Journal Mobile Options
Table of Contents
Vol. 91, No. 1, 2010
Issue release date: January 2010
Neuroendocrinology 2010;91:101–109

Impact of Multiphase 68Ga-DOTATOC-PET/CT on Therapy Management in Patients with Neuroendocrine Tumors

Ruf J. · Heuck F. · Schiefer J. · Denecke T. · Elgeti F. · Pascher A. · Pavel M. · Stelter L. · Kropf S. · Wiedenmann B. · Amthauer H.
aKlinik für Radiologie und Nuklearmedizin, and bInstitut für Biometrie und Medizinische Informatik, Universitätsklinikum Magdeburg A.ö.R, Magdeburg, cMedizinische Klinik m. S. Hepatologie und Gastroenterologie, Charité Centrum 13 für Innere Medizin mit Kardiologie, Gastroenterologie, und Nephrologie, dKlinik Strahlenheilkunde, Charité Centrum 6 für diagnostische und interventionelle Radiologie und Nuklearmedizin, and eKlinik für Allgemein-, Viszeral- und Transplantationschirurgie, Charité Centrum 8 für Chirurgische Medizin, Campus Virchow-Klinikum, Charité-Universitätsmedizin, Berlin, Germany; fNuclear Medicine Research Laboratory, Memorial Sloan-Kettering Cancer Center, New York City, N.Y., USA

