Ebner Ricarda, Sheikh Gabriel T, Brendel Matthias, Ricke Jens, Cyran Clemens C
Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany.
Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
Eur Radiol. 2025 Apr;35(4):1903-1912. doi: 10.1007/s00330-024-11095-7. Epub 2024 Oct 10.
Neuroendocrine neoplasms (NEN) originate from the secretory cells of the neuroendocrine system, with the majority arising in the gastrointestinal tract and pancreas. Given the heterogeneity in the biological behavior and morphological differentiation of these tumors, advanced imaging techniques are crucial for supporting the suspected diagnosis, accurate staging, and monitoring therapy. As most well-differentiated NEN demonstrate overexpression of somatostatin receptors (SSR) on the cell surface, SSR-directed PET/CT is considered the reference standard for imaging of this particular entity. SSR-PET/CT should be the imaging method of choice in every NEN G1 or G2 and considered for re-staging after both potentially curative and non-curative surgeries. The extent of SSR expression is also crucial for determining a patient's eligibility for peptide receptor radionuclide therapy (PRRT). PRRT utilizes [Lu]Lu-DOTA-TATE to target the SSR receptor and can significantly prolong progression-free survival in patients with advanced, progressive neuroendocrine tumor of the gastroenteropancreatic system (GEP-NET). PET/CT is a central component of the multidisciplinary management of NEN. Variable follow-up intervals are recommended, considering that tumors with higher proliferation rates or advanced metastatic disease require more frequent assessments. The combination with other imaging modalities, like MRI, complements SSR-PET/CT, further enhancing overall diagnostic accuracy. KEY POINTS: Somatostatin receptor-PET/CT (SSR-PET/CT) is the guideline-recommended reference standard for imaging well-differentiated neuroendocrine tumors (NET). SSR-PET/CT should be the diagnostic imaging of choice for staging and post-therapy re-staging of grade 1 or 2 NET (G1 or G2). Variable follow-up intervals are recommended for NET G1 and G2. Tumors with higher proliferation rates or advanced metastatic disease necessitate more frequent assessments.
神经内分泌肿瘤（NEN）起源于神经内分泌系统的分泌细胞，大多数发生在胃肠道和胰腺。鉴于这些肿瘤在生物学行为和形态学分化方面存在异质性，先进的成像技术对于支持疑似诊断、准确分期和监测治疗至关重要。由于大多数高分化NEN在细胞表面显示生长抑素受体（SSR）过表达，因此SSR导向的PET/CT被认为是该特定实体成像的参考标准。SSR-PET/CT应是每个NEN G1或G2的首选成像方法，并在潜在治愈性和非治愈性手术后考虑用于重新分期。SSR表达程度对于确定患者是否适合肽受体放射性核素治疗（PRRT）也至关重要。PRRT利用[镥]镥-DOTA-TATE靶向SSR受体，可显著延长晚期、进展性胃肠胰系统神经内分泌肿瘤（GEP-NET）患者的无进展生存期。PET/CT是NEN多学科管理的核心组成部分。考虑到增殖率较高或有晚期转移性疾病的肿瘤需要更频繁的评估，建议采用可变的随访间隔。与其他成像方式（如MRI）相结合，可补充SSR-PET/CT，进一步提高总体诊断准确性。要点：生长抑素受体-PET/CT（SSR-PET/CT）是指南推荐的高分化神经内分泌肿瘤（NET）成像的参考标准。SSR-PET/CT应是1级或2级NET（G1或G2）分期和治疗后重新分期的首选诊断成像方法。建议对NET G1和G2采用可变的随访间隔。增殖率较高或有晚期转移性疾病的肿瘤需要更频繁的评估。
