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Pancreatic neuroendocrine neoplasms panNENs are heterogeneous neoplasms with neuroendocrine differentiation that show peculiar clinical and histomorphological features with variable prognosis In recent years advances in knowledge regarding the pathophysiology and heterogeneous clinical presentation as well as the availability of different diagnostic procedures for panNEN diagnosis and novel therapeutic options for patient clinical management has led to the recognition of the need for an active multidisciplinary discussion for optimal patient care Molecular imaging with positron emission tomography computed tomography PET CT has become indispensable for the management of panNENs Several PET radiopharmaceuticals can be used to characterize either panNEN receptor expression or metabolism The aim of this review is to offer an overview of all the currently used radiopharmaceuticals and of the new upcoming tracers for pancreatic neuroendocrine tumors panNETs and their clinical impact on therapy management 68Ga Ga-DOTA-peptide PET CT SSA-PET CT has high sensitivity specificity and accuracy and is recommended for the staging and restaging of any non-insulinoma well-differentiated panNEN cases to carry out detection of unknown primary tumor sites or early relapse and for evaluation of in vivo somatostatin receptors expression SRE to select patient candidates for peptide receptor radiometabolic treatment PRRT with 90Y or 177Lu and or cold analogs SSA-PET CT also has a strong impact on clinical management leading to a change in treatment in approximately a third of the cases Its role for treatment response assessment is still under debate due to the lack of standardized criteria even though some semiquantitative parameters seem to be able to predict response 18F FDG PET CT generally shows low sensitivity in small growing and well-differentiated neuroendocrine tumors NET G1 and G2 while it is of utmost importance in the evaluation and management of high-grade NENs and also provides important prognostic information When positive 18F FDG PET CT impacts therapeutical management indicating the need for a more aggressive treatment regime Although FDG positivity does not exclude the patient from PRRT several studies have demonstrated that it is certainly useful to predict response even in this setting The role of 18F FDOPA for the study of panNET is limited by physiological uptake in the pancreas and is therefore not recommended Moreover it provides no information on SRE that has crucial clinical management relevance Early acquisition of the abdomen and premedication with carbidopa may be useful to increase the accuracy but further studies are needed to clarify its utility GLP-1R agonists such as exendin-4 are particularly useful for benign insulinoma detection but their accuracy decreases in the case of malignant insulinomas Being a whole-body imaging technique exendin-PET CT gives important preoperative information on tumor size and localization which is fundamental for surgical planning as resection enucleation of the lesion or partial pancreatic resection is the only curative treatment New upcoming tracers are under study such as promising SSTR antagonists which show a favorable biodistribution and higher tumor-to-background ratio that increases tumor detection especially in the liver 68Ga pentixafor an in vivo marker of CXCR4 expression associated with the behavior of more aggressive tumors seems to only play a limited role in detecting well-differentiated NET since there is an inverse expression of SSTR2 and CXCR4 in G1 to G3 NETs with an elevation in CXCR4 and a decrease in SSTR2 expression with increasing grade Other tracers such as 68Ga Ga-PSMA 68Ga Ga-DATA-TOC 18F SiTATE and 18F AlF-OC are also under investigation

Role of PET/CT and Therapy Management of Pancreatic Neuroendocrine Tumors.

Peptide Receptor Radionuclide Therapy for the Treatment of Pancreatic Neuroendocrine Tumors: Recent Insights.

Publication search with panNET as keyword

Role of PET/CT and Therapy Management of Pancreatic Neuroendocrine Tumors.

Peptide Receptor Radionuclide Therapy for the Treatment of Pancreatic Neuroendocrine Tumors: Recent Insights.

Publication search
with panNET as keyword