Molecular Imaging of Gastroenteropancreatic Neuroendocrine Tumors: Current Status and Future Directions.
Through diagnostic imaging and peptide receptor radionuclide therapy, nuclear medicine has earned a major role in gastroenteropancreatic neuroendocrine tumors (GEP NETs). GEP NETs are diagnosed fortuitously or on the basis of symptoms or hormonal syndrome. The functional tumor characteristics shown by radionuclide imaging allow for more accurate staging and treatment selection. Tumor grade helps determine which tracer should be selected. In the past,111In-pentetreotide has been successful in well-differentiated (G1 and G2) tumors. However, PET/CT imaging with novel somatostatin analogs (e.g.,68Ga-DOTATOC,68Ga-DOTATATE,68Ga-DOTANOC, and64Cu-DOTATATE) now offers improved sensitivity.18F-fluorodihydroxyphenylalanine (18F-FDOPA) is another interesting radiopharmaceutical.18F-FDOPA sensitivity is influenced by a tumor's capacity to take up, decarboxylate, and store amine precursors.18F-FDOPA sensitivities are highest in ileal NETs and may also be helpful in insulinomas. A high uptake of18F-FDG with a low uptake of somatostatin analog usually indicates poorly differentiated tumors (G3). Starting from these principles, this article discusses theranostic approaches to GEP NETs, taking into account both primary and metastatic lesions.
Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium.
Christophe M
CM
Deroose
Nuclear Medicine, Haut-Lévêque Hospital, University of Bordeaux, France.|LabEx TRAIL, University of Bordeaux, France.
Elif
E
Hindié
Endocrine Oncology Branch, National Cancer Institute, NIH, Bethesda, Maryland.
Electron
E
Kebebew
Internal Medicine, Strasbourg University Hospitals, Strasbourg, France.
Bernard
B
Goichot
Section on Medical Neuroendocrinology, Eunice Kennedy Shriver NICHD, NIH, Bethesda, Maryland.
Karel
K
Pacak
Nuclear Medicine, La Timone University Hospital, Aix-Marseille University, Marseille, France.|European Center for Research in Medical Imaging, Marseille, France.|INSERM UMR1068, Marseille, France.
David
D
Taïeb
Biophysics and Nuclear Medicine, Strasbourg University Hospitals, Strasbourg, France; and alessio.imperiale@chru-strasbourg.fr.|ICube, UMR 7357, University of Strasbourg/CNRS and FMTS, Faculty of Medicine, University of Strasbourg, Strasbourg, France.
Alessio
A
Imperiale
D006801:Humans; D007414:Intestinal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D057054:Molecular Imaging / Q000379:methods*; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D057285:Precision Medicine; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy
18F-FDG; 18F-FDOPA; 68Ga-somatostatin analogues; PET/CT; gastroenteropancreatic neuroendocrine tumors (GEP NETs)