cell surface receptors or uptake of molecules. Other radiopharmaceuticals are also used, based on certain physiological characteristics e.g. NETs can differentiate into tumors that do not express somatostatin receptors, becoming "imaging-occult" making recurrence or metastases more challenging to detect ![]() SPECT, PET-CT or PET-MRI 6Ĭan be used to predict response to nuclear medicine based therapies, and in some cases, to assess response to treatmentĬare should be taken with interpretation of images as drugs can interfere with somatostatin receptor expression, e.g. ![]() Multiple tumor sites and/or metastasis can be identified using a gamma-camera to detect the emitted radiationĬan be used in combination with cross-sectional imaging modalities to aid staging e.g. Nuclear medicineĬommon radiopharmaceutical is 111In-pentetreotide, which is a ligand for the somatostatin receptor on the cell membrane of many NETs 4,5 Used for suspected hepatic, pancreatic or retroperitoneal NETs, often with gadolinium contrast agents. Used for suspected gastric, enteric and pancreatic NETs pre and post IV iodinated contrast, ideally including arterial and portal venous phasesīowel distension with fluid, either by oral intake ( CT enterography) or via a nasojejunal tube ( CT enteroclysis) improves detection of primary GI NETs Ultrasound can also be used to guide biopsiesĮndoscopic/endoluminal US can be used to identify and characterize GI NETs as well as obtaining samples for cytology and/or histology Used for monitoring slow growing tumors and/or follow up of metastases Combined modalities and techniques are often used 1-3: Ultrasound There is no consensus on the best single imaging modality for NETs and it depends on the suspected location and local expertise. ![]() Vasoactive polypeptide secreting tumor (VIPoma): Non-functioning tumors and pancreatic polypeptide secreting tumors: Types of gastrointestinal-pancreatic neuroendocrine tumors:įound in pancreas, lymph nodes and duodenum
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