Open AccessImpact of 68Ga-DOTATOC PET/CT in comparison to 111In-Octreotide SPECT/CT in management of neuro-endocrine tumors
Author(s) -
Anna Tolomeo,
Gaetano Lopopolo,
Vincenzo Dimiccoli,
Luana Perioli,
Sergio Modoni,
Antonio Scilimati
Publication year - 2020
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000019162
Subject(s) - medicine , neuroendocrine tumors , nuclear medicine , octreotide , positron emission tomography , pet ct , radiology , radionuclide therapy , somatostatin receptor , colonoscopy , colorectal cancer , somatostatin , cancer
Rationale: In the diagnostics of neuroendocrine tumors (NETs), scintigraphy and Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) with 111 Indium-Octreotide occupy a prominent place. The introduction in clinical practice of 68 Gallium-labelled somatostatin analogues (DOTA-TOC, DOTA-TATE, DOTA-NOC) for Positron Emission Tomography/Computed Tomography (PET/CT), significantly improved NETs diagnostics due to greater sensitivity and improved lesion detection in addition to better patient convenience and decreased radiation dose. Patient concerns: We report a case of a patient who was diagnosed with a neuroendocrine tumor of the ileocecal valve. Diagnoses: Diagnosis was made by ultrasonography, CT, and colonoscopy. Hystology after surgery was G2 NET of ileo-cecal valve. Restaging was carried out by 111 In-Octreotide SPECT/CT and, 1 month later, by 68 Ga-DOTATOC PET/CT. 18 F-FDG PET/C was also carried out. Interventions: 68 Ga-DOTATOC PET/CT showed larger disease that modified disease management from surgery to medical treatment. Outcomes: After an initial improvement in the patient clinical condition, the tumor caused a worsening with the appearance of ascites. Lessons: 68 Ga-DOTA-conjugate PET/CT is appropriate in low and intermediate NET (Ki67 index respectively ≤3% and 3%–20%) characterized by better survival and better response after Peptide Receptor Radionuclide Therapy. 18 F-FDG is mostly useful in high grade (G3) of disease, so that 68 Ga-DOTA-conjugate SUV and 18 F-FDG SUV have an opposite trend in relation to the tumor grade. 68 Ga-DOTATOC PET/CT changes, as in our case, therapeutic management in about 40% of cases.