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Improved Staging of Patients With Carcinoid and Islet Cell Tumors With ¹⁸F-Dihydroxy-Phenyl-Alanine and ¹¹C-5-Hydroxy-Tryptophan Positron Emission Tomography

Klaas P. Koopmans, Oliver C. Neels, Ido P. Kema, Philip H. Elsinga, Wim J. Sluiter, Koen Vanghillewe, Adrienne H. Brouwers, Pieter L. Jager, Elisabeth G.E. de Vries

From the Departments of Nuclear Medicine and Molecular Imaging, Medical Oncology, Pathology and Laboratory Medicine, and Endocrinology, University Medical Center Groningen, University of Groningen; Department of Radiology, Martini Hospital Groningen, the Netherlands

Corresponding author: Elisabeth G.E. de Vries, MD, PhD, Department of Medical Oncology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands, e-mail: e.g.e.de.vries{at}int.umcg.nl

Purpose: To evaluate and compare diagnostic sensitivity of positron emission tomography (PET) scanning in carcinoid and islet cell tumor patients with a serotonin and a catecholamine precursor as tracers.

Patients and Methods: Carcinoid (n = 24) or pancreatic islet cell tumor (n = 23) patients with at least one lesion on conventional imaging including somatostatin receptor scintigraphy (SRS) and computed tomography (CT) scan underwent ¹¹C-5-hydroxytryptophan (¹¹C-5-HTP) PET and 6-[F-18]fluoro-L-dihydroxy-phenylalanin (¹⁸F-DOPA) PET. PET findings were compared with a composite reference standard derived from all available imaging along with clinical and cytologic/histologic information.

Results: In carcinoid tumor patients, per-patient analysis showed sensitivities for ¹¹C-5-HTP PET, ¹⁸F-DOPA PET, SRS, and CT of 100%, 96%, 86%, 96%, respectively, and in islet cell tumors of 100%, 89%, 78%, 87%, respectively. In carcinoid patients, per-lesion analysis revealed sensitivities for ¹¹C-5-HTP PET, ¹¹C-5-HTP PET/CT, ¹⁸F-DOPA PET, ¹⁸F-DOPA PET/CT, SRS, SRS/CT, and CT alone of, respectively, 78%, 89%, 87%, 98%, 49%, 73%, and 63% and in islet cell tumors of 67%, 96%, 41%, 80%, 46%, 77%, and 68%, respectively. In all carcinoid patients ¹⁸F-DOPA PET and ¹¹C-5-HTP PET detected more lesions than SRS (P < .001). ¹¹C-5-HTP PET was superior to ¹⁸F-DOPA PET in islet cell tumors (P < .0001). In all cases, CT improved the sensitivity of the nuclear scans.

Conclusion: ¹⁸F-DOPA PET/CT is the optimal imaging modality for staging in carcinoid patients and ¹¹C-5-HTP PET/CT in islet cell tumor patients.

Supported by Grant No. 2003-2936 from the Dutch Cancer Society.

Presented in part at the 54th Annual Meeting of the Society of Nuclear Medicine June 2-6, 2007, Washington, DC.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.