Impact of initial imaging with gallium-68 dotatate PET/CT on diagnosis and management of patients with neuroendocrine tumors (NETs): A sequential case series.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 379-379
Author(s):  
Hagen F. Kennecke ◽  
Preethi Raghu ◽  
Bruce Lin ◽  
Gayle L. Funk ◽  
Adnan Alseidi ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Imaging Modality ◽  
Case Series ◽  
Lesion Detection ◽  
Unknown Primary ◽  
Somatostatin Analogue ◽  
Diagnosis And Management ◽  
Pet Ct ◽  
Initial Imaging ◽  
The Impact

379 Background: Somatostatin analogue functional imaging with Ga-68 Dotatate PET/CT has demonstrated superiority in lesion detection in patients with NETs. The effect of this novel imaging modality on US clinical practice and its usefulness in different types of NETs is not well described. We describe the impact of initial NETSPOT imaging on diagnosis and management in NET patients at a large urban medical center. Methods: Consecutive patients diagnosed with NETs and referred to our institution who received an initial Ga-68 Dotatate PET/CT between 07/2017-09/2018 were included. Imaging was reviewed and compared to prior available CT, MRI, and/or In-111 Pentetreotide scans. Results: Among 101 patients, 51/50 were female/male, tumor origins were gastroenteropancreatic (GEP) (75%), Unknown Primary (UP) (13%), lung (8%), thymic (2%), and other (2%). All tumors were histologically well/moderately differentiated and 37/51/3/10 were G1/G2/G3/Unknown, respectively. Initial imaging with Ga-68 Dotatate PET/CT revealed additional metastatic disease in 37 of 77(48%) patients with prior evidence of metastatic disease. Most common sites were distant lymph nodes (18), bone (15) and liver (9), peritoneal/pleural (4). A previously UP tumor was identified in 3 patients. No patients with metastatic lung carcinoids (6 atypical, 2 typical) or thymic NETs (2 atypical/G2) NETs had evidence of Ga-68 Dota PET/CT uptake above reference liver SUV levels. Results of imaging altered patient management as follows: 14 initiated systemic therapy due to documentation of progression, in 6 surgical therapy was altered, in 4 biopsy/other management was changed. In 11 patients with no tumor Ga-68 Dotatate uptake, decisions about use of PRRT and somatostatin analogues was altered. Conclusions: In this series, Ga-68 Dotatate PET/CT altered diagnosis and management in 35/101 NET patients. Among GEP and UP NETs, Dotatate imaging diagnosed primarily new nodal, bone, liver and pleural/peritoneal metastases missed by other imaging modalities. Results support the routine use of Ga-68 Dotatate PET/CT in the care of patients with advanced and early stage NETS.

scholarly journals EVALUATING THE ROLE OF FDG PET-CT SCAN AS A SOLE IMAGING MODALITY IN THE MANAGEMENT OF MUO NECK

2020 ◽  
pp. 39-41
Author(s):  
Krishnappa Krishnappa ◽  
Krishna Prasad ◽  
Shruti Satish ◽  
Murali R Nadig
Keyword(s):  
Ct Scan ◽  
Predictive Value ◽  
Fdg Pet ◽  
Imaging Modality ◽  
False Negative ◽  
Unknown Primary ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

Aim:to study the role of PET- CT SCAN as a single imaging modality in the diagnosis of MUO neck. methodology: retrospective study analysis of 51 cases of clinical unknown primary with cervical metastasis . RESULTS: FDG PET CT tracer uptake was detected in 24/51. true positive in 18 cases out of 24,false positive in 6 cases, false negative in 2 cases with sensitivity of 90%, specificity of 82%,positive predictive value of 75%,negative predictive value of 93% and accuracy of 84.91%. conclusion: FDG PET CT can be used as a sole imaging modality in the diagnosis of MUO neck.it is complimentary to endoscopy.

scholarly journals A Case Report: Insulinoma in a Military Pilot Detected by 68Ga-Dotatate PET/CT

2020 ◽  
Vol 185 (9-10) ◽  
pp. e1887-e1890
Author(s):  
Lisa D Larose ◽  
Penny J Vroman ◽  
Sierra R Musick ◽  
Alexis A Beauvais
Keyword(s):  
Neuroendocrine Tumor ◽  
Air Force ◽  
Imaging Modality ◽  
Pancreatic Neuroendocrine Tumor ◽  
Altered Mental Status ◽  
Laparoscopic Distal Pancreatectomy ◽  
Nuclear Medicine Imaging ◽  
Pancreatic Lesion ◽  
Pet Ct ◽  
Initial Imaging

