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  • Sundin, Anders, et al. (författare)
  • Therapeutic monitoring of gastroenteropancreatic neuroendocrine tumors : the challenges ahead
  • 2012
  • Ingår i: Neuroendocrinology. - 0028-3835 .- 1423-0194. ; 96:4, s. 261-271
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND:Gastroenteropancreatic neuroendocrine tumors (NETs), a heterogeneous family of tumors arising in a variety of anatomic sites, are generally well differentiated and often metastatic at diagnosis. Morphologic and functional imaging modalities have vastly improved the understanding and diagnosis of NETs. However, use of conventional imaging techniques and response criteria to assess treatment response is often complicated by the clinical course and cytostatic nature of oncologic treatments for NETs.MATERIALS AND METHODS:The means of therapeutic monitoring discussed in this review were based on a PubMed search of the medical literature and on the clinical expertise of the authors.RESULTS:Morphology-based criteria for assessing tumor response in general oncology are presented, along with their limitations for assessing response in gastrointestinal and pancreatic NETs. Functional imaging and preliminary response criteria incorporating functional imaging are presented as possible solutions to monitoring treatment response in NETs.CONCLUSIONS:Morphology-based criteria to assess tumor response have limitations for NETs, which are often slow growing and frequently demonstrate low response rates when based on conventional radiological criteria. Furthermore, many NET treatments do not induce cytotoxic effects despite demonstrated clinical benefit. Novel imaging techniques are available which have the potential to measure changes in tumor physiology and metabolism. These include (68)Ga-labelled somatostatin analogs for PET/CT-based monitoring of NET, molecular imaging with PET tracers that are not based on somatostatin receptor targeting, and functional MRI. These techniques should be explored as options for monitoring treatment in patients with NET.
  • Sundin, Anders, 1954-, et al. (författare)
  • ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors : Radiological, Nuclear Medicine & Hybrid Imaging.
  • 2017
  • Ingår i: Neuroendocrinology. - 0028-3835 .- 1423-0194. ; 105:3, s. 212-244
  • Tidskriftsartikel (refereegranskat)abstract
    • Contrast-enhanced computed tomography (CT) of the neckthorax-abdomen and pelvis, including 3-phase examination of the liver, constitutes the basic imaging for primary neuroendocrine tumor (NET) diagnosis, staging, surveillance, and therapy monitoring. CT characterization of lymph nodes is difficult because of inadequate size criteria (short axis diameter), and bone metastases are often missed. Contrast-enhanced magnetic resonance imaging (MRI) including diffusion-weighted imaging is preferred for the examination of the liver, pancreas, brain and bone. MRI may miss small lung metastases. MRI is less well suited than CT for the examination of extended body areas because of the longer examination procedure. Ultrasonography (US) frequently provides the initial diagnosis of liver metastases and contrast-enhanced US is excellent to characterize liver lesions that remain equivocal on CT/MRI. US is the method of choice to guide the biopsy needle for the histopathological NET diagnosis. US cannot visualize thoracic NET lesions for which CTguided biopsy therefore is used. Endocopic US is the most sensitive method to diagnose pancreatic NETs, and additionally allows for biopsy. Intraoperative US facilitates lesion detection in the pancreas and liver. Somatostatin receptor imaging should be a part of the tumor staging, preoperative imaging and restaging, for which 68 Ga-DOTA-somatostatin analog PET/CT is recommended, which is vastly superior to somatostatin receptor scintigraphy, and facilitates the diagnosis of most types of NET lesions, for example lymph node metastases, bone metastases, liver metastases, peritoneal lesions, and primary small intestinal NETs. (18)FDG-PET/CT is better suited for G3 and high G2 NETs, which generally have higher glucose metabolism and less somatostatin receptor expression than low-grade NETs, and additionally provides prognostic information.
  • Sundin, Anders, et al. (författare)
  • Radiological Imaging : Computed Tomography, Magnetic Resonance Imaging and Ultrasonography.
  • 2015
  • Ingår i: Neuroendocrine Tumors. - : Krager. - 9783318027730 ; , s. 58-72
  • Bokkapitel (refereegranskat)abstract
    • Neuroendocrine tumor (NET) imaging is generally performed by a combination of radiological and functional methods. Conventional radiological imaging of morphology (anatomy) is usually performed by computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound, whereas functional imaging of somatostatin receptor expression generally utilizes scintigraphy, but recently also positron emission tomography (PET). Because of the large variations in tumor characteristics (for example primary location, presence or absence of hormonal production, proliferation and metastatic spread) and disease presentation, the imaging requirements in different patients are very diverse. Imaging also needs to be adapted according to the imaging application in the individual patient (tumor localization, staging, detection of recurrent disease, monitoring of therapy). Familiarity with the contrast-enhancement technique for CT and MRI is important in the interpretation and understanding of the radiological findings. The choice of the optimal imaging techniques also needs to be considered in the light of the department's local availability and expertise. In this review, methodological aspects of radiological imaging are described, imaging requirements for various types of NETs are discussed, and typical image findings are illustrated.
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