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Comparison of 68Ga-DOTATATE and 18F-fluorodeoxyglucose PET/CT in the detection of recurrent medullary thyroid carcinoma
Ist Teil von
European journal of nuclear medicine and molecular imaging, 2010, Vol.37 (1), p.49-57
Ort / Verlag
Berlin/Heidelberg: Springer-Verlag
Erscheinungsjahr
2010
Quelle
Alma/SFX Local Collection
Beschreibungen/Notizen
Purpose
This was a retrospective study to detect and map the extent of disease in recurrent medullary thyroid carcinoma (MTC) using the novel PET somatostatin analogue
68
Ga-DOTATATE and conventional
18
F-FDG positron emission tomography/computed tomography (PET/CT).
Methods
Eighteen patients (13 men, 5 women, median age: 54 years) who had previously been operated on for MTC and presented with biochemical (raised calcitonin levels) and/or imaging evidence of recurrence underwent both
68
Ga-DOTATATE and
18
F-FDG PET/CT within a maximum interval of 4 weeks (median interval of 1 week).
68
Ga-DOTATATE- and
18
F-FDG-avid lesions were recorded per patient as well as per region in six distinct regions: (1) thyroid bed—local recurrence, (2) cervical lymph nodes, (3) mediastinum, (4) lungs, (5) liver and (6) bones. The
68
Ga-DOTATATE and
18
F-FDG PET/CT findings were classified as positive or negative on visual interpretation. These findings were further characterised as concordant or discordant, depending on whether there was agreement or discrepancy in imaging with the two radiotracers. A separate analysis of the unenhanced CT component of the examination was performed. Verification of the lesions was achieved by histopathological analysis, further imaging studies and clinical follow-up.
Results
68
Ga-DOTATATE PET/CT imaging achieved disease detection in 13 of 18 and
18
F-FDG PET/CT in 14 of 18 patients. These results corresponded to per-patient sensitivities of 72.2% [95% confidence interval (CI): 46.4–89.3%] for
68
Ga-DOTATATE versus 77.8% (95% CI: 51.9–92.6%) for
18
F-FDG (non-significant difference).
18
F-FDG revealed a total of 28 metastatic MTC regions and
68
Ga-DOTATATE 23 regions. In ten patients a discordant tracer pattern of per-region and/or per-lesion distribution of recurrent disease was observed, while in four patients a concordant pattern was noted (no lesions were detected by either modality in the remaining four patients).
Conclusion
Neither
18
F-FDG nor
68
Ga-DOTATATE PET/CT can fully map the extent of disease in patients with recurrent MTC, although
18
F-FDG PET/CT may identify more lesions. However,
68
Ga-DOTATATE PET/CT can be a useful complementary imaging tool and may identify patients suitable for consideration of targeted radionuclide somatostatin analogue therapy.