PET/CT Galium-68 DOTA-TATE for Neuroendocrine Tumors

Hybrid Positron Emission and Computer Tomography (PET/CT) Ga68 DOTA-TATE is an imaging technique for detecting and characterizing well differentiated neuroendocrine tumors (NET) and neural crest tumors (e.g., pheochromocytoma, neuroblastoma, ganglioneuroma) and meningioma.

In recent years, the incidence and prevalence of NET is increased. NET is a group of tumors, most commonly arising in the gastroenteropancreatic tract and lungs. These tumors show overexpression of somatostatin receptors (SSTRs) on their membrane, most frequently type 2.

Why PET/CT Galium-68 DOTA-TATE

Ga68 DOTA-TATE is characterized by a high binding affinity to SSRT-2 receptors with sensitivity 90-98% and specificity 92-98% for the detection of NET in patients presented for staging and restaging after therapy. In meta-analysis study, Ga68-DOTATE better demonstrated disease extent (100%) than conventional (68%) imaging (contrast enhanced CT, MRI, ultrasound) with significant clinical impact (Deppen, S. J of Nucl Med 2016).

Accurate staging of NET is essential of optimizing patient management. In NET management, surgery is the only possible curative approach, but presence of metastasis can preclude surgical resection. Metastases are common, and both indolent and aggressive NET can metastasize. Therefore, Ga68 DOTA-TATE PET/CT is preferred imaging modality for initial diagnosis, selection patient for radionuclide therapy, surgery resection and localization.

Our advanced 128 slices Biograph mCT PET/CT may detect the early onset of the disease before it visualized on traditional modalities such as X-ray, CT or MRI, which has made significant clinical impact.

Middle age female with recent history of a pancreatic head mass presented for initial evaluation.

PET/CT Ga68 DOTA-TATE demonstrates a tracer avid mass measuring 4.6 x 4.6 cm in the pancreatic head region (SUV of 37.0), consistent with biopsy-proven neuroendocrine tumor. Additionally, DOTA-TATE scan showed avid foci in the bilateral hepatic lobes, suggestive of liver metastasis.

CHARTER RADIOLOGY where care starts at the molecular level with our state of the art 128 slices PET/CT Biograph mCT

Is PET/CT Ga68 DOTA-TATE safe?

At Charter Radiology we use low radiation dose. A typical administered activity (dose) of Ga68 DOTA-TATE is about 200 MBq (5.4 mCi) or ~ 4 mSV which is relatively low (compare to a regular CT scan radiation dose 7 mSV without contrast and >15 mSV with contrast).

WHAT I WILL EXPERIENCE DURING AND AFTER PET/CT DOTA-TATE Imaging

– Drink enough water so you are well hydrated (if you have any other test today where you are told not to eat or drink for a longer amount of time, follow those instructions).

– If you take Sandostan LAR or Lanreotide (somatuline) stop taking them 4 weeks before the test, Octreotide stop taking it only 12 hours before the test

-Our nuclear technologist will inject painless radiotracer IV (intravenous). Usually, majority of radiotracers take 30-45 minutes to travel through your body. During this waiting period, you will be asked to rest and avoid eating or vigorous exercise.

-You will be moved to the PET/CT scanner. The average scanning time is about 15 minutes

-When test is complete, you may resume your normal activities

-The radiotracer will pass through your body through urine, stool and natural radioactive decay

-We encourage you to drink plenty of water after the test

FDG PET/CT IMAGING FOR SOLITARY PULMONARY NODULES

While conventional imaging establishes the presence of solitary pulmonary nodules (SPNs), invasive procedures that involve risk may be required to characterize the lesions.

PET/CT utilization as a diagnostic tool could reduce the number of unnecessary biopsies or thoracotomies on benign SPNs. Nodules that were classified as indeterminate on CT were correctly characterized on PET in over 80% of the cases.

PET should be obtained in the diagnostic work-up of patients with SPN.

PET enables the physician to make a more informed clinical decision. 

The American College of Chest Physicians recommends: In patients with a low-to-moderate pretest probability of malignancy (5% to 65%) and an indeterminate SPN that measures at least 8 mm in diameter, we suggest that functional imaging, preferably with positron emission tomography (PET), should be performed to characterize the nodule.

Medicare recognizes the utility of PET and PET/CT in solitary pulmonary nodule (SPN).

Initial Treatment Strategy

Medicare covers PET scans for characterization of a single pulmonary nodule under the Initial Treatment Strategy of Lung Cancer. For the Initial Treatment Strategy, PET/CT may be used:

• To determine whether or not the beneficiary is an appropriate candidate for an invasive diagnostic or therapeutic procedure
• To determine the optimal anatomic location for an invasive procedure

To determine the anatomic extent of the tumor when the recommended anti-tumor treatment reasonably depends on the extent of the tumor.