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Purpose <p>To evaluate the diagnostic performance of <sup>68</sup>Ga-DOTATATE PET, contrast-enhanced CT, combined DOTATATE PET/CT, and MRI in detecting neuroendocrine liver metastases on a per-lesion basis and to assess the added value of diagnostic contrast-enhanced CT to PET interpretation as well as influence of lesion size.</p> Materials and methods <p>This retrospective study evaluated patients with histologically-confirmed gastroenteropancreatic neuroendocrine tumors who underwent both contrast-enhanced MRI and <sup>68</sup>Ga-DOTATATE PET/CT within 12&#xa0;weeks between August 2017 and December 2023. Three readers evaluated in consensus MRI, <sup>68</sup>Ga-DOTATATE PET, contrast-enhanced CT, and combined PET/CT in separate sessions. Lesions were stratified by size. Diagnostic performance metrics were calculated using generalized estimating equations with reference standard of imaging follow-up or histopathology.</p> Results <p>The study included 36 patients (mean age 66.4 ± 10.7&#xa0;years, 55.6% male) with 720 lesions, of which 582 were metastases. MRI demonstrated superior performance (sensitivity 94.0%, specificity 94.2%) compared to all other modalities (all <i>p</i> &lt; .001). Combined PET/CT showed superior sensitivity (68.1%) compared to PET alone (61.1%) (<i>p</i> &lt; .001). The addition of diagnostic contrast-enhanced CT to PET interpretation identified 41 additional metastases. Size-stratified analysis revealed superior detection of subcentimeter lesions by MRI (sensitivity 83.3% for ≤ 5&#xa0;mm, 99.6% for 6–10&#xa0;mm) compared to PET/CT (34.8% and 78.6%, respectively; <i>p</i> &lt; .001). For lesions &gt; 10&#xa0;mm, both MRI and PET/CT achieved 100% sensitivity, while PET alone reached 94.1% (<i>p</i> = .019).</p> Conclusion <p>MRI outperforms <sup>68</sup>Ga-DOTATATE PET/CT in detecting individual neuroendocrine liver metastases, particularly for subcentimeter lesions. While diagnostic CT improves PET performance, the combination of MRI with <sup>68</sup>Ga-DOTATATE PET/CT provides the most comprehensive assessment.</p>

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68Ga-DOTATATE PET/CT versus MRI in neuroendocrine liver metastases: a comprehensive per-lesion analysis

  • 期刊论文

  • 发表日期：

    2025年9月11日

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  • Alexander Herold,
  • Azadeh Hajati,
  • Yihan Cao,
  • Kevin P. Fialkowski,
  • Soumyadeep Ghosh,
  • Francis Delaney,
  • Vrushab Gowda,
  • Pedram Heidari,
  • Shadi A. Esfahani,
  • Mukesh G. Harisinghani,
  • Luigi Asmundo,
  • Lucian Beer,
  • Valeria Peña-Trujillo,
  • Samantha G. Harrington,
  • Steven Stufflebeam,
  • Bruce R. Rosen,
  • Michael Weber,
  • Susie Y. Huang,
  • Onofrio A. Catalano

摘要

Purpose

To evaluate the diagnostic performance of 68Ga-DOTATATE PET, contrast-enhanced CT, combined DOTATATE PET/CT, and MRI in detecting neuroendocrine liver metastases on a per-lesion basis and to assess the added value of diagnostic contrast-enhanced CT to PET interpretation as well as influence of lesion size.

Materials and methods

This retrospective study evaluated patients with histologically-confirmed gastroenteropancreatic neuroendocrine tumors who underwent both contrast-enhanced MRI and 68Ga-DOTATATE PET/CT within 12 weeks between August 2017 and December 2023. Three readers evaluated in consensus MRI, 68Ga-DOTATATE PET, contrast-enhanced CT, and combined PET/CT in separate sessions. Lesions were stratified by size. Diagnostic performance metrics were calculated using generalized estimating equations with reference standard of imaging follow-up or histopathology.

Results

The study included 36 patients (mean age 66.4 ± 10.7 years, 55.6% male) with 720 lesions, of which 582 were metastases. MRI demonstrated superior performance (sensitivity 94.0%, specificity 94.2%) compared to all other modalities (all p < .001). Combined PET/CT showed superior sensitivity (68.1%) compared to PET alone (61.1%) (p < .001). The addition of diagnostic contrast-enhanced CT to PET interpretation identified 41 additional metastases. Size-stratified analysis revealed superior detection of subcentimeter lesions by MRI (sensitivity 83.3% for ≤ 5 mm, 99.6% for 6–10 mm) compared to PET/CT (34.8% and 78.6%, respectively; p < .001). For lesions > 10 mm, both MRI and PET/CT achieved 100% sensitivity, while PET alone reached 94.1% (p = .019).

Conclusion

MRI outperforms 68Ga-DOTATATE PET/CT in detecting individual neuroendocrine liver metastases, particularly for subcentimeter lesions. While diagnostic CT improves PET performance, the combination of MRI with 68Ga-DOTATATE PET/CT provides the most comprehensive assessment.