Ga-68-DOTATATE PET/CT in recurrent medullary thyroid carcinoma: a lesion-by-lesion comparison with In-111-octreotide SPECT/CT and conventional imaging

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Data
2017
Autores
Itaya Yamaga, Lilian Yuri
Cunha, Marcelo L.
Campos Neto, Guilherme C.
Garcia, Marcio R. T.
Yang, Ji H. [UNIFESP]
Camacho, Cleber P. [UNIFESP]
Wagner, Jairo
Funari, Marcelo B. G.
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Artigo
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Purpose The aim of this study was to prospectively compare the detection rate of Ga-68-DOTATATE PET-CT with In-111-octreotide SPECT-CT and conventional imaging (CI) in medullary thyroid carcinoma (MTC) patients with increased calcitonin (Ctn) levels but negative CI after thyroidectomy. Methods Fifteen patients with raised Ctn levels and/or CI evidence of recurrence underwent Ga-68-DOTATATE PET-CT, In-111-octreotide SPECT-CT and CI. Histopathology, CI and biochemical/clinical/imaging follow-up were used as the reference standard. PET/CT, SPECT/CT and CI were compared in a lesion-based and organ-based analysis. Results PET/CT evidenced recurrence in 14 of 15 patients. There were 13 true positive (TP), 1 true negative (TN), 1 false positive (FP) and no false negative (FN) cases, resulting in a sensitivity and accuracy of 100% and 93%. SPECT/CT was positive in 6 of 15 cases. There were 6 TP, 2 TN, 7 FN and no FP cases, resulting in a sensitivity of 46% and accuracy of 53%. CI procedures detected tumor lesions in 14 of 15 patients. There were 13 TP, 1TN, 1 FP and no FN cases with a sensitivity of 100% and accuracy of 93%. A significantly higher number of lesions was detected by PET/CT (112 lesions, p = 0.005) and CI (109 lesions, p = 0.005) in comparison to SPECT/CT (16 lesions). There was no significant difference between PET/CT and CI for the total number of detected lesions (p = 0.734). PET/CT detected more lesions than SPECT/CT regardless of the organ. PET/CT detected more bone lesions but missed some neck nodal metastases evidenced by CI. The number of lesions per region demonstrated by PET/CT and CI were similar in the other sites. Conclusion Ga-68-DOTATATE PET/CT is superior to In-111-octreotide SPECT/CT for the detection of recurrent MTC demonstrating a significantly higher number of lesions. Ga-68-DOTATATE PET/CT showed a superior detection rate compared to CI in demonstrating bone metastases.
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European Journal Of Nuclear Medicine And Molecular Imaging. New York, v. 44, n. 10, p. 1695-1701, 2017.