Molecular Imaging of Gastroenteropancreatic Neuroendocrine Tumors

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after March 18, 2024:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 0.50
Procedures: 0.50
Abdomen and Pelvis: 0.50

Magnetic Resonance Imaging: 0.50
Procedures: 0.50
Body: 0.50

Nuclear Medicine Technology: 2.25
Procedures: 2.25
Endocrine and Oncology Procedures: 2.25

Registered Radiologist Assistant: 0.50
Procedures: 0.50
Abdominal Section: 0.50

Sonography: 0.50
Procedures: 0.50
Abdomen: 0.50

Outline

1. Introduction
2. Overview of GEP NETS
   1. Presentation
   2. Tumor Grading and Disease Staging
   3. Role of Imaging
3. Conventional Morphologic Procedures
   1. Primary Tumor Detection
   2. Tumor Extent and Metastatic Spread
4. Radionuclide Imaging
   1. Radiolabeled Somatostatin Analogs
   2. Radiolabeled MIBG
   3. ¹⁸F-Fluorodihydroxyphenylalanine (¹⁸F-FDOPA
   4. ¹⁸F-FDG
5. Toward Personalized Medicine
   1. Proposed Imaging Algorithm
   2. Therapeutic Decision Making
   3. Theranostics: The Image-and-Treat Attitude
6. Conclusion

Objectives

Upon completion of this course, students will:

1. know the type of neoplasms that GEP NETs are
2. be familiar with the various types of gastric NETs
3. be familiar with the presentation of duodenal NETs
4. understand the basic facts associated with pancreatic NETs
5. be familiar with the presentation of small-intestinal NETs
6. know the symptoms of colonic NETs
7. be familiar with the 2010 WHO GEP NET classification criteria
8. know the GEP NET staging criteria
9. know the value of functional imaging techniques to the management of patients with GEP NETs
10. be familiar with the various conventional morphologic procedures for NETs
11. recognize the primary characteristics and advantages of the currently available endoscopic and anatomic-imaging techniques for GEP NET investigation
12. understand the strengths of both contrast-enhanced CT and MR for evaluation of GEP NET extent and metastatic spread
13. be familiar with the processes that have been exploited for radiotracer development for radionuclide imaging of NETs
14. know which SSTRs subtype is most frequently expressed by GEP NETs
15. be familiar with the usage and advantages of ¹¹¹In pentetreotide
16. know the radiotracers that are collectively referred to as ⁶⁸Ga-DOTA-peptides
17. know the SSTR subtypes for which ⁶⁸Ga-DOTA-peptides have affinity
18. understand the advantages of ⁶⁸Ga-DOTA-peptide imaging over ¹¹¹In-pentetreotide imaging
19. understand how the sensitivity of ⁶⁸Ga-DOTATATE can lead to a change in therapy decisions, as found in the prospective study by Sadowski et al cited in the article
20. know the condition for which ⁶⁸Ga-peptide PET/CT is recommended in all patients
21. know the reasons for ⁶⁸Ga-peptide PET/CT to assess for NET recurrence
22. be familiar with the benefits of using ⁶⁸Ga-DOTA-peptide PET imaging versus ¹¹¹In-pentetreotide SPECT imaging
23. be familiar with the conditions that can be detected with ⁶⁸Ga-peptide PET imaging, even though insulinoma detection through SSTR imaging has classically been associated with low sensitivity
24. know the relationship between ⁶⁸Ga-DOTA-peptide PET/CT and PRRT
25. be familiar with the pitfalls of SSTR PET imaging
26. understand the advantages of the proposed radiolabeled antagonists over the current agonist imaging agents
27. be familiar with the facts about radiolabeled MIBG imaging
28. know the cases where ¹⁸F-FDOPA has excellent imaging sensitivity
29. know where ¹⁸F-FDOPA PET/CT is superior to both CT and ¹¹¹In-pentetreotide SSTR scintigraphy
30. know a definite advantage of ⁶⁸Ga-DOTA-peptide PET/CT over ¹⁸F-FDOPA PET/CT
31. know what is crucial for treatment planning, since surgical resection is associated with better symptom-free survival, overall survival, and quality of life
32. know how ¹⁸F-FDOPA PET/CT of adult insulinoma detection might be improved
33. know the GEP NET grades for which ¹⁸F-FDG is the preferred radiotracer
34. understand the importance of increased ¹⁸F-FDG uptake to NET diagnosis
35. be familiar with the proposed diagnostic imaging algorithm for patients with GEP NETs
36. know the factors that play into the choice of morphologic and functional imaging techniques in the proposed diagnostic imaging algorithm for patients with GEP NETs
37. be familiar with the available therapeutic options for unresectable advanced or metastatic GEP NET disease from well-differentiated tumors
38. know the factors that affect management of GEP NET patients
39. understand the so called “flip-flop phenomenon” relationship between the uptake of radiolabeled SSAs (or ¹⁸F-FDOPA) and that of ¹⁸F-FDG in low and high grade GEP NETs
40. understand the term “theranostics” and what aspects of personalized medicine are integrated in theranostic patient management