University of Groningen

Tracer development for detection and characterization of neuroendocrine tumors with PETNeels, Olivier Christiaan

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Publication date:2008

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Citation for published version (APA):Neels, O. C. (2008). Tracer development for detection and characterization of neuroendocrine tumors withPET s.n.

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Appendix

Chapter 1. Figure 1. Metastasized carcinoid. 18F-DOPA PET scan (A), Octreotide scan (B) and 18F-DOPA PET-CT fusion image (C) of a female patient presenting with a metastasized carcinoid. This patient illustrates the intra-individual heterogeneity in the uptake of different tracers by tumor metastases.

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Chapter 1. Figure 2. Metabolic pathways. In this figure the different metabolic pathways by which neuroendocrine tumors can be visualized using nuclear medicine imaging techniques are schematically depicted. Three major routes can be identified: receptor based techniques, techniques which use the metabolic properties of these tumors and labeled antibody based techniques

11C-5-HTP Serotonin

Catecholamine pathway

Glucose metabolism

Nucleus

L-3-[123I]-iodo-alpha-methyltyrosine (IMT)

IMT

Lysosome Phosphate metabolism

Passive diffusion Active transport Internalisation of receptor- ligand complex LAT 1 – 4F2HC complex transporter (family of LAT) Noradrenalin transporter NaPi co-transporter Glucose transporter VMAT transporter, located on secretory vesicle Somatostatin receptor with (labelled) ligand Bombesin receptor with (labelled ligand) CCK receptor with (labelled) ligand VIP receptor with (labelled) ligand Antigen with (labelled) antibody

99m

18F-DOPA

Tc-V-DMSA

Secretory vesicle

18F-Dopamine 18FDG MIBG

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Chapter 3. Figure 6. A - [11C]HTP PET after IV injection, coronal view. Left: control 22.6 g, 9.9 MBq, tumor weight 23.5 mg. Right: carbidopa treated 21.6 g, 6.2 MBq, tumor weight 61.1 mg. B - [18F]FDOPA PET after IV injection, coronal view. Left: control 20.5 g, 8.4 MBq, tumor weight 109 mg. Right: carbidopa treated 23.6 g, 8.4 MBq, tumor weight 57.9 mg. Summed frames. Hot spots in abdominal region were cleaned up using ASIPro’s clipping tool. Arrows point at tumors located in the right shoulder.

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Chapter 4. Figure 2. Imaging of a patient with carcinoid disease and metastases in the bone, mediastinum, liver, and abdomen. (A) 18F-DOPA PET imaging. Red arrows indicate areas with physiological 18F-DOPA uptake (striatum, kidneys, ureter, bladder), whereas all other black spots are tumour lesions. (B) Planar SRS imaging. Arrows indicate mediastinal tumour lesions. (C) CT–PET fusion imaging. Coloured areas indicate tumour lesions. In this patient, both planar and SPECT SRS missed most lesions found with 18F-DOPA PET imaging. Abdominal and femoral lesions were not recorded on CT.

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Chapter 5. Figure 2. Fused 18F-DOPA – PET CT scan (A), SRS (B), 18F-DOPA PET (C) and 11C-5-HTP PET (D) of a 80 year old male patient with metastatic carcinoid tumor. The CT scan shows a mesenterial mass and two smaller lesions in the upper mediastinum. On SRS (both planar and SPECT, not shown here) only the larger mediastinal mass, the large mesenterial mass and a small lesion on the left cranial side of the urinary bladder could be found. Both 18F-DOPA PET and 11C-5-HTP PET showed a number of smaller lesions in the upper mediastinum and upper lobes of both right and left lung, with 18F-DOPA yielding the best contrast. Note that the small lung lesions show less 11C-5-HTP uptake than 18F -DOPA uptake.

A DB C

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A B C D Chapter 5. Figure 3. CT scan (A), SRS (B), 18F-DOPA PET (C) and 11C-5-HTP PET (D) of a 54 year old male patient with metastatic islet cell tumor. The CT scan shows a large mass in the pancreatic head region (arrow), SRS shows equivocal (arrow) and 18F-DOPA PET shows low uptake in the pancreatic region and minor uptake in the upper chest and in two thoracic vertebrae. 11C-5-HTP PET, however, shows numerous bone, liver and abdominal lesions, including the pancreatic region with much higher contrast.