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Whole-Body ¹¹C-5-Hydroxytryptophan Positron Emission Tomography as a Universal Imaging Technique for Neuroendocrine Tumors: Comparison with Somatostatin Receptor Scintigraphy and Computed Tomography

Departments of Medical Sciences/Endocrine Oncology (H.O., K.O., B.S., B.E.), Radiology (A.S.), Nuclear Medicine (U.G.), and Surgery (C.J.) and Uppsala University PET Center IMANET (A.S., B.L., M.B.), Uppsala University Hospital, S-751 85 Uppsala, Sweden

Address all correspondence and requests for reprints to: Hakan Orlefors, M.D., Ph.D., Department of Medical Sciences/Endocrine Oncology, Uppsala University Hospital, S-751 85 Uppsala, Sweden. E-mail: hakan.orlefors{at}medsci.uu.se.

Neuroendocrine tumors (NETs) can be small and situated almost anywhere throughout the body. Our objective was to investigate whether whole-body (WB) positron emission tomography (PET) with ¹¹C-5-hydroxytryptophan (5-HTP) can be used as a universal imaging technique for NETs and to compare this technique with established imaging methods. Forty-two consecutive patients with evidence of NET and a detected lesion on any conventional imaging (six bronchial, two foregut, 16 midgut, and two thymic carcinoids; one ectopic Cushing’s syndrome; four gastrinomas; one insulinoma; six nonfunctioning endocrine pancreatic tumors; one gastric carcinoid, one paraganglioma; and two endocrine-differentiated pancreatic carcinomas) were studied. The WB-¹¹C-5-HTP-PET examinations were compared with WB-computed tomography (CT) and somatostatin receptor scintigraphy (SRS). Tumor lesions were imaged with PET in 95% of the patients. In 58% of the patients, PET could detect more lesions than SRS and CT and equal numbers in 34%, whereas in three cases, SRS or CT showed more lesions. In 84% (16 of 19 patients), PET could visualize the primary tumor compared with 47 and 42% for SRS and CT, respectively. The surgically removed PET-positive primary tumor sizes were 6–30 mm. To conclude, this study indicates that WB-¹¹C-5-HTP-PET can be used as a universal imaging method for detection of NETs. This study also shows that WB-¹¹C-HTP-PET is sensitive in imaging small NET lesions, such as primary tumors, and can in a majority of cases image significantly more tumor lesions than SRS and CT.

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