Abstracts

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E1531. Somatostatin Receptor Imaging and Therapy of Neuroendocrine Neoplasms: A Primer
Authors
  1. Jennifer Gillman; Children's Hospital of Philadelphia; Mid-Atlantic Permanente Medical Group
  2. Vincent Dam; Mid-Atlantic Permanente Medical Group
  3. Philipose Mulugeta; Mid-Atlantic Permanente Medical Group
Background
Neuroendocrine tumors (NET) are a rare heterogeneous group of tumors, with an incidence of approximately 7 in 100,000 people. Most NETs demonstrate increased somatostatin transmembrane receptor (SSTR) expression, especially when well-differentiated. Traditionally, functional imaging of these tumors was done using indium-111 pentetreotide, a somatostatin receptor analog. Advancements in SSTR imaging with the development of gallium-68 DOTATATE uses positron emission tomography (PET), and has greater sensitivity for neuroendocrine tumors, and the advantage of theranostic translation with peptide receptor radionuclide therapy (PRRT) using lutetium-177 DOTATATE.

Educational Goals / Teaching Points
- To compare the advantages and disadvantages of indium-111 pentetreotide and gallium-68 DOTATATE imaging for neuroendocrine tumors. - To discuss potential pitfalls gallium-68 DOTATATE PET imaging, specifically describing normal physiologic distribution in addition to potential false-positives and false-negatives. - To describe the implementation of PRRT into clinical practice, specifically explaining patient selection criteria, radiation safety precautions, and a practical guide for how to set up an infusion suite.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This educational exhibit will describe the normal physiologic distribution of both indium-111 pentetreotide planar imaging and gallium-68 DOTATATE PET/CT imaging techniques, in addition to differences in technique, availability, cost, and sensitivity. This exhibit will also discuss the role of gallium-68 DOTATATE PET/CT for NET staging, explain appropriate patient selection criteria for PRRT, describe the PRRT treatment protocol, and explore practical tips for developing a successful PRRT therapy clinic.

Conclusion
Gallium-68 DOTATATE PET is a sensitive modality for detecting and staging neuroendocrine tumors, with an associated theranostic PRRT which can be successfully translated into a practical clinical work-flow.