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Added value of [68Ga]Ga-DOTA-TOC PET/CT for characterizing pancreatic neuroendocrine neoplasms: a comparison with contrast-enhanced CT and/or MRI in a large study cohort

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Abstract

Objectives

To investigate an additional value of [68Ga]Ga-DOTA-TOC PET/CT for characterizing suspected pancreatic neuroendocrine neoplasms (NENs) in a large study cohort.

Methods

This retrospective study included 167 patients who underwent [68Ga]Ga-DOTA-TOC PET/CT for suspected pancreatic NENs detected by contrast-enhanced CT (n = 153) and/or MRI (n = 85). Two board-certified radiologists independently reviewed CT and/or MRI as well as [68Ga]Ga-DOTA-TOC PET/CT and scored the probability of NEN on a 5-point scale. Radiologists’ diagnostic performances with and without [68Ga]Ga-DOTA-TOC PET/CT were compared using pathologic findings as the standard of reference.

Results

All 167 patients were pathologically diagnosed with NENs (n = 131) or non-NENs (n = 36) by surgery (n = 93) or biopsy (n = 74). The non-NEN group included focal pancreatitis (n = 7), gastrointestinal stromal tumor (n = 6), serous cystadenoma (n = 5), metastatic renal cell carcinoma (n = 4), intrapancreatic accessory spleen (n = 4), ductal adenocarcinoma (n = 3), solid pseudopapillary neoplasm (n = 2), intraductal papillary mucinous carcinoma (n = 1), adenosquamous carcinoma (n = 1), schwannoma (n = 1), paraganglioma (n = 1), and solitary fibrous tumor (n = 1). Radiologists’ diagnostic performance significantly improved after the addition of [68Ga]Ga-DOTA-TOC PET/CT (AUC of CT: 0.737 vs. 0.886 for reviewer 1 [p = 0.0004]; 0.709 vs. 0.859 for reviewer 2 [p = 0.0002], AUC of MRI: 0.748 vs. 0.872 for reviewer 1 [p = 0.023]; 0.670 vs. 0.854 for reviewer 2 [p = 0.001]). [68Ga]Ga-DOTA-TOC PET/CT significantly improved sensitivity (CT: 87.4% vs. 96.6% for reviewer 1 [p = 0.001]; 74.8% vs. 92.5% for reviewer 2 [p = 0.0001], MRI: 86.9% vs. 98.4% for reviewer 1 [p = 0.016]; 70.5% vs. 91.8% for reviewer 2 [p = 0.002]).

Conclusions

[68Ga]Ga-DOTA-TOC PET/CT provided an additional value over conventional CT or MRI for the characterization of suspected pancreatic NENs.

Key Points

• [ 68 Ga]Ga-DOTA-TOC PET/CT could provide additional value over conventional CT and/or MRI for the exact characterization of suspected pancreatic NENs by increasing AUC values and sensitivity.

• Diagnostic improvement was significant, especially in NENs showing an atypical enhancement pattern.

• The inter-observer agreement was improved when [ 68 Ga]Ga-DOTA-TOC PET/CT was added to CT and/or MRI.

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Abbreviations

[68Ga]Ga-DOTA-TOC:

DOTA-D-Phe1-Tyr3-octreotide with gallium-68

AUC:

Area under the curve

CT:

Computed tomography

MRI:

Magnetic resonance imaging

NEC:

Neuroendocrine carcinoma

NEN:

Neuroendocrine neoplasm

NET:

Neuroendocrine tumor

PET:

Positron emission tomography

SSTR:

Somatostatin receptor

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Funding

This research was supported by the Basic Science Research Program of the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2019R1F1A1060131) and from the Seoul National University Hospital Research Fund No. 04-2020-2010.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul, 110-744, Korea

    Jeongin Yoo, Se Hyung Kim, Sun Kyung Jeon, Jae Seok Bae & Joon Koo Han

  2. Department of Radiology, Seoul National University College of Medicine, Seoul, Korea

    Se Hyung Kim & Joon Koo Han

  3. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea

    Se Hyung Kim & Joon Koo Han

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  1. Jeongin Yoo
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  2. Se Hyung Kim
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Correspondence to Se Hyung Kim.

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The scientific guarantor of this publication is Se Hyung Kim.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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• observational

• performed at one institution

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Yoo, J., Kim, S.H., Jeon, S.K. et al. Added value of [68Ga]Ga-DOTA-TOC PET/CT for characterizing pancreatic neuroendocrine neoplasms: a comparison with contrast-enhanced CT and/or MRI in a large study cohort. Eur Radiol 31, 7734–7745 (2021). https://doi.org/10.1007/s00330-021-07859-0

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