Imaging of Merkel Cell Carcinoma

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.50
Procedures: 1.50
Head, Spine, and Musculoskeletal: 0.50
Neck and Chest: 0.50
Abdomen and Pelvis: 0.50

Magnetic Resonance Imaging: 1.50
Procedures: 1.50
Neurological: 0.50
Body: 0.50
Musculoskeletal: 0.50

Nuclear Medicine Technology: 2.00
Procedures: 2.00
Endocrine and Oncology Procedures: 1.00
Other Imaging Procedures: 1.00

Registered Radiologist Assistant: 2.00
Procedures: 2.00
Abdominal Section: 0.50
Thoracic Section: 0.50
Musculoskeletal and Endocrine Sections: 0.50
Neurological, Vascular, and Lymphatic Sections: 0.50

Sonography: 1.50
Procedures: 1.50
Superficial Structures and Other Sonographic Procedures: 1.50

Radiation Therapy: 2.00
Patient Care: 0.50
Patient and Medical Record Management: 0.50
Procedures: 1.50
Treatment Sites and Tumors: 1.00
Treatments: 0.50

Outline

1. Introduction
2. Clinical Features
3. Causative Factors
4. MCPyV Serology Test
5. Staging and Prognosis
6. Role of Imaging
   1. Imaging of Primary or Regional MCC
   2. Sentinel Lymph Node Biopsy
   3. Detecting Nodal or Distant Metastasis
7. Treatment
8. Follow-up or Assessment of Treatment Response
9. Role of Specific Nuclear Medicine Studies
   1. ¹⁸F-FDG PET
   2. Bone Scintigraphy
   3. Somatostatin Receptor-Seeking Nuclear Medicine
   4. ¹⁸F-FDG PET versus ⁶⁸Ga-Somatostatin Analog PET
10. Peptide Receptor Radionuclide Therapy
11. Conclusion

Objectives

Upon completion of this course, students will:

1. be familiar with percentage of MCC patients with nodal or distant metastasis at initial presentation
2. identify the SSRT types for which MCC has a higher affinity
3. recognize the typical clinical feature of MCC nodules
4. be familiar with the significant features of MCC
5. be familiar with the serology test used for evaluation of MCC patients
6. be familiar with the clinical practice guidelines of the NCCN
7. be familiar with the stages of the AJCC TNM staging system
8. identify the most reliable staging tool for identifying subclinical nodal MCC disease
9. be familiar with the estimated 5-year overall survival for MCC patients with local MCC disease
10. identify the imaging modality that enables real-time imaging possible with simultaneous fine-needle or core needle biopsy
11. be familiar with the reported mean maximum SUV at ¹⁸F-FDG PET for primary MCC
12. be familiar with the sensitivity of SLNB in Stage I and II MCC
13. be familiar with the administration of ^99mTc sulfur colloid for sentinel lymph node mapping
14. identify the imaging modality used to localize sentinel lymph nodes in anatomically complex areas during lymphoscintigraphy
15. recognize the imaging modalities that may be used at MCC metastasis
16. identify the imaging modality that is increasingly being used for detection of distant MCC metastasis
17. identify which imaging modality should be used for brain metastasis in MCC patients
18. be familiar with the standard treatment options for MCC patients
19. be familiar with the preferable treatment for MCC patients with distant metastasis
20. identify the immunotherapy agents used for systemic therapy of MCC patients
21. be familiar with the imaging criteria for MCC patients receiving immunotherapy
22. identify the imaging modality that has significantly influenced treatment decisions and management of MCC patients
23. identify the radiopharmaceutical used to perform bone scintigraphy in MCC patients
24. be familiar with the flare phenomenon in bone scintigraphy
25. identify the radiopharmaceuticals that can be linked to peptides that bind to SSTR
26. be familiar with the advantages of ⁶⁸GA-DOTATATE vs. ¹¹¹In-pentetreotide for imaging patients with NETs
27. be familiar with the preparation time for imaging a patient with ⁶⁸GA-labeled somatostatin
28. identify the only PET radiotracer indicated for MCC in the NCCN guidelines
29. be familiar with the guidelines for tumor grading based on ENETS
30. identify the radioisotopes used for therapeutic treatment of MCC