68Ga-DOTA-TATE PET/CT improves accuracy and guides management in multiple endocrine neoplasia type 1 (MEN-1) patients with suspected duodeno-pancreatic neuroendocrine tumours.

Purpose: To evaluate the added benefit and accuracy of ⁶⁸Ga-DOTA-TATE PET/CT scans in detecting duodeno-pancreatic neuroendocrine tumours (dpNETs) compared to conventional cross-sectional imaging with CT or MRI scans in patients with multiple endocrine neoplasia type 1 (MEN-1), and whether the results from the ⁶⁸Ga-DOTA-TATE PET/CT produce a change in management plans for patients with MEN-1 and dpNETs.

Methods: A retrospective analysis was performed comparing the initial ⁶⁸Ga-DOTA-TATE PET/CT to the respective contemporary CT or MRI imaging in patients with MEN-1 under the care of a tertiary neuroendocrine centre. Imaging and electronic patient records were analysed to identify treatment plans and the records of multidisciplinary team discussions.

Results: In total, 85% (n = 39/46) of patients with MEN-1 had a ⁶⁸Ga-DOTA-TATE PET/CT study in the electronic patient record; 23 of those with duodeno-pancreatic lesions detected also had contemporaneous contrast-enhanced CT scans, while 18 had MRI scans. ⁶⁸Ga-DOTA-TATE PET/CT detected a total of 47 pancreatic lesions compared to 25 on CT, while ⁶⁸Ga-DOTA-TATE PET/CT detected 32 pancreatic lesions compared to 25 on MRI. There were no duodenal lesions detected on conventional CT or MRI, but in comparison to CT and MRI, ⁶⁸Ga-DOTA-TATE PET/CT detected eight and one duodenal lesions respectively. While ⁶⁸Ga-DOTA-TATE PET/CT detected more liver metastases compared to CT (n: 31 vs 21) and similar numbers compared to MRI (n: 11 vs 11), these differences were not statistically significant. As a result of findings on ⁶⁸Ga-DOTA-TATE PET/CT, a change of management was indicated in 69% (n = 27/39) of patients. Of these, 14 patients were offered somatostatin analogues (SSTA), eight patients were offered surgical intervention, three patients were offered peptide receptor radionuclide therapy, and one patient was offered ablation of liver metastases.

Conclusions: In patients with MEN-1, ⁶⁸Ga-DOTA-TATE PET/CT was shown to detect a greater number of duodeno-pancreatic lesions compared to conventional cross-sectional CT or MRI imaging. Management plans were changed in most patients following their initial ⁶⁸Ga-DOTA-TATE PET/CT. Therefore, we suggest that somatostatin receptor-targeted PET/CT scans should be an integral part of the investigation of patients with MEN-1 for staging of suspected duodeno-pancreatic NETs.