68Ga-DOTATATE PET/CT Compared with 131I-MIBG SPECT/CT in the Evaluation of Neural Crest Tumors

Abstract

<strong><em>Objective(s):</em></strong> ⁶⁸Ga-DOTATATE positron emission tomography (PET)/computed tomography (CT) has shown promising results in imaging of neural crest tumors (NCT). Herein, we compared the performance of ⁶⁸Ga-DOTATATE PET/CT and ¹³¹I-MIBG single photon emission computed tomography (SPECT)/CT in the initial diagnosis, staging and follow-up of patients with NCTs.<br /> <strong><em>Methods: </em></strong>Twenty-five patients (males:females=8:17; age range=2–71 years) with clinically proven or suspicious neuroblastoma, pheochromocytoma (PCC) or paraganglioma (PGL) were enrolled in this prospective study and underwent both ⁶⁸Ga-DOTATATE PET/CT and ¹³¹I-MIBG SPECT/CT. A composite reference standard derived from histopathological information, together with anatomical and functional imaging findings, was used to validate the results. Imaging findings were assessed on a per-patient and on a per-lesion basis. Sensitivity and accuracy were assessed using McNemar's test.<br /> <strong><em>R</em></strong><strong><em>esults</em></strong><em>: </em>Referring to radiological imaging and histopathological findings as reference standard, ⁶⁸Ga-DOTATATE and ¹³¹I-MIBG scans showed a sensitivity and accuracy of (100%, 96%) and (86.7%, 88%), respectively, on a per-patient basis. In PCC/PGL patients, on a per-patient basis, the sensitivity of ⁶⁸Ga-DOTATATE was 100% and that of ¹³¹I-MIBG was 77.8%. In neuroblastoma patients, on a per-patient basis, the sensitivities of both ⁶⁸Ga-DOTATATE and ¹³¹I-MIBG were 100%. Overall, in this patient cohort, ⁶⁸Ga-DOTATATE PET/CT identified 52 lesions and ¹³¹I-MIBG SPECT/CT identified only 30 lesions. On a per-lesion analysis, ⁶⁸Ga-DOTATATE was found to be superior to ¹³¹I-MIBG in detecting lesions in all anatomical locations, particularly osseous lesions. According to the McNemar test results, differences were not statistically significant.<br /> <strong><em>Conclusion: </em></strong>This relatively small patient cohort suggests ⁶⁸Ga-DOTATATE PET/CT be superior to ¹³¹I-MIBG SPECT/CT in providing particularly valuable information for both primary staging and follow-up in patients with NCT.