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Impact of Integrated Whole Body 68Ga PET/MR Imaging in Comparison with 68Ga PET/CT in Lesions Detection and Diagnosis of Suspected Neuroendocrine Tumours

Received: 26 June 2019    Accepted: 26 July 2019    Published: 10 August 2019
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Abstract

Combined PET/MR is a relatively new technique and so far there has been a very limited report of the potential simultaneous PET/MR and PET/CT application in the evaluation of neuroendocrine tumours. The present study aimed to compare "Ga-DOTATATE PET/CT and PET/MR imaging in patients with known neuroendocrine tumours (NET) and assess the confidence in anatomic lesion detection and localization. We analysed the data of 37 NET patients who underwent both 68Ga-DOTATATE PET/CT and PET/MR using the same injected activity. Visual findings by two observers of the two modalities were recorded. SUV max of both primary tumour and liver lesions for both modalities and PET/MR derived apparent diffusion coefficient (ADC) values were measured. To study the value of additional MRI sequences, the differences in performance between PET with T1+T2w, PET with DWI reads, and PET with post contrast was assessed. No significant differences between the two modalities were seen regarding the number of patients affected by primary or metastatic disease. However, counting the number of lesions per patient, both observers were able to recognize more liver lesions in MRI T1 and T2. The interclass correlation coefficient (ICC) demonstrated a strong correlation between SUV max derived from PET/CT and PET/MR in both primary lesions (ICC = 0.92; p = 0.001) and liver (ICC = 0.882; p = 0.001). In the evaluation of lesion per patient, PET+ contrast and DWI detected more metastasis than the evaluation of PET +T1 and T2 alone. There was no significant correlation between ADC values and PET/MR SUV max of the tumour (respectively: p = 0.43, p 0.88 and p = 0.295). PET/MRI has comparable accuracy in localization and staging to PET/CT, and has a potential to become a valid alternative to PET/CT in staging and follow up of NET patients, with advantages in the characterization of liver lesions. In our study DWI and contrast helped to detect more lesions.

Published in American Journal of Internal Medicine (Volume 7, Issue 4)
DOI 10.11648/j.ajim.20190704.14
Page(s) 102-111
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

