Multiple endocrine neoplasia type 1 other imaging findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Overview

Other imaging studies for multiple endocrine neoplasia type 1 include fluoro-di-glucose-PET/CT, venous sampling, angiography and endovascular procedures, such as trans-arterial chemo-embolization (TACE).

Nuclear Medicine

• Common radiopharmaceutical agent is 111-indium-pentetreotide, which is a ligand for somatostatin receptor on the cell membrane of many neuroendocrine tumors. Multiple tumor sites and metastasis can be identified using a gamma-camera which detect the emitted radiation.
• Can be used in combination with cross-sectional imaging modalities to aid staging e.g. SPECT or PET-CT or PET-MRI
• Can be used to predict response to nuclear medicine based therapies, and, in some cases, to assess response to treatment
• Care should be taken with interpretation of images as drugs can interfere with somatostain receptor expression, e.g. interferon.
• Neuroendocrine tumors can differentiate into tumors that do not express somatostatin receptors can become ‘image negative’ making reoccurrence or metastases more challenging to detect. Other radiopharmaceuticals are also used, based on certain physiological characteristics e.g. cell surface receptors or uptake of molecules.
• Gallium-68 labelled somatostatin analogues (PET/CT) is thought to be more sensitive in detecting neuroendocrine tumors except pulmonary and hepatic metastases. For aggressive, rapidly growing tumors (i.e. high metabolism) fluoro-di-glucose-PET/CT can be used (FDG-PET)
• F18 DOPA and C11 Hydroxytryptophan may be used in future but are not routinely available.

Invasive Imaging Techniques

• Venous sampling can be used in small functional neuroendocrine tumors where cross sec-tional imaging is equivocal.
• Multiple endocrine neoplasia type 1 can present with multiple lesions. Functional neuroendocrine tumors can be identified from these, using calcium stimulation with venous sampling.
• Angiography and endovascular procedures, such as trans-arterial chemo-embolization (TACE), can be used to treat hepatic metastases.