Advances in the Diagnosis of Neuroendocrine Neoplasms

• Published in: Seminars in nuclear medicine 2016-09, Vol.46 (5), p.395-404
• Main Authors: Kulkarni, Harshad R., MD, Singh, Aviral, MD, Baum, Richard P., MD, PhD
• Format: Article
• Language: English
• Subjects: Humans; Neuroendocrine Tumors - diagnosis; Neuroendocrine Tumors - diagnostic imaging; Neuroendocrine Tumors - metabolism; Positron Emission Tomography Computed Tomography; Radiology; Receptors, Somatostatin - metabolism
• ISSN: 0001-2998; 1558-4623
• DOI: 10.1053/j.semnuclmed.2016.06.001

Somatostatin receptor PET/CT using68 Ga-labeled somatostatin analogs, is a mainstay for the evaluation of the somatostatin receptor status in neuroendocrine neoplasms. In addition, the assessment of glucose metabolism by18 F-FDG PET/CT at diagnosis can overcome probable shortcomings of histopathologic grading. This offers a systematic theranostic approach for the management of neuroendocrine neoplasms, that is, patient selection for the appropriate treatment—surgery, somatostatin analogs, peptide receptor radionuclide therapy, targeted therapies like everolimus and sunitinib, or chemotherapy—and also for therapy response monitoring. Novel targets, for example, the chemokine receptor CXCR4 in higher-grade tumors and glucagon like peptide-1 receptor in insulinomas, appear promising for imaging. Scandium-44 and Copper-64, especially on account of their longer half-life (for pretherapeutic dosimetry) and cyclotron production (which favors mass production), might be the potential alternatives to68 Ga for PET/CT imaging. The future of molecular imaging lies in Radiomics, that is, qualitative and quantitative characterization of tumor phenotypes in correlation with tumor genomics and proteomics, for a personalized cancer management.