PET/MRI, 68Ga-DOTATATE, Neuroendocrine Tumours

References
[1] Ellis L, Shale M, Coleman M P. Carcinoid Tumors of the Gastrointestinal Tract: Trends in Incidence in England since 1971. The American Journal of Gastroenterology. 2010; 105: 25632569.
[2] Hallet J, Law CH, Cukier M, et al. Exploring the rising incidence of neuroendocrine tumors: a population-based analysis of epidemiology, metastatic presentation, and outcomes. Cancer. 2015; 121: 589–597.
[3] Jann H, Roll S, Couvelard A, et al. Neuroendocrine tumors of mid-gut and hindgut origin: tumor-node-metastasis classification determines clinical outcome. Cancer. 2011; 117: 3332–3341.
[4] Berzaczy D, Giraudo C, Haug AR, Raderer M, Senn D, Karanikas G, et al. Whole-Body 68Ga-DOTANOC PET/MRI Versus 68Ga-DOTANOC PET/CT in Patients With Neuroendocrine Tumors A Prospective Study in 28 Patients. Clinical Nuclear Medicine. 2017; 42 (9): 669-674.
[5] Ramage JK, Ahmed A, Ardill J, Bax N, Breen DJ, Caplin ME, Corrie P, Davar J, Davies A H, V Lewington V, Meyer T, Newell-Price J, et al. UK and Ireland Neuroendocrine Tumour Society. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours (NETS). Gut. 2012; 61 (1): 6-32.
[6] Mojtahedi A, Thamake S, Tworowska I, et al. The value of (68) Ga-DOTATATE PET/CT in diagnosis and management of neuroendocrine tumors compared to current FDA approved imaging modalities: a review of literature. Am J Nucl Med Mol Imaging. 2014; 4: 426–434.
[7] Haug AR, Cindea-Drimus R, Auernhammer CJ, et al. The role of 68Ga-DOTATATE PET/CT in suspected neuroendocrine tumors. J Nucl Med. 2012; 53: 1686–1692.
[8] HaugAR, Assmann G, Rist C, et al. Quantification of immunohistochemical expression of somatostatin receptors in neuroendocrine tumors using 68Ga-DOTATATE PET/CT. Radiologe. 2010; 50: 349–354.
[9] Niederle B, Pape UF, Costa F, et al. ENETS consensus guidelines update for neuroendocrine neoplasms of the jejunum and ileum. Neuroendocrinology. 2016; 103: 125–138.
[10] Yoon SH, Goo JM, Lee SM, Park CM, Cheon GJ. PET/MR Imaging for Chest Diseases: Review of Initial Studies on Pulmonary Nodules and Lung Cancers. Magn Reson Imaging Clin N Am. 2015; 23 (2):245-59.
[11] Krausz Y, Rubinstein R, Appelbaum L, Mishani E, Orevi M, Fraenkel M, et al. Ga-68 DOTA-NOC uptake in the pancreas: pathological and physiological patterns. Clin Nucl Med. 2012; 37 (1): 57-62.
[12] Frilling A, Modlin IM, Kidd M, et al.; Working Group on Neuroendocrine Liver Metastases. Recommendations for management of patients with neuroendocrine liver metastases. Lancet Oncol. 2014; 15: e8–e21.
[13] Vercher-Conejero JL, Paspulati RM, Kohan A, Rubbert C, Partovi S, Ros P, et al. Imaging Pancreatic Pathology with PET/MRI: A Pictorial Essay. Annual Meeting of the Radiological Society of North America. 2013.
[14] Sekine T, Barbosa FG, Sah BR, et al. PET/MR outperforms PET/CT in suspected occult tumors. Clin Nucl Med. 2017; 42: e88–e95.
[15] Xie P, Liu K, Peng W, Zhou Z. The Correlation between Diffusion-Weighted Imaging at 3T Magnetic Resonance Imaging and Histopathology for Pancreatic Ductal Adenocarcinoma. J Comp Assist Tomogr. 2015; 39 (5): 697-701.
[16] Flechsig P, Zechmann CM, Schreiweis J, Kratochwil C, Rath D, Schwartz LH, et al. Qualitative and quantitative image analysis of CT and MR imaging in patients with neuroendocrine liver metastases in comparison to 68Ga-DOTATOC PET. Eur J Radiol. 2015; 84 (8): 1593-600.
[17] Noij DP, Pouwels PJ, Ljumanovic R, Knol DL, Doornaert P, de Bree R, et al. Predictive value of diffusion-weighted imaging without and with including contrast-enhanced magnetic resonance imaging in image analysis of head and neck squamous cell carcinoma. Eur J Radiol. 2015; 84 (1): 108-16.
[18] Shortman RI, Neriman D, Hoath J, Millner L, Endozo R, Azzopardi G, et al. A comparison of the psychological burden of PET/MRI and PET/CT scans and association to initial state anxiety and previous imaging experiences. Br J Radiol. 2015; 88: 20150121.
[19] Beiderwellen K, Poeppel T, Hartung-Knemeyer V, Buchbender C, Kuehl H, Bockisch A, et al. Simultaneous 68Ga-DOTATOC PET/MRI in patients with gastroenteropancreatic neuroendocrine tumors: initial results. Invest Radiol. 2013; 48 (5): 273-279.
[20] Stolzmann P, Veit-Haibach P, Chuck N, Rossi C, Frauenfelder T, Alkadhi H, et al. Detection rate, location, and size of pulmonary nodules in trimodality PET/CTMR: comparison of low-dose CT and Dixon- based MR imaging. Invest Radiol. 2013; 48 (5): 241-246.
[21] Ohno Y, Koyama H, Yoshikawa T, Takenaka D, Seki S, Yui M, et al. Three-way Comparison of Whole-Body MR, Co-registered WB FDG PET/MR, and Integrated Whole-Body FDG PET/CT Imaging: TNM and Stage Assessment Capability for Non-Small Cell Lung Cancer Patients. Radiology. 2015; 275 (3): 849-61.
[22] Jacobsson H, Larsson P, Jonsson C, et al. Normal uptake of 68Ga-DOTA-TOC by the pancreas uncinate process mimicking malignancy at somatostatin receptor PET. Clin Nucl Med. 2012; 37: 362-365.
[23] Etchebehere EC, de Oliveira Santos A, Gumz B, Vicente A, Hoff PG, Corradi G, et al. 68Ga-DOTATATE PET/CT, 99mTc-HYNIC Octreotide SPECT/CT, and Whole-Body MR Imaging in Detection of Neuroendocrine Tumors: A Prospective Trial. Nucl Med. 2014; 55: 1598-1604.
[24] Schreiter NF, Nogami M, Steffen I, Pape UF, Hamm B, Brenner W, R6ttgen R. Evaluation of the potential of PET/MRI fusion for detection of liver metastases in patients with neuroendocrine tumours. Eur Radiol. 2012; 22 (2): 458-67.
[25] Flechsig P, Zechmann CM, Schreiweis J, Kratochwil C, Rath D, Schwartz LH, et al. Qualitative and quantitative image analysis of CT and MR imaging in patients with neuroendocrine liver metastases in comparison to 68Ga-DOTATOC PET. Eur J Radiol. 2015; 84 (8): 1593-600.
[26] Buchbender C, Hartung-Knemeyer V, Beiderwellen K, Heusch P, Kuhl H, Lauenstein TC, et al. Diffusion-weighted imaging as part of hybrid PET/MR' protocols for whole-body cancer staging: Does it benefit lesion detection? European Journal of Radiology. 2013; 82: 877-882.
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    Alshaima Alshammari, Michael Masoomi, Rizwan Syed, Evangelia Skoura, Sofia Michopoulou, et al. (2019). Impact of Integrated Whole Body 68Ga PET/MR Imaging in Comparison with 68Ga PET/CT in Lesions Detection and Diagnosis of Suspected Neuroendocrine Tumours. American Journal of Internal Medicine, 7(4), 102-111. https://doi.org/10.11648/j.ajim.20190704.14

