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THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
Rivista di Medicina Nucleare e Imaging Molecolare
A Journal on Nuclear Medicine and Molecular Imaging
Affiliated to the and to the International Research Group of Immunoscintigraphy
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index (SciSearch), Scopus
Impact Factor 2,413
The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2008 Dicembre;52(4):323-33
Octreo-SPECT/CT imaging for accurate detection and localization of suspected neuroendocrine tumors
Perri M., Erba P., Volterrani D., Lazzeri E., Boni G., Grosso M., Mariani G.
Regional Center of Nuclear Medicine University of Pisa Medical School, Pisa, Italy
Aim. The aim of the present study was to prospectively evaluate the add value provided by [111In]DTPA-octreotide single-photon emission computed tomography/computed tomography (Octreo-SPECT/CT) with respect to [111In]DTPA-octreotide SPECT (Octreo-SPECT) in terms of diagnostic accuracy and localization of neuroendocrine tumors (NETs).
Methods. Eighty-one consecutive patients with known or suspected NET underwent [111In]DTPA-octreotide scintigraphy using an integrated SPECT/low-energy-CT system (Infinia & Hawkeye; GE Medical Systems, Milwaukee, WI, USA). SPECT and fused SPECT/CT images were interpreted separately and a lesion-by-lesion analysis was performed with regard to classification (probability of NET graded on a 5-point scale) and localization of each abnormal focal tracer uptake. A subgroup analysis, distinguishing between abdominal and thoracic lesions, and a patient-by-patient analysis for likelihood of NET in each patient was also performed. Standard of reference for confirming presence or absence of NET was either histopathology or clinical/imaging follow-up data. The value of SPECT/CT imaging was assessed by ROC analysis and McNemar test.
Results. A final diagnosis of NET was achieved in 43 out of 81 patients and a total of 169 areas (138 NET and 31 benign/physiological) with focal tracer uptake were included in the final lesion-by-lesion analysis. SPECT/CT imaging led to a significantly higher proportion of patients (75/81=92.6% vs 64/81=79%) and lesions (163/169=96.4% vs 138/169=81.1%) correctly classified vs SPECT alone. ROC analysis confirmed that Octreo-SPECT/CT performed significantly better than Octreo-SPECT for the detection of NET on both patient- and lesion-based analysis, improving especially evaluation of abnormal tracer uptake in the abdomen. Moreover, Octreo-SPECT/CT accurately localized 160/169 (94.7%) lesions, significantly higher than SPECT alone (77/169= 45.6%).
Conclusion. Octreo-SPECT/CT allows more accurate detection and localization of NETs than simple Octreo-SPECT, with major benefits for lesions located in the abdomen.