Cu-64-DOTATATE PET for Neuroendocrine Tumors: A Prospective Head-to-Head Comparison with In-111-DTPA-Octreotide in 112 Patients

摘要

Neuroendocrine tumors (NETs) can be visualized using radiolabeled somatostatin analogs. We have previously shown the clinical potential of Cu-64-DOTATATE in a small first-in-human feasibility study. The aim of the present study was, in a larger prospective design, to compare on a head-to-head basis the performance of Cu-64-DOTATATE and In-111-diethylenetriaminepentaacetic acid (DTPA)-octreotide (In-111-DTPA-OC) as a basis for implementing Cu-64-DOTATATE as a routine. Methods: We prospectively enrolled 112 patients with pathologically confirmed NETs of gastroenteropancreatic or pulmonary origin. All patients underwent both PET/CT with Cu-64-DOTATATE and SPECT/CT with In-111-DTPA-OC within 60 d. PET scans were acquired 1 h after injection of 202 MBq (range, 183-232 MBq) of Cu-64-DOTATATE after a diagnostic contrast-enhanced CT scan. Patients were followed for 42-60 mo for evaluation of discrepant imaging findings. The McNemar test was used to compare the diagnostic performance. Results: Eighty-seven patients were congruently PET-and SPECT-positive. No SPECT-positive cases were PET-negative, whereas 10 false-negative SPECT cases were identified using PET. The diagnostic sensitivity and accuracy of Cu-64-DOTATATE (97% for both) were significantly better than those of In-111-DTPA-OC (87% and 88%, respectively, P = 0.017). In 84 patients (75%), Cu-64-DOTATATE identified more lesions than In-111-DTPA-OC and always at least as many. In total, twice as many lesions were detected with Cu-64-DOTATATE than with In-111-DTPA-OC. Moreover, in 40 of 112 cases (36%) lesions were detected by Cu-64-DOTATATE in organs not identified as disease-involved by In-111-DTPA-OC. Conclusion: With these results, we demonstrate that Cu-64-DOTATATE is far superior to In-111-DTPAOC in diagnostic performance in NET patients. Therefore, we do not hesitate to recommend implementation of Cu-64-DOTATATE as a replacement for In-111-DTPA-OC.