Role of combined [68Ga]Ga-DOTA-SST analogues and [18F]FDG PET/CT in the management of GEP-NENs. a systematic review

Gastro-entero-pancreatic neuroendocrine neoplasia (GEP-NENs) are rare tumors, but their frequency is increasing. Neuroendocrine tumors normally express somatostatin (SST) receptors (SSTR) on cell surface, especially G1 and G2 stage tumors, but they can show a dedifferentiation in their clinical history as they become more aggressive. Somatostatin receptor imaging has previously been performed with a gamma camera using [In-111]In or [Tc-99m]Tc-labelled compounds, while [Ga-68]Ga-labelled compounds and PET/CT imaging has recently become the gold standard for the diagnosis and management of these tumors. Moreover, in the last few years F-18-fluorodeoxyglucose ([F-18]FDG) PET/CT has emerged as an important tool to define tumor aggressiveness and give relevant prognostic information, particularly when coupled with [Ga-68]Ga-labelled SST analogues PET/CT. This review focuses on the importance of combined imaging with [Ga-68]Ga-labelled SST analogues and [F-18]FDG for the management of GEP-NENs.