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    Alshaima Alshammari; Michael Masoomi; Rizwan Syed; Evangelia Skoura; Sofia Michopoulou, et al. Impact of Integrated Whole Body 68Ga PET/MR Imaging in Comparison with 68Ga PET/CT in Lesions Detection and Diagnosis of Suspected Neuroendocrine Tumours. Am. J. Intern. Med. 2019, 7(4), 102-111. doi: 10.11648/j.ajim.20190704.14

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    AMA Style

    Alshaima Alshammari, Michael Masoomi, Rizwan Syed, Evangelia Skoura, Sofia Michopoulou, et al. Impact of Integrated Whole Body 68Ga PET/MR Imaging in Comparison with 68Ga PET/CT in Lesions Detection and Diagnosis of Suspected Neuroendocrine Tumours. Am J Intern Med. 2019;7(4):102-111. doi: 10.11648/j.ajim.20190704.14

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  • @article{10.11648/j.ajim.20190704.14,
      author = {Alshaima Alshammari and Michael Masoomi and Rizwan Syed and Evangelia Skoura and Sofia Michopoulou and Fulvio Zaccagna and Jamshed Bomanji and Francesco Fraioli},
      title = {Impact of Integrated Whole Body 68Ga PET/MR Imaging in Comparison with 68Ga PET/CT in Lesions Detection and Diagnosis of Suspected Neuroendocrine Tumours},
      journal = {American Journal of Internal Medicine},
      volume = {7},
      number = {4},
      pages = {102-111},
      doi = {10.11648/j.ajim.20190704.14},
      url = {https://doi.org/10.11648/j.ajim.20190704.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20190704.14},
      abstract = {Combined PET/MR is a relatively new technique and so far there has been a very limited report of the potential simultaneous PET/MR and PET/CT application in the evaluation of neuroendocrine tumours. The present study aimed to compare "Ga-DOTATATE PET/CT and PET/MR imaging in patients with known neuroendocrine tumours (NET) and assess the confidence in anatomic lesion detection and localization. We analysed the data of 37 NET patients who underwent both 68Ga-DOTATATE PET/CT and PET/MR using the same injected activity. Visual findings by two observers of the two modalities were recorded. SUV max of both primary tumour and liver lesions for both modalities and PET/MR derived apparent diffusion coefficient (ADC) values were measured. To study the value of additional MRI sequences, the differences in performance between PET with T1+T2w, PET with DWI reads, and PET with post contrast was assessed. No significant differences between the two modalities were seen regarding the number of patients affected by primary or metastatic disease. However, counting the number of lesions per patient, both observers were able to recognize more liver lesions in MRI T1 and T2. The interclass correlation coefficient (ICC) demonstrated a strong correlation between SUV max derived from PET/CT and PET/MR in both primary lesions (ICC = 0.92; p = 0.001) and liver (ICC = 0.882; p = 0.001). In the evaluation of lesion per patient, PET+ contrast and DWI detected more metastasis than the evaluation of PET +T1 and T2 alone. There was no significant correlation between ADC values and PET/MR SUV max of the tumour (respectively: p = 0.43, p 0.88 and p = 0.295). PET/MRI has comparable accuracy in localization and staging to PET/CT, and has a potential to become a valid alternative to PET/CT in staging and follow up of NET patients, with advantages in the characterization of liver lesions. In our study DWI and contrast helped to detect more lesions.},
     year = {2019}
    }
    

