The clinical benefits of [18F]AlF-NOTA-octreotide PET/CT in staging and restaging patients with gastroenteropancreatic neuroendocrine neoplasms: comparison of [18F]FDG PET/CT

Abstract Background Accurate clinical TNM staging is crucial for managing GEP-NENs according to the latest NCCN guidelines. [68Ga] labeled somatostatin receptor (SSTR) PET/CT outperforms [18F]FDG PET/CT in evaluating well and moderately differentiated NENs. However, few studies have investigated the...

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Main Authors: Donghe Chen, Zhenfeng Liu, Guolin Wang, Mengjiao Tu, Fei Yang, Chunting Jiang, Kui Zhao, Xinhui Su
Format: Article
Language:English
Published: BMC 2025-07-01
Series:BMC Medical Imaging
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Online Access:https://doi.org/10.1186/s12880-025-01824-9
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author Donghe Chen
Zhenfeng Liu
Guolin Wang
Mengjiao Tu
Fei Yang
Chunting Jiang
Kui Zhao
Xinhui Su
author_facet Donghe Chen
Zhenfeng Liu
Guolin Wang
Mengjiao Tu
Fei Yang
Chunting Jiang
Kui Zhao
Xinhui Su
author_sort Donghe Chen
collection DOAJ
description Abstract Background Accurate clinical TNM staging is crucial for managing GEP-NENs according to the latest NCCN guidelines. [68Ga] labeled somatostatin receptor (SSTR) PET/CT outperforms [18F]FDG PET/CT in evaluating well and moderately differentiated NENs. However, few studies have investigated the performance of [18F] labeled SSTRs in the exploration of GEP-NENs. Purpose This retrospective study compared the performance of [18F]AlF-NOTA-octreotide ([18F]OC) with [18F]FDG PET/CT for precise staging and restaging GEP-NENs. Methods Participants with clinically suspected or confirmed NENs were enrolled and underwent paired [18F]OC and [18F]FDG PET/CT between. Lesion findings and PET metabolic parameters, such as the maximum standardized uptake value (SUVmax) and tumor-to-background ratio (TBR), were compared between the two types of radiotracers. The results of histology or imaging follow-up served as the reference standard for the final diagnosis. Results Thirty-seven patients and 209 suspicious lesions were included in the statistical analysis. In patients for initial staging (n = 19), [18F]OC PET/CT led to upstaging of the clinical T stage in 13 (66.7%) patients and TNM stage in 10 (52.6%) patients compared with [18F]FDG PET/CT. In posttreatment patients for restaging (n = 18), [18F]OC PET/CT demonstrated superior performance in 9 (50%) patients and inferior performance in 3 (16.7%) patients compared with [18F]FDG PET/CT. For the 176 confirmed NEN lesions, the SUVmax and TBR of [18F]OC were greater than those of [18F]FDG (median SUVmax, 11.3 vs. 2.1; P < 0.001; median TBR, 8.0 vs. 1.6; P < 0.001, respectively). For lesions < 0.5 cm, 0.5 ~ 1.0 cm and 1.0 ~ 2.0 cm in size, [18F]OC PET/CT had a significantly higher sensitivity than [18F]FDG PET/CT did (P = 0.041, < 0.001, 0.028, respectively), whereas for lesions between 2.0 ~ 4.0 cm and > 4.0 cm in size, the differences were not significant (P = 0.103 and 0.539). Conclusions [18F]OC PET/CT outperformed [18F]FDG PET/CT in detecting small well-differentiated GEP-NEN lesions and metastases less than 2.0 cm in size, even tiny lesions (≤ 0.5 cm), which helps improve GEP-NEN staging and restaging. Clinical trial number Not applicable.
