title: 18F-FDOPA PET/CT-Guided Radiofrequency Ablation of Liver Metastases from Neuroendocrine Tumours: Technical Note on a Preliminary Experience.
abstract: OBJECTIVE
  To review our preliminary experience with 6-L-18F-fluorodihydroxyphenylalanine (18F-FDOPA) PET/CT-guided radiofrequency ablation (RFA) of liver metastases from neuroendocrine tumours (NETs).
  
  
  METHODS
  Three patients (mean age 51.3 years; range 43-56) with gastro-entero pancreatic NET (GEP-NET) liver metastases underwent 18F-FDOPA PET/CT-guided RFA. Patients were referred with oligometastatic hepatic-confined disease (1-6 metastases; <3 cm) on 18F-FDOPA PET/CT; poor lesion visualisation on US, CT, and MR; and ongoing symptoms. Procedures were performed in an interventional PET/CT scanner under general anaesthesia using a split-dose protocol. Lesion characteristics, procedural duration and technical success (accurate probe placement and post-procedural ablation-zone photopaenia), complications, patient and operator dose, and clinical outcomes were evaluated.
  
  
  RESULTS
  Thirteen liver metastases (mean size 11.4 mm, range 8-16) were treated in three patients (two presented with "carcinoid syndrome"). Technical success was 100 % with a mean procedural duration of 173.3 min (range 90-210) and no immediate complications. Mean patient dose was 2844 mGy·cm (range 2104-3686). Operator and radiographer doses were acceptable other than the operator's right hand in the first case (149 µSv); this normalised in the second case. There was no local tumour or extra-hepatic disease progression at mid-term follow-up (mean 12.6 months; range 6-20); however, two cases progressed with new liver metastases at different sites. There was 100 % clinical success (n = 2) in resolving carcinoid syndrome symptoms.
  
  
  CONCLUSIONS
  18F-FDOPA PET/CT-guided RFA appears technically feasible, safe, and effective in patients with GEP-NETs and low-burden hepatic metastases. Further prospective studies are required to elucidate its precise role in tailored multimodality management of GEP-NET liver metastases.
authors.affiliation: Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), 1, place de l'Hôpital, 67000, Strasbourg, France. gigicazzato@hotmail.it.
authors.forename: Roberto Luigi
authors.initials: RL
authors.lastname: Cazzato
authors.affiliation: Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), 1, place de l'Hôpital, 67000, Strasbourg, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Garnon
authors.affiliation: Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
authors.forename: Nitin
authors.initials: N
authors.lastname: Ramamurthy
authors.affiliation: Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), 1, place de l'Hôpital, 67000, Strasbourg, France.
authors.forename: Georgia
authors.initials: G
authors.lastname: Tsoumakidou
authors.affiliation: Department of Biophysics and Nuclear Medicine, Hôpital de Hautepierre (Hôpitaux Universitaires de Strasbourg, HUS), Avenue Molière, 67200, Strasbourg, France.
authors.forename: Alessio
authors.initials: A
authors.lastname: Imperiale
authors.affiliation: Department of Biophysics and Nuclear Medicine, Hôpital de Hautepierre (Hôpitaux Universitaires de Strasbourg, HUS), Avenue Molière, 67200, Strasbourg, France.
authors.forename: Izzie Jacques
authors.initials: IJ
authors.lastname: Namer
authors.affiliation: Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Hôpital de Hautepierre (Hôpitaux Universitaires de Strasbourg, HUS), Avenue Molière, 67200, Strasbourg, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bachellier
authors.affiliation: Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), 1, place de l'Hôpital, 67000, Strasbourg, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Caudrelier
authors.affiliation: Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), 1, place de l'Hôpital, 67000, Strasbourg, France.
authors.forename: Pramod
authors.initials: P
authors.lastname: Rao
authors.affiliation: Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), 1, place de l'Hôpital, 67000, Strasbourg, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Koch
authors.affiliation: Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), 1, place de l'Hôpital, 67000, Strasbourg, France.
authors.forename: Afshin
authors.initials: A
authors.lastname: Gangi
mesh_terms: D000328:Adult; D017115:Catheter Ablation / Q000379:methods*; D004295:Dihydroxyphenylalanine / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000601:surgery; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology*; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000379:methods; D016896:Treatment Outcome
chemical_list: C043437:fluorodopa F 18; D004295:Dihydroxyphenylalanine
keywords: Liver metastasis; Neuroendocrine tumours; PET/CT; Radiofrequency ablation