Department of Nuclear Medicine, Erasmus MC, 's Gravendijkwal 230, Rotterdam, 3015 GD, Netherlands.
Department of Radiology, Karolinska University Hospital, Stockholm, 17176 Stockholm, Sweden.
Nat Rev Endocrinol. 2014 Feb;10(2):102-14. doi: 10.1038/nrendo.2013.246. Epub 2013 Dec 10.
In patients with neuroendocrine tumours (NETs), a combination of morphological imaging and nuclear medicine techniques is mandatory for primary tumour visualization, staging and evaluation of somatostatin receptor status. CT and MRI are well-suited for discerning small lesions that might escape detection by single photon emission tomography (SPECT) or PET, as well as for assessing the local invasiveness of the tumour or the response to therapy. Somatostatin receptor imaging, by (111)In-pentetreotide scintigraphy or PET with (68)Ga-labelled somatostatin analogues, frequently identifies additional lesions that are not visible on CT or MRI scans. Currently, somatostatin receptor scintigraphy with (111)In-pentetreotide is the more frequently available of the two techniques to determine somatostatin receptor expression and is needed to select patients for peptide receptor radionuclide therapy. In the future, because of its higher sensitivity, PET with (68)Ga-labelled somatostatin analogues is expected to replace somatostatin receptor scintigraphy. Whereas (18)F-FDG-PET is only used in high-grade neuroendocrine cancers, PET-CT with (18)F-dihydroxy-L-phenylalanine or (11)C-5-hydroxy-L-tryptophan is a useful problem-solving tool and could be considered for the evaluation of therapy response in the future. This article reviews the role of imaging for the diagnosis and management of intestinal and pancreatic NETs. Response evaluation and controversies in NET imaging will also be discussed.
在神经内分泌肿瘤（NET）患者中，形态学成像和核医学技术的组合对于原发肿瘤的可视化、分期以及生长抑素受体状态的评估是强制性的。CT 和 MRI 非常适合辨别可能逃避单光子发射断层扫描（SPECT）或正电子发射断层扫描（PET）检测的小病变，也适用于评估肿瘤的局部侵袭性或对治疗的反应。生长抑素受体成像，通过（111）In-喷曲肽闪烁显像或用（68）Ga 标记的生长抑素类似物进行 PET，经常可以识别 CT 或 MRI 扫描上不可见的其他病变。目前，（111）In-喷曲肽生长抑素受体闪烁显像技术是确定生长抑素受体表达的两种技术中更为常用的技术，并且需要选择接受肽受体放射性核素治疗的患者。将来，由于其更高的敏感性，用（68）Ga 标记的生长抑素类似物进行 PET 将取代生长抑素受体闪烁显像。虽然（18）F-FDG-PET 仅用于高级别神经内分泌癌，但用（18）F-二羟基-L-苯丙氨酸或（11）C-5-羟基-L-色氨酸进行 PET-CT 是一种有用的解决问题的工具，并且将来可以考虑用于评估治疗反应。本文综述了成像在肠和胰腺 NET 诊断和管理中的作用。NET 成像的反应评估和争议也将进行讨论。
