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PET in the Diagnosis of Neuroendocrine Tumors
ANDERS SUNDINa,
BARBRO ERIKSSONb,
MATS BERGSTRÖMc,
BENGT LÅNGSTRÖMc,
KJELL ÖBERGb AND
HÅKAN ÖRLEFORSb
aDepartment of Radiology, Uppsala University Hospital, SE-751 85 Uppsala, Sweden
bEndocrinologic Oncology, Uppsala University Hospital, SE-751 85 Uppsala, Sweden
cUppsala University Petcentre (Imanet), Uppsala University Hospital, SE-751 85 Uppsala, Sweden
Address for correspondence: Anders Sundin, M.D., Assistant Professor, Department of Radiology, Uppsala University Hospital, SE-751 85 Uppsala, Sweden. Voice: 46-18-611-00 00. anders.sundin{at}radiol.uu.se
Ann. N.Y. Acad. Sci. 1014: 246-257 (2004).
For general oncological imaging, positron emission tomography (PET) using [18F]fluoro-deoxy-glucose (FDG) has evolved as a powerful functional imaging modality. Unfortunately, FDG-PET has not been as advantageous for imaging gastropancreatic neuroendocrine tumors, and only tumors with high proliferative activity and low differentiation have shown an increased FDG uptake. Therefore, the 11C-labeled amine precursors L-dihydroxyphenylalanine and 5-hydroxy-L-tryptophan (5-HTP) were developed for PET imaging of these tumors. Because of the higher tumor uptake of the latter tracer in a study of patients with endocrine pancreatic tumors, 11C-5-HTP was chosen for further evaluation. In comparative studies of patients with carcinoids and endocrine pancreatic tumors, 5-HTP-PET proved better than CT and somatostatin receptor scintigraphy for tumor visualization, and many small, previously overlooked lesions were diagnosed by 11C-5-HTP-PET. The strong correlation found during medical treatment between the changes in the transport rate constant at repeated PET and those of U-HIAA indicates the possible use of 11C-5-HTP-PET also for therapy monitoring. By premedication of patients with Carbidopa orally before PET examination, in order to block the aromatic amino acid decarboxylase enzyme, the decarboxylation rate of 11C-5-HTP was decreased, leading to a higher tumor uptake and a considerably lower urinary radioactivity concentration.
Key Words: NET • neuroendocrine • carcinoid • EPT • PET • positron • 5-hydroxytryptophane • serotonin • l-dopa
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