NEUROENDOCRINE TUMORS: CHOOSING APPROPRIATE IMAGING METHODS
With an overall increased incidence in general population neuroendocrine tumors (NETs) are often late diagnosed. Symptoms are nonspecific and almost 50% of all patients have regional or distant metastases at the time of diagnosis. This article provides an overview of the current state of the imaging modalities used for primary tumor visualization, staging and follow-up. Detection of NETs and patient monitoring relies mainly on anatomical imaging such as computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US) under certain conditions. Molecular imaging techniques in combination with CT or MRI (hybrid imaging) greatly benefit patient management, including better localization of occult tumors and better staging. Octreoscan or somatostatin receptors (SSTRs) scintigraphic imaging in combination with CT represents the standard diagnostic of NETs in most countries. However, it is rapidly surpassed by SSTRs PET/CT with 68Ga-labelled somatostatin analogues with a superior spatial resolution and faster imaging (one-stop shop principle). Other more specific tracers are 18F-L-DOPA, 11C-L-DOPA and 11C-5-hydroxytryptophan, which have demonstrated excellent results in previously published studies. Diagnosis of patients with NETs is a complex process and, it is unlikely that any single diagnostic modality to be effective. Thus, NET diagnosis is a process utilizing a variety of methods including blood, urine and tumor tissue samples in combination with anatomical or hybrid imaging for localization, delineation and staging of the disease. Diagnostic approach to patients with NETs should focus on including hybrid imaging methods, which might play an important role in the future.
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