K S Winter1, C J Auernhammer2,3, A Todica4,3, J Ricke5,3, C Cyran5,3. 1. Klinik und Poliklinik für Radiologie, Klinikum der Universität München, LMU München, Marchioninistraße 15, 81377, München, Deutschland. stella.winter@med.uni-muenchen.de. 2. Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Deutschland. 3. Interdisziplinäres Zentrum für Neuroendokrine Tumoren des GastroEnteroPankreatischen Systems des Klinikums der Universität München (GEPNET-KUM), München, Deutschland. 4. Klinik und Poliklinik für Nuklearmedizin, Klinikum der Universität München, München, Deutschland. 5. Klinik und Poliklinik für Radiologie, Klinikum der Universität München, LMU München, Marchioninistraße 15, 81377, München, Deutschland.
Abstract
CLINICAL/METHODICAL ISSUE: Pulmonary carcinoids and carcinoids of the small intestine (jejunum and ileum) are often asymptomatic and can affect various parts of the body, which makes diagnosis difficult. STANDARD RADIOLOGICAL METHODS: Contrast-enhanced computed tomography (CE-CT) is commonly used for primary diagnostics. In case of concomitant pulmonary consolidation (e.g., atelectasis or pneumonia), tumor lesions can be obscured. In addition, differentiation between atypical (AC) and typical carcinoids (TC) is not possible using CT. Small tumors of the small intestine are easily overlooked (sensitivity: 50-85%, specificity: 25-97%, based on the literature). Additional functional imaging evaluation using hybrid imaging techniques can be applied, e.g., positron emission tomography/computed tomography (PET/CT). METHODICAL INNOVATIONS/PERFORMANCE: Depending on the histological characteristics of the tumor, PET/CT scans can be performed with different tracers. Since most carcinoids (e.g., TC) express somatostatin receptors (SSR), 68 gallium-radiolabeled PET tracers (e.g. 68 Ga-DOTA-TOC) are commonly used (sensitivity: 88-93%, specificity: 88-95%, based on the literature). Poorly differentiated carcinoids (e.g., AC) demonstrate lower SSR expression; thus, use of 18F‑FDG (sensitivity: 37-72%, based on the literature) is indicated. In principle, these methods enable a noninvasive prognostic differentiation based on SSR expression and 18F‑FDG uptake. However, the diagnosis must always be histologically confirmed. ACHIEVEMENTS/PRACTICAL RECOMMENDATIONS: Hybrid imaging with CE-CT and PET is useful to detect pulmonary carcinoids and carcinoids of the small intestine, respectively, and can be utilized for primary diagnostics and restaging.
CLINICAL/METHODICAL ISSUE: Pulmonary carcinoids and carcinoids of the small intestine (jejunum and ileum) are often asymptomatic and can affect various parts of the body, which makes diagnosis difficult. STANDARD RADIOLOGICAL METHODS: Contrast-enhanced computed tomography (CE-CT) is commonly used for primary diagnostics. In case of concomitant pulmonary consolidation (e.g., atelectasis or pneumonia), tumor lesions can be obscured. In addition, differentiation between atypical (AC) and typical carcinoids (TC) is not possible using CT. Small tumors of the small intestine are easily overlooked (sensitivity: 50-85%, specificity: 25-97%, based on the literature). Additional functional imaging evaluation using hybrid imaging techniques can be applied, e.g., positron emission tomography/computed tomography (PET/CT). METHODICAL INNOVATIONS/PERFORMANCE: Depending on the histological characteristics of the tumor, PET/CT scans can be performed with different tracers. Since most carcinoids (e.g., TC) express somatostatin receptors (SSR), 68 gallium-radiolabeled PET tracers (e.g. 68 Ga-DOTA-TOC) are commonly used (sensitivity: 88-93%, specificity: 88-95%, based on the literature). Poorly differentiated carcinoids (e.g., AC) demonstrate lower SSR expression; thus, use of 18F‑FDG (sensitivity: 37-72%, based on the literature) is indicated. In principle, these methods enable a noninvasive prognostic differentiation based on SSR expression and 18F‑FDG uptake. However, the diagnosis must always be histologically confirmed. ACHIEVEMENTS/PRACTICAL RECOMMENDATIONS: Hybrid imaging with CE-CT and PET is useful to detect pulmonary carcinoids and carcinoids of the small intestine, respectively, and can be utilized for primary diagnostics and restaging.
Authors: M E Caplin; E Baudin; P Ferolla; P Filosso; M Garcia-Yuste; E Lim; K Oberg; G Pelosi; A Perren; R E Rossi; W D Travis Journal: Ann Oncol Date: 2015-02-02 Impact factor: 32.976
Authors: Marybeth S Hughes; Saïd C Azoury; Yasmine Assadipour; David M Straughan; Apurva N Trivedi; Ramona M Lim; Grishma Joy; Mark T Voellinger; Derek M Tang; Aradhana M Venkatesan; Clara C Chen; Adeline Louie; Martha M Quezado; Joanne Forbes; Stephen A Wank Journal: Surgery Date: 2015-10-09 Impact factor: 3.982