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Intraindividual Tumor Heterogeneity in Neuroendocrine Tumors Revealed with 18F-FDG and 68Ga-DOTA-TATE PET/CT | OMICS International
ISSN: 2155-9619
Journal of Nuclear Medicine & Radiation Therapy

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Intraindividual Tumor Heterogeneity in Neuroendocrine Tumors Revealed with 18F-FDG and 68Ga-DOTA-TATE PET/CT

Emre Demirci1*, Betül Vatankulu2, Resit Akyel2, Fuat Dede3 and Metin Halac2

1Department of Nuclear Medicine, Sisli Etfal Training and Research Hospital, Istanbul, Turkey

2Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey

3Department of Nuclear Medicine Marmara Medical School, Istanbul, Turkey

*Corresponding Author:
Emre Demirci, M.D
Department of Nuclear Medicine
Sisli Etfal Training and Research Hospital
Istanbul, Turkey
Tel: +90 (212) 3735000
Email: [email protected]

Received date: December 19, 2015 Accepted date: January 27, 2016 Published date: January 31, 2016

Citation: Demirci E, Vatankulu B, Akyel R, Dede F, Halac M (2016) Intraindividual Tumor Heterogeneity in Neuroendocrine Tumors Revealed with 18F-FDG and 68Ga-DOTA-TATE PET/CT. J Nucl Med Radiat Ther 7:277. doi:10.4172/2155-9619.1000277

Copyright: © 2016 Demirci E, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License; which permits unrestricted use; distribution; and reproduction in any medium; provided the original author and source are credited.

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68Ga-DOTA-TATE PET/CT is widely used in functional imaging of neuroendocrine tumors (NETs) and is superior to conventional somatostatin receptor scintigraphy (SRS), which is recommended for low grade NETs according to NANETS/ENETS guidelines. On the contrary 18F-FDG PET is suggested in patients with high grade NETs or when SRS is negative. However, tumor heterogeneity is a common finding along with NETs and causes differential expression of somatostatin receptor (sstr) and various FDG metabolisms. Here, we present a case where tumor heterogeneity is revealed with combined use of 18F-FDG PET/CT and 68Ga-DOTA-TATE PET/CT in the same patient and how does it influence clinical decision-making Conclusion: We here present the first report of FFF-VMAT achieving a comparable plan quality with less delivery time to that of FF-VMAT and HT in head and neck cancer. FFF-VMAT is a highly efficient and feasible option for the treatment of head and neck cancer in clinical practice.


Neuroendocrine tumors; 68Ga-DOTA-TATE PET/CT

Case Report

A 59-year-old female patient was diagnosed with WHO Grade 2 NET (Ki67: %25) by a tru-cut biopsy from a metastatic liver lesions discovered by a CT scan. Initial 18F-FDG PET/CT revealed intensely FDG avid multiple liver lesions with an index lesion measuring 9 × 7 cm (SUVmax:13.5) and FDG avid bone lesions (SUVmax:4.8) consistent with metastases. Other imaging methods and gastrointestinal endoscopies failed to detect primary tumor site.

Contrarily bone metastasis, which had a lower FDG avidity compared to liver lesions (Figure 1C), showed strongly increased uptake in 68Ga-DOTA-TATE PET/CT (Figure 1D) indicating high expression of sstr2.


Figure 1: A,C: PET, CT, PET/CT fusion and maximum intensity projection (MIP) images of 18F-FDG PET/CT. B,D: PET, CT, PET/CT fusion and MIP images of 68Ga-DOTA-TATE PET/CT.

68Ga-DOTA-TATE PET/CT was also detected more bone lesions compared to 18F-FDG PET/CT. In light of these findings patient was referred to intra-arterial 90Y-microsphere therapy to control liver metastases. Also 4 courses of PRRT treatment were planned to treat bone metastases.

68Ga-DOTA-TATE PET/CT is superior to conventional SRS in NETs and also recommended for low grade NETs [1]. However, tumor heterogeneity which can be seen in NETs causes differential sstr expression and various FDG metabolisms [2,3]. This case is a good example of how NETs may show intraindividual tumor heterogeneity and how it effects the selection of treatment choices.


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Review summary

  1. Euaristos Brassington
    Posted on Oct 24 2016 at 2:59 pm
    This is an interesting article and clearly demonstrated the heterogeneity in neuroendocrine tumours. In an era of personalized medicine, it is worthy to note modifications of treatment dependent on the results of two types of PET/CT scan. There is increasing evidence of different receptor sites on tumours that make them viable to multiple treatment types. It will be interesting to see this published with a larger database of patients.

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