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Clinical Application of 18F-AlF-NOTA-Octreotide PET/CT in Combination With 18F-FDG PET/CT for Imaging Neuroendocrine Neoplasms

Long, Tingting, MD, PhD*; Yang, Nengan, BS*; Zhou, Ming, MM*; Chen, Dengming, MD*; Li, Yulai, MD, PhD*; Li, Jian, MD, PhD*; Tang, Yongxiang, MD*; Liu, Zhaoqian, PhD; Li, Zibo, PhD; Hu, Shuo, MD, PhD

doi: 10.1097/RLU.0000000000002578
Original Articles
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Objectives The study is to evaluate biodistribution, dosimetry, safety, and clinical usefulness of 18F-AlF-NOTA-octreotide (18F-OC) PET/CT in combination with 18F-FDG PET/CT for detection of neuroendocrine neoplasms (NENs).

Methods The biodistribution, dosimetry, and safety of 18F-OC were evaluated in 3 healthy volunteers. Twenty-two NEN patients underwent PET/CT at 60 minutes after intravenous injection of 3.7 to 4.44 MBq (0.1–0.12 mCi) per kilogram of body weight of 18F-OC. This was followed by 18F-FDG PET/CT within a 2-week period.

Results 18F-OC was well tolerated by all healthy volunteers and NEN patients. The calculated effective dose of 18F-OC was 0.023 ± 0.002 mSv/MBq. In NEN patients, we observed prominent 18F-OC tumor uptake and high tumor-to-background ratios. Tumor uptake of 18F-OC was greater than that of 18F-FDG, and this was particularly evident in G2 NENs (median SUVmax, 45.6 vs 4.3; P < 0.015). Tumor uptake of 18F-OC or 18F-FDG was significantly correlated with tumor differentiation (P < 0.05). Dual tracer PET/CT detected more lesions and also yielded information on the biological status of tumors.

Conclusions The tracer 18F-OC exhibited favorable safety and dosimetry profiles. 18F-OC provided superior imaging of well-differentiated NENs and significantly higher tumor-to-background ratio compared with 18F-FDG. Combining 18F-FDG with 18F-OC PET/CT has the potential to improve NEN staging and management of patient treatment.

From the Departments of *PET Center and

Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China;

Department of Radiology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; and

§National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, China.

Received for publication December 13, 2018; revision accepted February 22, 2019.

T.L. and N.Y. are co–first authors and contributed equally to this work.

Conflicts of interest and sources of funding: This study was funded by grants 81771873 and 81471689 from the National Natural Science Foundation of China. None declared to all authors.

Correspondence to: Shuo Hu, MD, PhD, Department of PET Center, National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China. E-mail: hushuo2018@163.com.

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