Anatomic and Functional Imaging of Neuroendocrine Tumors
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Neuroendocrine Cancers (JR Strosberg, Section Editor)
Anatomic and Functional Imaging of Neuroendocrine Tumors Brian Morse, MD1,* Taymeyah Al-Toubah, MPH2 Jaime Montilla-Soler, MD1 Address *,1 Department of Diagnostic Imaging, Moffitt Cancer Center, 12902 Magnolia Drive, WCB-RAD, Tampa, FL, 33612, USA Email: [email protected] 2 Department of Gastrointestinal Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, USA
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Neuroendocrine Cancers Keywords Neuroendocrine tumors I Computed tomography (CT) I Magnetic resonance imaging (MRI) I Gallium-68 PET/CT
Opinion statement Neuroendocrine tumors (NETs) can occur in a wide variety of organs and display a spectrum of pathologic behavior. Accurate and effective imaging is paramount to the diagnosis, staging, therapy, and surveillance of patients with NET. There have been continuous advancements in the imaging of NET which includes anatomic and functional techniques.
Introduction CT and MRI are referred to as anatomic imaging modalities since they depict normal and abnormal organs and tissue with very high spatial resolution but limited functional information. For example, in a patient with liver metastases, CT and MRI will show the number, size, and distribution of the metastases but provide limited
information about the pathology of the metastases or the amount of viable versus necrotic or treated tumor. Functional imaging techniques utilize compounds that can be imaged which bind to or are metabolized by tumor cells. The most common functional imaging employed in oncology is 18 F-fluorodeoxyglucose
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(FDG) positron emission tomography/computed tomography (PET/CT) which uses radiolabeled glucose to quantify tumor metabolism. Functional imaging
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using compounds that specifically bind to neuroendocrine tumor cells has dramatically improved the staging and management of NET.
Anatomic imaging—introduction Standardization of imaging protocols for the evaluation of NET is complicated by the wide variety of primary tumor locations and sites of metastatic disease. The exact details of the anatomic imaging which provide optimal assessment of NET vary based on the organs affected and primary tumor. This review covers the anatomic imaging of the various primary sites of NET including relevant published guidelines or best practices (if available) and any special considerations that exist for certain organs. There is one key imaging concept which applies to all NET subtypes: multiphase or dynamic imaging. When intravenous (IV) contrast is administered for a scan, images are acquired at one or more time points after contrast injection to better depict various structures. Three or four sets of images are acquired at certain time points after IV contrast administration in order to optimize visualization of certain structures, thus the term “multiphase” or “dynamic” imaging. For liver im
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