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This version published online on March 8, 2005
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2004-1938
A more recent version of this article appeared on June 1, 2005
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Submitted on September 30, 2004
Accepted on March 2, 2005

Whole-body 11C-5-hydroxytryptophan positron emission tomography as a universal imaging technique for neuroendocrine tumors - comparison with somatostatin receptor scintigraphy and computed tomography

H. Orlefors*, A. Sundin, U. Garske, C. Juhlin, K. Oberg, B. Langstrom, M. Bergstrom, and B. Eriksson

Department of Medical Sciences /Endocrine Oncology, Department of Radiology, Uppsala University PET Center (IMANET), Department of Nuclear Medicine and Department of Surgery, Uppsala University Hospital, Sweden

* To whom correspondence should be addressed. E-mail: hakan.orlefors{at}medsci.uu.se.

Neuroendocrine tumors (NET's) can be small and situated almost anywhere throughout the body. Our objective was to investigate if whole body (WB) positron emission tomography (PET) with 11C-5-hydroxytryptophan (5-HTP) can be used as a universal imaging technique for NET's 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 (6 bronchial-, 2 foregut-, 16 midgut-, and 2 thymic carcinoids, 1 ectopic Cushing's syndrome, 4 gastrinomas, 1 insulinoma, 6 non-functioning endocrine pancreatic tumors, 1 gastric carcinoid, 1 paraganglioma and 2 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, equal numbers in 34% whereas in 3 cases SRS or CT showed more lesions. In 84% (16/19 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-HTP-PET can be used as a universal imaging method for detection of NET's. 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.
Key words: Neuroendocrine tumor (NET) • carcinoid • endocrine pancreatic tumor (EPT) • PET • imaging




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