Abstract A 37-year-old active duty male Air Force instructor pilot, with no prior medical history, was found unresponsive at his home after awakening with symptoms of altered mental status when the Emergency Medical Service (EMS) was called. The patient was found to be hypoglycemic with a glucose of 37 mg/dL. The patient recovered after administration of a dextrose bolus. Further investigation revealed that over the last several years, the patient exhibited symptoms of lightheadedness and tremors if fasted greater than 3 hours. Further clinical workup strongly suggested the presence of a neuroendocrine tumor. Initial imaging studies to include a multiphasic dedicated pancreatic computed tomography (CT) scan did not demonstrate a pancreatic lesion. However, the utilization of an innovative new nuclear medicine imaging modality, a 68Ga-Dotatate PET/CT, clearly demonstrated a 19 × 16 mm lesion of the distal pancreatic tail, which guided surgical resection. He underwent a robotic-assisted laparoscopic distal pancreatectomy, pathologically characterized as an insulinoma. The patient’s symptoms immediately resolved with no recurrence over the next 6 months. The pilot was granted a waiver, returning him to his flying duties. The 68Ga-Dotatate PET/CT enabled the identification of an otherwise occult pancreatic neuroendocrine tumor ultimately leading to this patient’s definitive cure and the salvage of this military asset’s aviation career.

Impact of initial imaging with gallium‐68 dotatate PET/CT on diagnosis and management of patients with neuroendocrine tumors

2019 ◽  
Vol 121 (3) ◽  
pp. 480-485 ◽  
Author(s):  
Angelena Crown ◽  
Flavio G. Rocha ◽  
Preethi Raghu ◽  
Bruce Lin ◽  
Gayle Funk ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Diagnosis And Management ◽  
Pet Ct ◽  
Initial Imaging ◽  
Gallium 68

Postoperative PET-CT in patients (pts) with pathological stage III colon cancer (CC): Interim results from the first prospective validation study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e15599-e15599
Author(s):  
Roi Tschernichovsky ◽  
Gali Perl ◽  
Inbar Finkel ◽  
Idit Peretz ◽  
Oded Jacobi ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Disease Free Survival ◽  
Stage Iii ◽  
Second Primary ◽  
Surgical Removal ◽  
Pathological Stage ◽  
Ct Findings ◽  
Pet Ct ◽  
The Impact

e15599 Background: A substantial number of pts with pathological stage III CC recur despite the absence of metastatic disease on pre-operative CT. In a previous large retrospective study from our institution on 348 pts, we reported that early postoperative PET-CT modified the staging and management of 13.4% of assumed stage III CC pts. The aim of the current study was to prospectively validate these results. Methods: A prospective, single-center study of pts with pathological stage III CC who underwent early postoperative PET-CT between the years 2013-2021. Results: 83 pts were accrued and 81 (48.1% males, median age 66y) were evaluable for the primary endpoint i.e. PET-CT results. Pathological stage was IIIA, IIIB and IIIC in 7 (8.6%), 56 (69.1%) and 17 (21%) of pts, respectively. Median number of lymph nodes examined and of positive nodes were 17 (range, 9-134) and 2 (range, 0-15), respectively. Post-operative PET-CT findings were significant in 7 pts (8.6%): 4 pts (4.9%) were upstaged to stage IV, 2 (2.5%) were diagnosed with a second primary malignancy, and 1 (1.2%) was both upstaged and diagnosed with another cancer. Three additional pts (3.7%) are currently undergoing evaluation for suspicious PET-CT findings. At a median follow-up of 30.6 months (range, 6.2-92), 13 of the 71 pts with true stage III CC recurred; the estimated 3y disease-free survival rate was 81%. The estimated 5y overall survival rates for the entire cohort and for true stage III pts were 82% and 90%, respectively. Of the 5 pts found to have metastatic disease based on PET-CT findings, one is scheduled to undergo potentially curative surgical removal of a solitary liver metastasis. Conclusions: Interim results from the first prospective study to evaluate the impact of early postoperative PET-CT in pts with pathological stage III CC seem to support earlier retrospective data: the use of PET-CT in this setting changed the staging and management of 8.6% of pts, including the possibility for early detection of potentially curable metastatic disease. Additional data, with more pts and longer follow-up, will be presented at the meeting.

scholarly journals Cases of thyroid cartilage metastasis as abnormal findings seen in prostate cancer patients visualized by 68Ga-PSMA-11 PET/CT

