Physiological and tumoral uptake of 68 Ga-DOTATATE: standardized uptake values and challenges in interpretation
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ORIGINAL ARTICLE
Physiological and tumoral uptake of 68Ga-DOTATATE: standardized uptake values and challenges in interpretation ¨ zkan • Serkan Kuyumcu • Zeynep Go¨zde O Yasemin Sanli • Ebru Yilmaz • Ayse Mudun Isik Adalet • Seher Unal
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Received: 21 January 2013 / Accepted: 11 March 2013 Ó The Japanese Society of Nuclear Medicine 2013
Abstract Purpose The objective of this study is to determine the range of SUVmax of 68Ga-DOTATATE in normal organs and tumoral lesions and establish uptake unrelated to NET. Materials and methods One hundred and twenty patients (57 men, 63 women), who underwent 68Ga-DOTATATE PET/CT imaging in our institution were analyzed. Patients were indicated for 68Ga-DOTATATE PET/CT imaging to detect primary tumor or metastasis of suspected or previously known NET, to determine SSTR positivity and to detect occult source of ectopic Cushing syndrome. Normal range of uptake was calculated for the organs that were proven to have no pathology by either conventional radiological imaging or clinical follow-up, using SUVmax as a semiquantitative measure. Uptake and tumor to background (T/B) ratios of tumoral lesions in liver, pancreas, bone, brain and lymph nodes were calculated. Uptakes due to lesions unrelated to NET were also documented. Results Significant uptake was found in spleen, kidneys, adrenal glands, liver and pituitary gland with mean SUVmax of 24.67, 14.30, 13.73, 9.12 and 9.74 respectively. Uptake was measured separately for the pancreatic head and body separately, however, besides a slightly heterogeneous uptake; the difference was not statistically significant. Uptake in the tumoral lesions had high (T/B) ratios with mean SUVmax of 28.72, 25.21, 18.28, 34.73 and 12.59 for liver, pancreas, bone, brain and lymph nodes, respectively. Incidental benign tumoral lesions were detected in 3 patients (2.5 %) which were meningioma and fibrous
¨ zkan Y. Sanli E. Yilmaz S. Kuyumcu (&) Z. G. O A. Mudun I. Adalet S. Unal ¨ niversitesi, Nu¨kleer Tıp Anabilim Dali, Istanbul U Istanbul Tip Fakultesi, Fatih, Istanbul 34390, Turkey e-mail: [email protected]
dysplasia demonstrating significant and breast fibroadenoma demonstrating mild 68Ga-DOTATATE uptake. Nonneoplastic processes were detected in 4 patients (14.1 %), including postsurgical inflammation, reactive lymph nodes, arthritis and demonstrated faint to mild 68Ga-DOTATATE uptake, with the exception of significant uptake in accessory spleen. Conclusion 68Ga-DOTATATE has high T/B ratio with physiological biodistribution comparable to its counterparts. However, the presence of SSTRs in benign and malignant lesions unrelated to NET may be challenging in interpretation particularly where the physiological uptake is variable. Keywords 68Ga-DOTATATE SUVmax PET/CT Neuroendocrine tumors
Introduction Recently, the use of 68Ga labeled positron emission tomography (PET) tracers has increased, due to their convenient preparation using a 68Ge/68Ga generator [1]. High potential for imaging of somatostatin receptor (SSTR)-positive neuro
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