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Background <p>[<sup>68</sup>Ga]Ga-DOTATATE PET/CT has been widely used in the diagnosis and staging of gastroenteropancreatic neuroendocrine tumors (GEP-NETs), while PET/MR may have greater advantages in the diagnosis of hepatic lesions. This study aimed to compare the diagnostic performance of conventional [<sup>68</sup>Ga]Ga-DOTATATE PET/CT and delayed PET/MR in detecting hepatic metastases in patients with GEP-NETs.</p> Methods <p>This prospective observational study enrolled GEP-NETs patients with liver metastases who underwent conventional [⁶⁸Ga]Ga-DOTATATE PET/CT followed by delayed PET/MR of the upper abdomen on the same day. The final status of all identified lesions was defined by a composite reference standard integrating histopathology, clinical follow-up, and contrast-enhanced MRI findings. Lesion detection rates, maximum standardized uptake value (SUVmax), target-to-background ratio (TBR), sensitivity, specificity, and accuracy were compared between the two modalities.</p> Results <p>46 patients (mean age 56.4 ± 12.9 years, 18 males and 28 females) were included. A total of 542 liver metastases were identified, with PET/CT detecting 368 (67.9%) lesions and delayed PET/MR contributing an additional 146 (94.8%) lesions. For matched lesions, SUVmax and TBR values showed no statistically significant differences between PET/CT and delayed PET/MR imaging (17.2 ± 11.0 vs. 16.4 ± 10.8, <i>P</i> = 0.746; 4.1 ± 3.6 vs. 4.0 ± 2.8, <i>P</i> = 0.178, respectively). For additional lesions detected on delayed PET/MR, 54 high-uptake liver metastases were identified (mean diameter 4.7 ± 1.9&#xa0;mm; SUVmax 9.1 ± 2.2), along with 92 non-uptake lesions (mean diameter 5.5 ± 2.3&#xa0;mm; Z = − 2.149, <i>P</i> = 0.0315). The sensitivity, specificity and accuracy between conventional PET/CT and delayed PET/MR were (65.9% vs. 92.4%, <i>P</i> &lt; 0.001), (59.3% vs. 51.9%, <i>P</i> = 0.77) and (65.6% vs.90.5%, <i>P</i> &lt; 0.001), respectively.</p> Conclusion <p>Delayed [<sup>68</sup>Ga]Ga-DOTATATE PET/MR with an optimized acquisition protocol improved liver metastasis detection in GEP-NETs compared with conventional PET/CT. Combining PET/CT with delayed PET/MR provides a complementary strategy for hepatic staging in selected clinical settings.</p>

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Incremental value of delayed [68Ga]Ga-DOTATATE PET/MR in the detection of liver metastases from gastroenteropancreatic neuroendocrine tumors

  • 期刊论文

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  • 发表日期：

    2026年7月31日

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  • Zefang Lin,
  • Sen Ma,
  • Shaoming Chen,
  • Jiaying Zhang,
  • Zenan Wu,
  • Weibing Miao

摘要

Background

[68Ga]Ga-DOTATATE PET/CT has been widely used in the diagnosis and staging of gastroenteropancreatic neuroendocrine tumors (GEP-NETs), while PET/MR may have greater advantages in the diagnosis of hepatic lesions. This study aimed to compare the diagnostic performance of conventional [68Ga]Ga-DOTATATE PET/CT and delayed PET/MR in detecting hepatic metastases in patients with GEP-NETs.

Methods

This prospective observational study enrolled GEP-NETs patients with liver metastases who underwent conventional [⁶⁸Ga]Ga-DOTATATE PET/CT followed by delayed PET/MR of the upper abdomen on the same day. The final status of all identified lesions was defined by a composite reference standard integrating histopathology, clinical follow-up, and contrast-enhanced MRI findings. Lesion detection rates, maximum standardized uptake value (SUVmax), target-to-background ratio (TBR), sensitivity, specificity, and accuracy were compared between the two modalities.

Results

46 patients (mean age 56.4 ± 12.9 years, 18 males and 28 females) were included. A total of 542 liver metastases were identified, with PET/CT detecting 368 (67.9%) lesions and delayed PET/MR contributing an additional 146 (94.8%) lesions. For matched lesions, SUVmax and TBR values showed no statistically significant differences between PET/CT and delayed PET/MR imaging (17.2 ± 11.0 vs. 16.4 ± 10.8, P = 0.746; 4.1 ± 3.6 vs. 4.0 ± 2.8, P = 0.178, respectively). For additional lesions detected on delayed PET/MR, 54 high-uptake liver metastases were identified (mean diameter 4.7 ± 1.9 mm; SUVmax 9.1 ± 2.2), along with 92 non-uptake lesions (mean diameter 5.5 ± 2.3 mm; Z = − 2.149, P = 0.0315). The sensitivity, specificity and accuracy between conventional PET/CT and delayed PET/MR were (65.9% vs. 92.4%, P < 0.001), (59.3% vs. 51.9%, P = 0.77) and (65.6% vs.90.5%, P < 0.001), respectively.

Conclusion

Delayed [68Ga]Ga-DOTATATE PET/MR with an optimized acquisition protocol improved liver metastasis detection in GEP-NETs compared with conventional PET/CT. Combining PET/CT with delayed PET/MR provides a complementary strategy for hepatic staging in selected clinical settings.