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Quantitative SSTR-PET/CT: a potential tool for predicting everolimus response in neuroendoctine tumour patients

Homeira Karim
Homeira Karim
, 
Michael Winkelmann
Michael Winkelmann
, 
Freba Grawe
Freba Grawe
, 
Friederike Völter
Friederike Völter
, 
Christoph Auernhammer
Christoph Auernhammer
, 
Johannes Rübenthaler
Johannes Rübenthaler
, 
Jens Ricke
Jens Ricke
, 
Maria Ingenerf
Maria Ingenerf
 e 
Christine Schmid-Tannwald
Christine Schmid-Tannwald
   | 12 giu 2024
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Article Category: Research Article
Pubblicato online: 12 giu 2024
Pagine: -
Ricevuto: 12 mar 2024
Accettato: 10 mag 2024
DOI: https://doi.org/10.2478/raon-2024-0032
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© 2024 Homeira Karim et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

63-year-old female with responding liver metastasis of ileal neuroendocrine tumor. On the pretherapeutic PETCT (A, B) there were high tumor-to-liver (T/L) ratio. After three months of treatment with everolimus, the liver metastasis showed no significant shrinkage in size, but a significantly reduced uptake of 68Ga-DOTATATE (C, D) compared to pretherapeutic PET/CT (Tmax/Lmax: 0.94 vs. 2,09 and Tmean/Lmax 1.54 vs. 0.76).
63-year-old female with responding liver metastasis of ileal neuroendocrine tumor. On the pretherapeutic PETCT (A, B) there were high tumor-to-liver (T/L) ratio. After three months of treatment with everolimus, the liver metastasis showed no significant shrinkage in size, but a significantly reduced uptake of 68Ga-DOTATATE (C, D) compared to pretherapeutic PET/CT (Tmax/Lmax: 0.94 vs. 2,09 and Tmean/Lmax 1.54 vs. 0.76).

FIGURE 2.

31-year-old male with non-responding liver metastasis of pancreatic neuroendocrine tumor. On the pretherapeutic PET/CT (A, B) there were low tumor-to-liver (T/L) ratios. After three months of treatment with everolimus, liver metastasis (arrow) showed an increase in size on CT (C), but also a significantly increased uptake of 68Ga-DOTATATE (D) compared to pretherapeutic PET/CT.
31-year-old male with non-responding liver metastasis of pancreatic neuroendocrine tumor. On the pretherapeutic PET/CT (A, B) there were low tumor-to-liver (T/L) ratios. After three months of treatment with everolimus, liver metastasis (arrow) showed an increase in size on CT (C), but also a significantly increased uptake of 68Ga-DOTATATE (D) compared to pretherapeutic PET/CT.

FIGURE 3.

Predictive value of %-change of Tmean/Lmax ratio and %-change of Tmax/Lmax ratio.
Predictive value of %-change of Tmean/Lmax ratio and %-change of Tmax/Lmax ratio.

