Tolomeo Anna, Lopopolo Gaetano, Dimiccoli Vincenzo, Perioli Luana, Modoni Sergio, Scilimati Antonio
Radiopharmaceutical Division, ITEL Telecomunicazioni srl, Ruvo di Puglia.
Department of Pharmaceutical Sciences, University of Perugia, Perugia.
Medicine (Baltimore). 2020 Feb;99(7):e19162. doi: 10.1097/MD.0000000000019162.
In the diagnostics of neuroendocrine tumors (NETs), scintigraphy and Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) with Indium-Octreotide occupy a prominent place.The introduction in clinical practice of Gallium-labelled somatostatin analogues (DOTA-TOC, DOTA-TATE, DOTA-NOC) for Positron Emission Tomography/Computed Tomography (PET/CT), significantly improved NETs diagnostics due to greater sensitivity and improved lesion detection in addition to better patient convenience and decreased radiation dose.
We report a case of a patient who was diagnosed with a neuroendocrine tumor of the ileocecal valve.
Diagnosis was made by ultrasonography, CT, and colonoscopy. Hystology after surgery was G2 NET of ileo-cecal valve. Restaging was carried out by In-Octreotide SPECT/CT and, 1 month later, by Ga-DOTATOC PET/CT. F-FDG PET/C was also carried out.
Ga-DOTATOC PET/CT showed larger disease that modified disease management from surgery to medical treatment.
After an initial improvement in the patient clinical condition, the tumor caused a worsening with the appearance of ascites.
Ga-DOTA-conjugate PET/CT is appropriate in low and intermediate NET (Ki67 index respectively ≤3% and 3%-20%) characterized by better survival and better response after Peptide Receptor Radionuclide Therapy.F-FDG is mostly useful in high grade (G3) of disease, so that Ga-DOTA-conjugate SUV and F-FDG SUV have an opposite trend in relation to the tumor grade. Ga-DOTATOC PET/CT changes, as in our case, therapeutic management in about 40% of cases.
在神经内分泌肿瘤（NETs）的诊断中，使用铟-奥曲肽的闪烁扫描法和单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）占据重要地位。用于正电子发射断层扫描/计算机断层扫描（PET/CT）的镓标记生长抑素类似物（DOTA-TOC、DOTA-TATE、DOTA-NOC）引入临床实践后，显著改善了NETs的诊断，这是因为其具有更高的敏感性，能更好地检测病变，此外还提高了患者的便利性并降低了辐射剂量。
我们报告一例被诊断为回盲瓣神经内分泌肿瘤的患者。
通过超声、CT和结肠镜检查进行诊断。术后组织学检查显示为回盲瓣G2级NET。通过铟-奥曲肽SPECT/CT进行再分期，1个月后通过镓-DOTATOC PET/CT进行再分期。还进行了F-FDG PET/C检查。
镓-DOTATOC PET/CT显示疾病范围扩大，从而将疾病管理从手术改为药物治疗。
患者临床状况最初有所改善后，肿瘤导致病情恶化并出现腹水。
镓-DOTA偶联物PET/CT适用于低级别和中级别的NET（Ki67指数分别≤3%和3%-20%），其特点是生存期更长，肽受体放射性核素治疗后的反应更好。F-FDG主要用于高级别（G3）疾病，因此镓-DOTA偶联物的SUV与F-FDG的SUV在肿瘤分级方面呈相反趋势。如我们的病例所示，镓-DOTATOC PET/CT在约40%的病例中改变了治疗管理。
