oncology, Rigshospitalet, Copenhagen, Denmark; and.
authors.forename: Seppo W
authors.initials: SW
authors.lastname: Langer
authors.affiliation: Hevesy Laboratory, DTU-Risø, Roskilde, Denmark.
authors.forename: Palle
authors.initials: P
authors.lastname: Rasmussen
authors.affiliation: Hevesy Laboratory, DTU-Risø, Roskilde, Denmark.
authors.forename: Dennis
authors.initials: D
authors.lastname: Elema
authors.affiliation: Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark ENETS Center of Excellence for Neuroendocrine Tumors, Copenhagen, Denmark.
authors.forename: Eric
authors.initials: E
authors.lastname: von Benzon
authors.affiliation: Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark ENETS Center of Excellence for Neuroendocrine Tumors, Copenhagen, Denmark.
authors.forename: Liselotte
authors.initials: L
authors.lastname: Højgaard
authors.affiliation: Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark ENETS Center of Excellence for Neuroendocrine Tumors, Copenhagen, Denmark akjaer@sund.ku.dk.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kjaer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009362:Neoplasm Metastasis; D018358:Neuroendocrine Tumors / Q000175:diagnosis / Q000000981:diagnostic imaging*; D015282:Octreotide / Q000031:analogs & derivatives*; D009942:Organometallic Compounds; D004369:Pentetic Acid; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D017481:Receptors, Somatostatin / Q000737:chemistry; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
chemical_list: C575629:64Cu-DOTATATE; D009942:Organometallic Compounds; D017481:Receptors, Somatostatin; C094279:indium-111-octreotide; D004369:Pentetic Acid; D015282:Octreotide
keywords: 111In-DTPA-octreotide; 64Cu-DOTATATE; PET; PET/CT; SPECT; cancer; molecular imaging; neuroendocrine tumors; prospective; somatostatin receptor imaging