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Ayman M. Gaber ◽  
Rodolfo Núñez ◽  
Ebrahim Delpassand
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Metastatic Disease ◽  
Imaging Modality ◽  
Imaging Techniques ◽  
Cricoid Cartilage ◽  
Thyroid Cartilage ◽  
Interpretation Criteria ◽  
Pet Ct ◽  
Proper Interpretation

Abstract Background 68Ga-PSMA-11 PET/CT is increasingly being used worldwide in prostate cancer patients. Accordingly, there is a pressing need for educational resources on the proper interpretation criteria that need to be used, including a deeper understanding on the pitfalls and variants that one can encounter with this new PET/CT imaging modality. 68Ga-PSMA-11 PET/CT provides very accurate staging of disease in prostate cancer, superior to what can be achieved with other standard imaging techniques. It has allowed the recognition of patterns of metastatic disease in prostate cancer that perhaps were not fully determined. Case presentation We present three cases of patients with advanced metastatic prostate cancer imaged with 68Ga-PSMA-11 PET/CT in which, in addition to widespread osseous metastatic disease, there is evidence of unknown and unsuspected metastatic disease in the thyroid cartilage. Conclusion Although rare and unusual, it is helpful to consider the possibility of prostate carcinoma metastasizing to the thyroid and cricoid cartilage, especially in prostate cancer patients with advanced widespread osseous metastatic disease.

Somatostatin analogues have no role in the treatment of advanced differentiated thyroid cancer

2004 ◽  
Vol 118 (8) ◽  
pp. 653-654 ◽  
Author(s):  
O. Alhamarneh ◽  
J. Murphy ◽  
S.L. Atkin ◽  
R.J.A. England
Keyword(s):  
Thyroid Cancer ◽  
Metastatic Disease ◽  
Differentiated Thyroid Cancer ◽  
Imaging Modality ◽  
Somatostatin Analogues ◽  
Somatostatin Analogue ◽  
Follicular Thyroid Cancer ◽  
Endocrine Tumours ◽  
Physiological Processes ◽  
Analogue Octreotide

Somatostatins are neuropeptides that have a downregulatory effect on various physiological processes. Their use in the management of certain endocrine tumours is well recognized. Their use in thyroid cancer is not established, although there is some evidence to suggest that they have a role in advanced metastatic disease. We report a case of a patient with advanced metastatic follicular thyroid cancer which demonstrated strong octreotide uptake with reduced avidity for I131. Treatment with the somatostatin analogue octreotide, however, failed to achieve a significant response. We feel this case is important as it suggests that although octreotide provides a useful further imaging modality in differentiated thyroid cancer, it has no therapeutic role.

The Role of FDG-PET/CT Imaging in Head and Neck Malignant Conditions: Impact on Diagnostic Accuracy and Patient Care

2007 ◽  
Vol 137 (1) ◽  
pp. 130-137 ◽  
Author(s):  
Arie Gordin ◽  
Avishay Golz ◽  
Zohar Keidar ◽  
Marcello Daitzchman ◽  
Rachel Bar-Shalom ◽  
...  
Keyword(s):  
Head And Neck ◽  
Clinical Management ◽  
Imaging Modality ◽  
Head And Neck Carcinoma ◽  
Diagnostic Procedures ◽  
Positron Emission ◽  
Neck Carcinoma ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
The Impact

BACKGROUND: To assess the value of positron emission tomography/computed tomography (PET/CT) with 18 F-Fluorodeoxyglucose (FDG) in patients with head and neck carcinoma as compared with PET and conventional imaging alone, and to assess the impact of PET/CT on further clinical management. STUDY DESIGN: Prospective nonrandomized study. SETTING: Ninety patients with head and neck tumors had 107 PET/CT examinations. RESULTS: The study analysis showed that PET/CT had a sensitivity of 89%, specificity 95%, PPV 94%, NPV 90%, and accuracy of 92%. PET/CT altered management in 51 patients (56%). PET/CT eliminated the need for previously planned diagnostic procedures in 24 patients, induced a change in the planned therapeutic approach in 21 patients and guided biopsy in 6 patients. CONCLUSIONS: PET/CT is an imaging modality with high diagnostic performance in the assessment of head and neck cancer, and induced a change in further clinical management in more than half of the study population.