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spelling doaj-art-56de801a005447b0b9bd4e920ac425572025-08-20T03:06:29ZengBMCBMC Medical Imaging1471-23422025-07-0125111110.1186/s12880-025-01824-9The clinical benefits of [18F]AlF-NOTA-octreotide PET/CT in staging and restaging patients with gastroenteropancreatic neuroendocrine neoplasms: comparison of [18F]FDG PET/CTDonghe Chen0Zhenfeng Liu1Guolin Wang2Mengjiao Tu3Fei Yang4Chunting Jiang5Kui Zhao6Xinhui Su7Department of Nuclear Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityDepartment of Nuclear Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityDepartment of Nuclear Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityDepartment of Nuclear Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityDepartment of Nuclear Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityDepartment of Nuclear Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityDepartment of Nuclear Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityDepartment of Nuclear Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityAbstract Background Accurate clinical TNM staging is crucial for managing GEP-NENs according to the latest NCCN guidelines. [68Ga] labeled somatostatin receptor (SSTR) PET/CT outperforms [18F]FDG PET/CT in evaluating well and moderately differentiated NENs. However, few studies have investigated the performance of [18F] labeled SSTRs in the exploration of GEP-NENs. Purpose This retrospective study compared the performance of [18F]AlF-NOTA-octreotide ([18F]OC) with [18F]FDG PET/CT for precise staging and restaging GEP-NENs. Methods Participants with clinically suspected or confirmed NENs were enrolled and underwent paired [18F]OC and [18F]FDG PET/CT between. Lesion findings and PET metabolic parameters, such as the maximum standardized uptake value (SUVmax) and tumor-to-background ratio (TBR), were compared between the two types of radiotracers. The results of histology or imaging follow-up served as the reference standard for the final diagnosis. Results Thirty-seven patients and 209 suspicious lesions were included in the statistical analysis. In patients for initial staging (n = 19), [18F]OC PET/CT led to upstaging of the clinical T stage in 13 (66.7%) patients and TNM stage in 10 (52.6%) patients compared with [18F]FDG PET/CT. In posttreatment patients for restaging (n = 18), [18F]OC PET/CT demonstrated superior performance in 9 (50%) patients and inferior performance in 3 (16.7%) patients compared with [18F]FDG PET/CT. For the 176 confirmed NEN lesions, the SUVmax and TBR of [18F]OC were greater than those of [18F]FDG (median SUVmax, 11.3 vs. 2.1; P < 0.001; median TBR, 8.0 vs. 1.6; P < 0.001, respectively). For lesions < 0.5 cm, 0.5 ~ 1.0 cm and 1.0 ~ 2.0 cm in size, [18F]OC PET/CT had a significantly higher sensitivity than [18F]FDG PET/CT did (P = 0.041, < 0.001, 0.028, respectively), whereas for lesions between 2.0 ~ 4.0 cm and > 4.0 cm in size, the differences were not significant (P = 0.103 and 0.539). Conclusions [18F]OC PET/CT outperformed [18F]FDG PET/CT in detecting small well-differentiated GEP-NEN lesions and metastases less than 2.0 cm in size, even tiny lesions (≤ 0.5 cm), which helps improve GEP-NEN staging and restaging. Clinical trial number Not applicable.https://doi.org/10.1186/s12880-025-01824-9Neuroendocrine neoplasmsGEP-NENs[18F]FDG[18F]OCPET/CTSUVmax
spellingShingle Donghe Chen
Zhenfeng Liu
Guolin Wang
Mengjiao Tu
Fei Yang
Chunting Jiang
Kui Zhao
Xinhui Su
The clinical benefits of [18F]AlF-NOTA-octreotide PET/CT in staging and restaging patients with gastroenteropancreatic neuroendocrine neoplasms: comparison of [18F]FDG PET/CT
BMC Medical Imaging
Neuroendocrine neoplasms
GEP-NENs
[18F]FDG
[18F]OC
PET/CT
SUVmax
title The clinical benefits of [18F]AlF-NOTA-octreotide PET/CT in staging and restaging patients with gastroenteropancreatic neuroendocrine neoplasms: comparison of [18F]FDG PET/CT
title_full The clinical benefits of [18F]AlF-NOTA-octreotide PET/CT in staging and restaging patients with gastroenteropancreatic neuroendocrine neoplasms: comparison of [18F]FDG PET/CT
title_fullStr The clinical benefits of [18F]AlF-NOTA-octreotide PET/CT in staging and restaging patients with gastroenteropancreatic neuroendocrine neoplasms: comparison of [18F]FDG PET/CT
title_full_unstemmed The clinical benefits of [18F]AlF-NOTA-octreotide PET/CT in staging and restaging patients with gastroenteropancreatic neuroendocrine neoplasms: comparison of [18F]FDG PET/CT
title_short The clinical benefits of [18F]AlF-NOTA-octreotide PET/CT in staging and restaging patients with gastroenteropancreatic neuroendocrine neoplasms: comparison of [18F]FDG PET/CT
title_sort clinical benefits of 18f alf nota octreotide pet ct in staging and restaging patients with gastroenteropancreatic neuroendocrine neoplasms comparison of 18f fdg pet ct
topic Neuroendocrine neoplasms
GEP-NENs
[18F]FDG
[18F]OC
PET/CT
SUVmax
url https://doi.org/10.1186/s12880-025-01824-9
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