Clinical and imaging parameters at baseline and follow-up with changes

Responder Pre- vs. Post-therapy Non-responder p-value R vs. NR Pre-treatment R vs. NR Post-treatment
Pre-treatment Post-treatment p Pre-treatment Post-treatment p p
Clinical parameters
Age 63.5 +- 12.5 62.4 +- 13.4 0.42
Sex (male) 10 (45%) 7 (37%) 0.2
Ki-67 % 7.9 (+- 7.8) 10.5 (+-7) 0.28
Pre Bilirubin 0.6 (0.2) 0.7 (0.3) 0.13
Pre CgA 551 (77.6–933.5) 422 (47–1414) 0.11
Imaging parameters
SUVmax Liver 8 (6–9.3) 9.4 (5–10.9) 0.17 6.9 (4.9–9.2) 6.4 (3.5–10) 0.05 0.6 0.1
SUVmean Spleen 12.3 (9.9–18.6) 16.4 (9.9–20.1) 0.02 13.8 (10.1–16.9) 11 (9.8–15.1) 0.04 0.3 0.5
SUVmax LM 28.1 (15.1–35.3) 22.2 (14.2–31.7) < 0.01 21.3 (12.7–34.7) 22.5 (9.4–29.6) 0.19 0.3 0.6
SUVmean LM 12.4 (10.5–19.1) 12.9 (9.3–18.9) 0.03 14.5 (9.3–18.3) 13.5 (7.8–17.4) 0.13 0.4 0.5
Tmax/Lmax LM 3.0 (2.4–4.3) 2.4 (2–3.3) 0.02 2.8 (2.4–3.8) 3 (1.9–4.6) 0.36 0.3 0.8
Tmean/Lmax LM 1.8 (1.4–2.3) 1.6 (1.2–1.9) 0.02 1.9 (1.2–2.2) 1.6 (1.4–2.5) 0.26 0.2 0.7
Tmax/Smean LM 1.6 (1.3–2.4) 1.3 (0.9–1.7) 0.25 1.5 (1.2–2.3) 1.5 (0.9–3.0) 0.3 0.4 0.8
Tmean/Smean LM 1.0 (0.8–1.1) 0.8 (0.5–1.0) 0.49 0.9 (0.6–1.6) 0.9 (0.5–1.6) 0.46 0.5 1.0
Size LM 21 (17–29) 20 (15–31.2) 0.64 21 (15–32) 21 (15–32) 0.95 0.7 0.5
Density LM (HU) 101.9 (± 19.9) 90.5 (± 20.5) 0.03 89.4 (± 22.6) 81.7 (± 22.1) 0.1 0.2 0.3
SUVmax NET 32.8 (6.9–39.8) 30.4 (10.3–31.5) 0.49 36.4 (28.8–47.4) 43.1 (29.7–53.7) 0.97 0.5 0.3
SUVmean NET 16 (4.6–16.9) 13.4 (7.1–14.7) 0.9 17.6 (14–19.4) 22.3 (13.6–28.5) 0.25 0.4 0.3
Size NET 18 (15-36) 25 (11.2–37.3) 0.48 43.5 (24–60.8) 44.5 (25.3–66) 0.37 0.7 0.5
Density NET 83.3 (± 9.1) 81.5 (± 18) 0.9 89.3 (± 17.5) 78.2 (± 11.6) 0.4 0.6 0.8
Change (%) between pre- and post-treatment Responder Non-responder R vs. NR p
SUVmax Liver −9.5 (−14–19.9) −13 (−37.5–8.7) 0.04
SUVmean Spleen 13 (−6.6–29.1) −10.7 (−26.3–2.6) 0.01
SUVmax LM −20.4 (−27–6) −0.9 (−22.8–26.3) 0.21
SUVmean LM −10 (−28.5–12.7) −7 (−23.4–11.1) 0.62
Tmax/Lmax LM −15.5 (−47–5.5) 5.5 (−20.4–20.7) 0.01
Tmean/Lmax LM −16.3 (−37–9) 7 (−22.3–31.1) 0.03
Tmax/Smean LM −16.6 (−44.2–13.6) 4.5 (−16.8–51.4) 0.01
Tmean/Smean LM −16.3 (−39.3–8.8) 0.9 (−17.4–50) 0.04
Size LM −7 (−27.8–6.1) 14.3 (−17.6–28) 0.77
Density LM −5.6 (−12.3–0.2) −7 (−16.5–4.1) 0.8
SUVmax NET −7.3 (−16.2–35.5) −18.1 (−41.6–25.6) 0.77
SUVmean NET 15.6 (−0.6–48) 18.4 (−7.8–40.5) 0.65
Size NET −15.9 (−37.4–11.1) 3.6 (−2.1–13.3) 0.72
Density NET −5.2 (−20–14.5) −18.3 (−22.9– −4.6) 0.69
Bilirubin −33 (−61.7–0) −25 (−66.7–0) 0.43
CgA 56.4 (17.4–144.9) 32.1 (−2.8–72.8) 0.18

Patients demographics

Sex (male) 17 (59%)
Age (mean + SD ) 63 ± 13.2
Grading
  G1 7 (24%)
  G2 20 (69%)
  G3 1 (3%)
  n/a 1 (3%)
Ki-67 (mean + SD) 9.1 ± 7.6
Primary tumor site
  Pancreas 11 (38%)
  Stomach 1 (3%)
  Liver 1 (3%)
  Lung 1 (3%)
  Small-intestine 11 (38%)
  Kidney 1 (3%)
  Breast 1 (3%)
  Retroperitoneal 1 (3%)
  Rectum 1 (3%)
Bilirubin prior to therapy (mg/dl) 0.6 (0.3–1.3)
Bilirubin after therapy (mg/dl) 0.5 (0.2–2.6)
Median CgA prior to therapy (ng/ml) (range) 487 (10 –8983)
Median CgA after therapy (ng/ml) (range) 929 (43–23348)
eISSN:
1581-3207
Lingua:
Inglese
Frequenza di pubblicazione:
4 volte all'anno
Argomenti della rivista:
Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
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