PO122 SODIUM FLUORIDE PET/CT: A SUPERIOR IMAGING MODALITY IN EVALUATION OF OSSEOUS METASTATIC DISEASE

The Breast ◽  
2015 ◽  
Vol 24 ◽  
pp. S63-S64
Author(s):  
Emily Harrold ◽  
Jennifer Murphy ◽  
Seamus O'Reilly ◽  
Kevin O'Reagan
Keyword(s):  
Metastatic Disease ◽  
Sodium Fluoride ◽  
Imaging Modality ◽  
Pet Ct

scholarly journals P-P58 The role of PET-CT in the management of pancreatic cancer. A Northern Ireland experience

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Lauren Laverty ◽  
Stephen McCain ◽  
Lloyd McKie
Keyword(s):  
Pancreatic Cancer ◽  
Northern Ireland ◽  
Ct Scan ◽  
Surgical Resection ◽  
Metastatic Disease ◽  
Time Interval ◽  
Resectable Disease ◽  
Number Of Patients ◽  
Pet Ct ◽  
The Impact

Abstract Background Diagnosis and staging has proven to be difficult in 10-20% of patients with pancreatic cancer. The PET-PANC study found that PET-CT significantly influenced the staging and management of pancreatic cancer and therefore the NICE guidelines now advise PET-CT in all patients who have localised potentially resectable disease. This study aimed to investigate the impact of PET-CT on the management of pancreatic cancer patients in a single tertiary referral centre. Methods There were 288 patients with pancreatic cancer discussed at the Northern Ireland Regional Hepatobiliary MDM from January 2020 to March 2021. Of these patients, 176 were deemed to have inoperable disease based on initial CT, 5 had borderline resectable disease, 1 had holding chemotherapy due to COVID restrictions and 57 were excluded from surgical resection for a variety of reasons. These included the patient being unfit for surgery, the patient declining operative intervention and an alternative treatment offered as result of COVID-19 pandemic. Therefore, there were 49 patients with pancreatic adenocarcinoma which the MDT concluded should be considered for surgical resection. Results A total of 27 patients who were due to undergo a curative resection had a pre-operative PET-CT scan (55.1%). This demonstrated metastatic disease in 9 cases (33.3%). Four patients who did not have a preoperative PET-CT were found to have metastatic disease at operation (9.7%). This equated to a total metastatic incidence of 26.5% in those who had been initially deemed resectable based on CT scan alone. The time interval from MDM decision to surgery averaged 25.4 days in those who did not have a PET/CT compared to 40.43 days in those who did. This was an average delay of 15.07 days until treatment. Conclusions This study demonstrates the important role the PET-CT has in the management of patients with pancreatic cancer. A significant number of patients avoided an unnecessary operation which would have delayed the commencement of chemotherapy. However, there are limitations to PET-CT, demonstrated in the patient with an inconclusive result, who was found to have liver metastases at surgery. The introduction of PET-CT in the staging process does undoubtedly cause delays to surgical resection and a more streamlined pathway needs to be developed to limit the delay to curative treatment.

Utility of 18F-FDG-PET/CT imaging in patients with recurrent gynecological malignancies prior to pelvic exenteration

2019 ◽  
Vol 29 (4) ◽  
pp. 816-820
Author(s):  
Soyoun Rachel Kim ◽  
Yoo-Young Lee ◽  
Harinder Brar ◽  
Arianne Albert ◽  
Allan Covens ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Pelvic Exenteration ◽  
Treatment Plan ◽  
Ct Imaging ◽  
Gynecologic Malignancies ◽  
Pelvic Mri ◽  
Gynecological Malignancies ◽  
Pet Ct ◽  
Operative Findings ◽  
The Impact

BackgroundIn patients with recurrent gynecologic malignancies isolated to the pelvis, pelvic exenteration is a potential option. 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), is often used to confirm no evidence of metastatic disease.ObjectiveTo assess the impact of PET/CT on clinical management of patients with recurrent gynecologic malignancies being considered for pelvic exenteration.MethodsPatients with recurrent gynecological malignancies who underwent PET/CT imaging between 2011 and 2014 were identified. All were considered for pelvic exenteration and underwent conventional imaging with CT +/- pelvic MRI. Patient anthropometric data, disease sites, histology, stage, treatment received, and treatment plan based on PET/CT findings were extracted.ResultsA total of 40 patients met inclusion criteria. In 15 (37.5%) of these patients, results of PET/CT changed the original plan of pelvic exenteration owing to metastatic disease/unresectability (11/15) or no evidence of disease on PET/CT imaging (4/15). Twenty-five (62.5%) patients had their planned surgery after PET/CT with 19 (76%) patients undergoing a completed exenteration procedure. Six (24%) patients with PET/CT indicating isolated pelvic recurrence ultimately had intra-operative findings of extra-pelvic metastasis or nodal disease and therefore the planned surgery was aborted.ConclusionIn nearly 40% of patients with recurrent gynecologic malignancies being considered for radical salvage surgery, PET/CT can significantly alter the originally intended treatment and hence may reduce the number of futile surgical procedures.

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