Abstract
The objective of this study was to evaluate the diagnostic efficacy of Pixon-based reconstruction method on planar somatostatin receptor scintigraphy (SRS). All patients with neuroendocrine tumors (NETs) disease who were referred for SRS to our department during 1-year period from January to December 2015 were consecutively included. Three nuclear physicians independently reviewed all the data sets of images which included conventional images (CI; 15 min/view) and processed images (PI) obtained by reconstructing the first 450 s extracted data using Oncoflash® software package. Image analysis using a 3-point rating scale for abnormal uptake of 111 Indium-DTPA-Phe-octreotide in any lesion or organ was interpreted as positive, uncertain, or negative for the evidence of NET disease. A maximum grade uptake of the radiotracer in the lesion was assessed by the Krenning scale method. The results of image interpretation by the two methods were considered significantly discordant when the difference in organ involvement assessment was negative vs. positive or in lesion uptake was ≥2 grades. Agreement between the results of two methods and by different scan observers was evaluated using Cohen κ coefficients. There was no significant (p = 0.403) correlation between data acquisition protocol and quality image. The rates of significant discrepancies for exam interpretation and organs involvement assessment were 2.8 and 2.6%, respectively. Mean κ values revealed a good agreement for concordance between CI and PI interpretation without difference of agreement for inter/intra-observer analysis. Our results suggest the feasibility to use a Pixon-based reconstruction method for SRS planar images allowing a twofold reduction of acquisition time and without significant alteration of image quality or on image interpretation.
Highlights
Neuroendocrine tumors (NETs) are a group of tumors of common definitions and characteristics originating in tissues that contain cells derived from the embryonic neural crest and representing nearly 1% of all neoplasia [1]
Functional imaging plays a major role in the characterization of NETs including staging, therapeutic management, and recurrence diagnosis and treatment decision for peptide receptor radionuclide therapy (PRRT) that depends on the histological differentiation [7,8,9,10]
The Pixon method is an adaptative image processing, initially used for astronomical observations [17, 18] and allowing a smoothing spatially correlated to signal variations without loss of resolution [19]. This method has initially been studied for reconstruction of different scintigraphy planar images, especially in 99mTc-methylene diphosphonate, 67Ga-citrate, 123I-metaiodobenzylguanidine (123I-MIBG), and 99mTcdimercaptosuccinic-acid functional imaging [20, 21]; the method showed a significant increase in the signal-to-noise ratio (SNR) suggesting a reduction in image acquisition time and in the administered radioactivity of the radio-pharmaceuticals
Summary
Neuroendocrine tumors (NETs) are a group of tumors of common definitions and characteristics originating in tissues that contain cells derived from the embryonic neural crest and representing nearly 1% of all neoplasia [1]. NETs can arise in many locations (mainly in gastrointestinal system) and often secrete various hormones, which are responsible for different clinical manifestations in 20–30% of cases, classified as functional tumors. Somatostatin receptor scintigraphy (SRS) with 111In-Pentetreotide is recommended for WD-NETs because this radioactive tracer derives from a somatostatin analog that binds preferentially its subtype 2 and 5 receptors, usually expressed on the tumor cell surface of G1–G2 forms. Diagnostic performances of SRS are excellent [11] for WD-NETs: a review conducted on 35 centers and including approximately 1,200 patients showed a median sensitivity of 84% to detect tumors [12]
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