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
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.
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 . 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.