Tumori Neuroendocrini - Imaging perioperatorio. Annibale Versari Medicina Nucleare, Az.Osp. S.Maria Nuova-IRCCS - Reggio Emilia
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1 Tumori Neuroendocrini - Imaging perioperatorio Annibale Versari Medicina Nucleare, Az.Osp. S.Maria Nuova-IRCCS - Reggio Emilia
2 Imaging medico-nucleare=imaging molecolare Le immagini sono espressione delle caratteristiche biochimiche e metaboliche dei tessuti Ormoni Peptidi Recettori Neurotrasmettitori
3 Neuroendocrine Tumors (NETs) Somatostatin Receptors
4 NETs Nuclear Medicine Imaging (molecular imaging) Mainly SSTR2 Target Neuroendocrine Tumors expressing somatostatin receptors Somatostatin Analogs Scintigraphy, SPECT, SPECT/CT with 111 In-Octreoscan PET/CT con 68 Ga-DOTATOC 68 Ga-DOTANOC 68 Ga-DOTATATE
5 111 In-Octreoscan Ileum NET
6 Octreoscan : SPECT/CT Ileum NET Prof. Giuliano Mariani - Pisa
7 Generatore 68Ge/68Ga 68 Ga DOTATOC PET/CT
8 68Ga PET/CT SSRS SPECT/CT MR CT (4 yrs before)
9
10 Metastatic GEP-NET 111In-Octreoscan 68 Ga-Dotatoc PET/CT
11 CONCLUSION 68Ga-DOTATOC and 68Ga-DOTATATE possess a comparable diagnostic value in the detection of lesions of NETs
12 68Ga-DOTANOC PET/CT Physiological uptake in the uncinate process of pancreatic head Pathological uptake in the uncinate process of pancreatic head
13 Any visible focal tracer uptake in the pancreas must be considered as suspicious for malignancy irrespective of quantitative parameters. Therefore, follow-up with 68Gasstr-PET/CT is mandatory in the clinical setting if uptake in the head/uncinate process is observed.
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15
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17 Bone Metastases from pancreatic NET
18 Grimaldi F et al. Italian Association of Clinical Endocrinologists (AME) position statement: a stepwise clinical approach to the diagnosis of gastroenteropancreatic neuroendocrine neoplasms. J Endocrinol Invest (2014) 37:
19 Staging Diagnosis Diagnostic flow-chart for GEP-NEN suspected at endoscopy Endoscopy ± biopsy Small bowel NEN Gastric or duodenal or rectal NEN CT, MRI ± biopsy EUS ± FNA 68 Ga-PET-CT or SRS (G1-G2) 18 F-FDG-PET-CT if G3 or high G2 Grimaldi F et al. Italian Association of Clinical Endocrinologists (AME) position statement: a stepwise clinical approach to the diagnosis of gastroenteropancreatic neuroendocrine neoplasms. J Endocrinol Invest (2014) 37:
20 Staging Diagnosis Diagnostic flow-chart for GEP-NEN suspected at morphological imaging Abdominal secondary lesion (e.g. liver metastasis) Pancreatic lesion CT/MRI CT/MRI US-guided biopsy EUS-FNA/FNB 68 Ga-PET-CT or SRS (G1-G2) 18 F-FDG-PET-CT if G3 or high G2 Grimaldi F et al. Italian Association of Clinical Endocrinologists (AME) position statement: a stepwise clinical approach to the diagnosis of gastroenteropancreatic neuroendocrine neoplasms. J Endocrinol Invest (2014) 37:
21 Diagnosis Diagnostic flow-chart in the patient with metastatic disease and unknown primary tumor Liver NEN metastases Low grade High grade Unknown primary at conventional imaging 18 F-FDG-PET IHC for site of origin + lab tests MRI, EUS, enteroct/mri, 68 Ga-DOTA-PET, VCE, DBE Grimaldi F et al. Italian Association of Clinical Endocrinologists (AME) position statement: a stepwise clinical approach to the diagnosis of gastroenteropancreatic neuroendocrine neoplasms. J Endocrinol Invest (2014) 37:
22 A A B B Head pancreatic NET (A) with lymph node metastasis (B)
23 68Ga-DOTATOC PET/CT M.G. m 45 a Reperto ecografico di lesioni epatiche multiple. Biopsia: NET G1 TC: sospetta primitività intestinale 68Ga-DOTATOC PET/CT : conferma di primitività ileale
24 68Ga-DOTATOC PET/CT M.G. m 45 a 18F-FDG PET/CT
25 Pre-intervento Post-intervento M.G. m 45 a 68Ga-DOTATOC PET/CT : metastasi epatiche da NET ileale
26 NETs Coesistenza di lesioni con diversa differenziazione 68Ga-DOTATOC FDG-PET/CT
27 J Nucl Med 2010; 51:
28 SUV <9 SUV <3 SUV >9 SUV >3
29
30 68 Ga-DOTATOC PET Pancreatic Gastrinoma
31 68Ga DOTATO C PET/CT Multiple insulinomas of pancreatic body and tail (recurrence)
32 68 Ga-DOTATOC PET Carcinoma neuroendocrino del pancreas con metastasi epatiche
33 68 Ga-DOTATOC PET Carcinoide dell ileo operato Follow up: Metastasi linfonodali
34 Clin Nucl Med 2015
35 Lococo Clin Nucl Med 2015
36 68 Ga-DOTATATE PET/CT 68 Ga-DOTA 18 F-FDG F 42 aa Carcinoide polmonare tipico
37 68 Ga-DOTATATE PET/CT F 64aa 18F-FDG Carcinoide polmonare atipico 68Ga-DOTA
38 Carcinoma midollare della tiroide
39 J Nucl Med 2011; 52:
40 Gastroenteropancreatic Neuroendocrine Tumor Patients Imaged Favorably with Somatostatin Receptor Antagonist: Results of a Phase I/II Study Comparing 68 Ga-OPS202 with 68 Ga-DOTATOC PET/CT
41 NETs Octreoscan versus 68Ga-DOTA PET/CT Availability Clinical use Cost Duration Accuracy NPV PPV 111 Inpentetreotide (Octreoscan ) widespread yes high 2 days Ga-DOTAconiugate peptides low but increasing yes high 2 hours
42 68Ga DOTATOC/TATE PET/CT Reggio Emilia Ga PET/CT Ga68PET/CT Colonna1 February June Ga DOTATOC/TATE PET/CT: 3892
43 Nuclear medicine procedures We recommend the use of SSTR functional imaging for localization and staging of G1-G2 GEP-NENs We recommend PET/CT with 68 Ga-labeled SA as the procedure of choice. When not available, 111 In-pentetreotide (Octreoscan ) scintigraphy may be used We recommend against the routine use of 18 F-FDG PET/CT We suggest 18 F-FDG PET/CT for staging high grade (G3) and selected G2 GEP-NENs
44 Grazie per l attenzione 11 Giugno 2016 Un girotondo di cittadini, pazienti, operatori inaugura il nuovo Centro Oncoematologico di Reggio Emilia
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