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  • TY  - JOUR
    T1  - Impact of Integrated Whole Body 68Ga PET/MR Imaging in Comparison with 68Ga PET/CT in Lesions Detection and Diagnosis of Suspected Neuroendocrine Tumours
    AU  - Alshaima Alshammari
    AU  - Michael Masoomi
    AU  - Rizwan Syed
    AU  - Evangelia Skoura
    AU  - Sofia Michopoulou
    AU  - Fulvio Zaccagna
    AU  - Jamshed Bomanji
    AU  - Francesco Fraioli
    Y1  - 2019/08/10
    PY  - 2019
    N1  - https://doi.org/10.11648/j.ajim.20190704.14
    DO  - 10.11648/j.ajim.20190704.14
    T2  - American Journal of Internal Medicine
    JF  - American Journal of Internal Medicine
    JO  - American Journal of Internal Medicine
    SP  - 102
    EP  - 111
    PB  - Science Publishing Group
    SN  - 2330-4324
    UR  - https://doi.org/10.11648/j.ajim.20190704.14
    AB  - Combined PET/MR is a relatively new technique and so far there has been a very limited report of the potential simultaneous PET/MR and PET/CT application in the evaluation of neuroendocrine tumours. The present study aimed to compare "Ga-DOTATATE PET/CT and PET/MR imaging in patients with known neuroendocrine tumours (NET) and assess the confidence in anatomic lesion detection and localization. We analysed the data of 37 NET patients who underwent both 68Ga-DOTATATE PET/CT and PET/MR using the same injected activity. Visual findings by two observers of the two modalities were recorded. SUV max of both primary tumour and liver lesions for both modalities and PET/MR derived apparent diffusion coefficient (ADC) values were measured. To study the value of additional MRI sequences, the differences in performance between PET with T1+T2w, PET with DWI reads, and PET with post contrast was assessed. No significant differences between the two modalities were seen regarding the number of patients affected by primary or metastatic disease. However, counting the number of lesions per patient, both observers were able to recognize more liver lesions in MRI T1 and T2. The interclass correlation coefficient (ICC) demonstrated a strong correlation between SUV max derived from PET/CT and PET/MR in both primary lesions (ICC = 0.92; p = 0.001) and liver (ICC = 0.882; p = 0.001). In the evaluation of lesion per patient, PET+ contrast and DWI detected more metastasis than the evaluation of PET +T1 and T2 alone. There was no significant correlation between ADC values and PET/MR SUV max of the tumour (respectively: p = 0.43, p 0.88 and p = 0.295). PET/MRI has comparable accuracy in localization and staging to PET/CT, and has a potential to become a valid alternative to PET/CT in staging and follow up of NET patients, with advantages in the characterization of liver lesions. In our study DWI and contrast helped to detect more lesions.
    VL  - 7
    IS  - 4
    ER  - 

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Author Information
  • Nuclear Medicine Department, Adan Hospital, Kuwait City, Kuwait

  • Nuclear Medicine Department, Adan Hospital, Kuwait City, Kuwait

  • Institute of Nuclear Medicine, University College London Hospitals, London, UK

  • PET/CT Department, Bioiatriki Hospital, Athens, Greece

  • Institute of Nuclear Medicine, University College London Hospitals, London, UK

  • School of Clinical Medicine, University of Cambridge, Cambridge, UK

  • Institute of Nuclear Medicine, University College London Hospitals, London, UK

  • Institute of Nuclear Medicine, University College London Hospitals, London, UK

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