ACR Practice Parameter for the Performance of Gallium-68 DOTATATE PET/CT for Neuroendocrine Tumors

Radiopharmaceuticals targeting cell surface expression of somatostatin receptors (SSTRs) are particularly useful in the evaluation of neuroendocrine tumors. Gallium-68 DOTA-Tyr³-octreotatate (⁶⁸Ga-DOTATATE) primarily binds to SSTR type 2 receptors. ⁶⁸Ga DOTATATE PET/CT is proven to have high impact on the management of neuroendocrine patients compared to traditional anatomical imaging as well as provides additional information over that of conventional nuclear medicine studies (indium-III DTPA-octreotide). It can result in change in management of approximately 75% of patients with neuroendocrine tumors. ⁶⁸Ga DOTATATE and ¹⁸F FDG PET/CT imaging are complementary, with the degree of uptake varying depending on the degree of differentiation of the tumor. Well-differentiated tumors maintain their SSTRs and are positive on ⁶⁸Ga DOTATATE PET/CT scan, while dedifferentiated tumors are less likely to demonstrate uptake of ⁶⁸Ga DOTATATE but will demonstrate uptake with ¹⁸F FDG PET/CT. In addition, ⁶⁸Ga DOTATATE PET/CT identifies patients with SSTR expression in their tumors, who have progressed on somatostatin analog therapy, for treatment with ¹⁷⁷Lu DOTATATE.