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Aim: Retrospective evaluation of the impact of integrated positron emission tomography/computed tomography (PET/CT) using 68Ga-DOTA(0)-Phe(1)-Tyr(3)-octreotide (68Ga-DOTATOC) on the therapeutic management of patients with neuroendocrine tumors (NET). Methods: The 68Ga-DOTATOC-PET/CT data of 66 patients (31 male, 35 female; age: 29–79, mean age: 56 years) with known or suspected NET were included. Imaging data (PET and triple-phase contrast-enhanced CT) were evaluated in consensus by two readers for the visualization of NET manifestations. Combined PET/CT, clinical and imaging follow-up as well as histopathology (if available) served as the reference standard. In order to assess the impact of the respective submodalities on the therapeutic strategy chosen, the results were compared to the treatment decision made by the interdisciplinary NET tumor board of our institution. Results: Two of the initial 66 patients included did not suffer from NET according to further immunohistopathological examination. In 50 of the remaining 64 (78%) NET patients, a total of 181 NET manifestations were detected by PET/CT. 59/181 (32.6%) were detected by one submodality only (CT 17.1%, PET 15.5%, p for comparison of both = 0.459). Combined PET/CT reading had an impact on the therapeutic management in 24 of 64 (38%) NET patients: primary resection (n = 5), curative lymph node resection (n = 1), initiation/switch of chemotherapy (CTx) due to progressive disease (n = 10), no surgery due to systemic disease (n = 2), radiopeptide receptor therapy instead of CTx (n = 1), additional bisphosphonate therapy (n = 4), and hepatic brachytherapy (n = 1). In 12 of 24 (50%) of these patients, relevant findings were detected by a single submodality only: CT (n = 5), PET (n = 7); p for comparison = 0.774). Conclusion:68Ga-DOTATOC-PET/CT influences therapeutic management in about one third of patients examined. CT and PET are comparably sensitive, deliver complementary information and equally contribute to therapeutic decision-making. Thus, despite the merits of the PET modality, the CT component must not be neglected and an optimized multiphase CT protocol is recommended.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Hoyer D, Bell GI, Berelowitz M, Epelbaum J, Feniuk W, Humphrey PP, O’Carroll AM, Patel YC, Schonbrunn A, Taylor JE, Reisine T: Classification and nomenclature of somatostatin receptors. Trends Pharmacol Sci 1995;16:86–88.
  2. Reubi JC: Peptide receptors as molecular targets for cancer diagnosis and therapy. Endocr Rev 2003;24:389–427.
  3. Reubi JC: Neuropeptide receptors in health and disease: the molecular basis for in vivo imaging. J Nucl Med 1995;36:1825–1835.
  4. Reubi JC, Schar JC, Waser B, Wenger S, Heppeler A, Schmitt JS, Macke HR: Affinity profiles for human somatostatin receptor subtypes SST1-SST5 of somatostatin radiotracers selected for scintigraphic and radiotherapeutic use. Eur J Nucl Med 2000;27:273–282.
  5. Miederer M, Seidl S, Buck A, Scheidhauer K, Wester HJ, Schwaiger M, Perren A: Correlation of immunohistopathological expression of somatostatin receptor 2 with standardised uptake values in 68Ga-DOTATOC PET/CT. Eur J Nucl Med Mol Imaging 2009;36:48–52.
  6. Krenning EP, Kwekkeboom DJ, Bakker WH, Breeman WA, Kooij PP, Oei HY, van Hagen M, Postema PT, de Jong M, Reubi JC, et al: Somatostatin receptor scintigraphy with [111In-DTPA-D-Phe1]- and [123I-Tyr3]-octreotide: the Rotterdam experience with more than 1,000 patients. Eur J Nucl Med 1993;20:716–731.
  7. Kaltsas G, Rockall A, Papadogias D, Reznek R, Grossman AB: Recent advances in radiological and radionuclide imaging and therapy of neuroendocrine tumours. Eur J Endocrinol 2004;151:15–27.
  8. Cherry SR, Sorenson SA, Phelps M: Physics in Nuclear Medicine, ed 3. Philadelphia, Saunders, 2003.
  9. Antunes P, Ginj M, Zhang H, Waser B, Baum RP, Reubi JC, Maecke H: Are radiogallium-labelled DOTA-conjugated somatostatin analogues superior to those labelled with other radiometals? Eur J Nucl Med Mol Imaging 2007;34:982–993.
  10. Hofmann M, Maecke H, Börner R, Weckesser E, Schöffski P, Oei L, Schumacher J, Henze M, Heppeler A, Meyer J, Knapp H: Biokinetics and imaging with the somatostatin receptor PET radioligand 68Ga-DOTATOC: preliminary data. Eur J Nucl Med 2001;28:1751–1757.
  11. Buchmann I, Henze M, Engelbrecht S, Eisenhut M, Runz A, Schäfer M, Schilling T, Haufe S, Herrmann T, Haberkorn U: Comparison of 68Ga-DOTATOC PET and 111In-DTPAOC (Octreoscan) SPECT in patients with neuroendocrine tumours. Eur J Nucl Med Mol Imaging 2007;34:1617–1626.
  12. Kowalski J, Henze M, Schuhmacher J, et al: Evaluation of positron emission tomography imaging using [68Ga]-DOTA-D-Phe(1)-Tyr(3)-octreotide in comparison to [111In]-DTPAOC SPECT. First results in patients with neuroendocrine tumors. Mol Imaging Biol 2003;5:42–48.
  13. Gabriel M, Decristoforo C, Kendler D, Dobrozemsky G, Heute D, Uprimny C, Kovacs P, Von Guggenberg E, Bale R, Virgolini IJ: 68Ga-DOTA-Tyr3-octreotide PET in neuroendocrine tumors: comparison with somatostatin receptor scintigraphy and CT. J Nucl Med 2007;48:508–518.
  14. Mawlawi O, Townsend DW: Multimodality imaging: an update on PET/CT technology. Eur J Nucl Med Mol Imaging 2009;36(suppl 1):15–29.

    External Resources

  15. Kayani I, Bomanji JB, Groves A, Conway G, Gacinovic S, Win T, Dickson J, Caplin M, Ell PJ: Functional imaging of neuroendocrine tumors with combined PET/CT using 68Ga-DOTATATE (DOTA-D-Phe1,Tyr3-octreotate) and 18F-FDG. Cancer 2008;112:2447–2455.
  16. Elgeti F, Amthauer H, Denecke T, Steffen I, Heuck F, Stelter L, Ruf J: Incidental detection of breast cancer by 68Ga-DOTATOC-PET/CT in women suffering from neuroendocrine tumours. Nuklearmedizin 2008;47:261–265.
  17. Haug A, Auernhammer CJ, Wängler B, Tiling R, Schmidt G, Göke B, Bartenstein P, Pöpperl G: Intraindividual comparison of 68Ga-DOTA-TATE and 18F-DOPA PET in patients with well-differentiated metastatic neuroendocrine tumours. Eur J Nucl Med Mol Imaging 2009;36:765–770.
  18. Zhernosekov KP, Filosofov DV, Baum RP, Aschoff P, Bihl H, Razbash AA, Jahn M, Jennewein M, Rösch F: Processing of generator-produced 68Ga for medical application. J Nucl Med 2007;48:1741–1748.
  19. Sundin A, Vullierme MP, Kaltsas G, Plöckinger U: ENETS Guidelines for the Standards of Care in Patients with Neuroendocrine Tumours: Radiological examinations in patients with neuroendocrine tumours. Neuroendocrinology 2009;90:167–183.
  20. SAS/STAT® 9.2 User’s Guide. Cary, SAS Institute Inc., USA, 2008.
  21. Seemann MD, Meisetschlaeger G, Gaa J, Rummeny EJ: Assessment of the extent of metastases of gastrointestinal carcinoid tumors using whole-body PET, CT, MRI, PET/CT and PET/MRI. Eur J Med Res 2006;11:58–65.
  22. Seemann MD: Detection of metastases from gastrointestinal neuroendocrine tumors: prospective comparison of 18F-TOCA PET, triple-phase CT, and PET/CT. Technol Cancer Res Treat 2007;6:213–220.
  23. Meisetschläger G, Poethko T, Stahl A, Wolf I, Scheidhauer K, Schottelius M, Herz M, Wester HJ, Schwaiger M: Gluc-Lys([18F]FP)-TOCA PET in patients with SSTR-positive tumors: biodistribution and diagnostic evaluation compared with [111In]DTPA-octreotide. J Nucl Med 2006;47:566–573.

    External Resources

  24. Schottelius M, Poethko T, Herz M, Reubi JC, Kessler H, Schwaiger M, Wester HJ: First 18F-labeled tracer suitable for routine clinical imaging of SST receptor-expressing tumors using positron emission tomography. Clin Cancer Res 2004;10:3593–3606.
  25. Kim JH, Czernin J, Allen-Auerbach MS, Halpern BS, Fueger BJ, Hecht JR, Ratib O, Phelps ME, Weber WA: Comparison between 18F-FDG PET, in-line PET/CT, and software fusion for restaging of recurrent colorectal cancer. J Nucl Med 2005;46:587–595.
  26. Krishnasetty V, Fischman AJ, Halpern EL, Aquino SL: Comparison of alignment of computer-registered data sets: combined PET/CT versus independent PET and CT of the thorax. Radiology 2005;237:635–639.
  27. Weigert M, Pietrzyk U, Müller S, Palm C, Beyer T: Whole-body PET/CT imaging: combining software- and hardware-based co-registration. Z Med Phys 2008;18:59–66.
  28. van Dalen JA, Visser EP, Vogel WV, Corstens FH, Oyen WJ: Impact of Ge-68/Ga-68-based versus CT-based attenuation correction on PET. Med Phys 2007;34:889–897.
  29. Goerres GW, Burger C, Kamel E, Seifert B, Kaim AH, Buck A, Buehler TC, Von Schulthess GK: Respiration-induced attenuation artifact at PET/CT: technical considerations. Radiology 2003;226:906–910.
  30. Prabhakar HB, Sahani DV, Fischman AJ, Mueller PR, Blake MA: Bowel hot spots at PET-CT. Radiographics 2007;27:145–159.
  31. Pape UF, Böhmig M, Berndt U, Tiling N, Wiedenmann B, Plöckinger U: Survival and clinical outcome of patients with neuroendocrine tumors of the gastroenteropancreatic tract in a German referral center. Ann N Y Acad Sci 2004;1014:222–233.
  32. Oliver JH 3rd, Baron RL, Federle MP, Jones BC, Sheng R: Hypervascular liver metastases: do unenhanced and hepatic arterial phase CT images affect tumor detection? Radiology 1997;205:709–715.
  33. Hukovic N, Panetta R, Kumar U, Patel YC: Agonist-dependent regulation of cloned human somatostatin receptor types 1–5 (hSSTR1–5): subtype selective internalization or upregulation. Endocrinology 1996;137:4046–4049.
  34. Yalcin S, Oyan B, Bayraktar Y: Current medical treatment of pancreatic neuroendocrine tumors. Hepatogastroenterology 2007;54:278–284.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50