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array:23 [ "pii" => "S2253808918301071" "issn" => "22538089" "doi" => "10.1016/j.remnie.2018.10.015" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1030" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Med Nucl Imagen Mol. 2020;39:31-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "PDF" => 2 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S2253654X18301616" "issn" => "2253654X" "doi" => "10.1016/j.remn.2018.10.002" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1030" "copyright" => "Sociedad Española de Medicina Nuclear e Imagen Molecular" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Med Nucl Imagen Mol. 2020;39:31-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 20 "formatos" => array:2 [ "HTML" => 8 "PDF" => 12 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Nota clínica</span>" "titulo" => "¿Es posible la rediferenciación de NET tras la quimioterapia? 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"crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2020;39:35-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting images</span>" "titulo" => "FDG PET/CT vs. NaF PET/CT in relapsing polychondritis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "35" "paginaFinal" => "36" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FDG PET/TC vs. NaF PET/TC en policondritis recidivante" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1360 "Ancho" => 2500 "Tamanyo" => 206104 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The maximum intensity projection images (A and B) of <span class="elsevierStyleSup">18</span>F-NaF, PET (C, F and I) axial CT (D, G and J) and fused images (E, H and K) revealed relapsing polychondritis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Yanggang Liu, Yuxiao Xia, Yue Chen, Liang Cai" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Yanggang" "apellidos" => "Liu" ] 1 => array:2 [ "nombre" => "Yuxiao" "apellidos" => "Xia" ] 2 => array:2 [ "nombre" => "Yue" "apellidos" => "Chen" ] 3 => array:2 [ "nombre" => "Liang" "apellidos" => "Cai" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X19300824" "doi" => "10.1016/j.remn.2019.05.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false 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"idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical note</span>" "titulo" => "False positive in <span class="elsevierStyleSup">18</span>F-fluorodeoxyglucose-<span class="elsevierStyleSup">18</span>F positron emission tomography computed tomography scan of inferior vena cava leiomyoma in patient with a suspected paraganglioma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "27" "paginaFinal" => "30" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Falso positivo en estudio de tomografía de emisión de positrones con <span class="elsevierStyleSup">18</span>F-fluorodeoxiglucosa de un leiomioma de vena cava inferior en paciente con sospecha de paraganglioma" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1207 "Ancho" => 1755 "Tamanyo" => 196579 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">PET/CT image in MIP view (A) and transverses PET (B), CT (C) and PET/CT (D) slices that show an increased metabolic activity in anterior aspect of inferior vena cava, in relation to nodular lesion.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Antonio Daniel González Jiménez, Antonio Rodríguez Fernández, Rocío Sánchez Sánchez, Fernando Jaén Águila, Juan Diego Mediavilla García, José Manuel Llamas Elvira" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Antonio Daniel" "apellidos" => "González Jiménez" ] 1 => array:2 [ "nombre" => "Antonio" "apellidos" => "Rodríguez Fernández" ] 2 => array:2 [ "nombre" => "Rocío" "apellidos" => "Sánchez Sánchez" ] 3 => array:2 [ "nombre" => "Fernando" "apellidos" => "Jaén Águila" ] 4 => array:2 [ "nombre" => "Juan Diego" "apellidos" => "Mediavilla García" ] 5 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Llamas Elvira" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X19300666" "doi" => "10.1016/j.remn.2019.06.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X19300666?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808919300886?idApp=UINPBA00004N" "url" => "/22538089/0000003900000001/v1_202001150636/S2253808919300886/v1_202001150636/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical report</span>" "titulo" => "Is it possible NET-redifferentiation after chemotherapy? Ga68 DOTA-peptide imaging as a game-changer in therapy management" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "31" "paginaFinal" => "34" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Nurhan Ergül, Tevfik Fikret Çermik, Nevra Dursun" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Nurhan" "apellidos" => "Ergül" "email" => array:1 [ 0 => "nurhanergul@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Tevfik Fikret" "apellidos" => "Çermik" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Nevra" "apellidos" => "Dursun" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Clinic of Nuclear Medicine, Istanbul Training and Research Hospital, Kasap İlyas Mah. Org. Abdurrahman Nafiz Gürman Cd., 34098 Fatih, Istanbul, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "University of Health Sciences, Clinic of Nuclear Medicine, Istanbul Training and Research Hospital, Kasap İlyas Mah. Org. Abdurrahman Nafiz Gürman Cd., 34098 Fatih, Istanbul, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Clinic of Pathology, Istanbul Training and Research Hospital, Kasap İlyas Mah. Org. Abdurrahman Nafiz Gürman Cd., 34098 Fatih, Istanbul, Turkey" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Es posible la rediferenciación de NET tras la quimioterapia? Captación de imágenes de DOTA-Péptidos marcados con Ga68 como cambio de estrategia en el tratamiento terapéutico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2014 "Ancho" => 2083 "Tamanyo" => 407510 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Ga-68 DOTANOC PET/CT scan before and after 3 cycles of chemotherapy; decrease in lesion size and increase of uptake in primary lesion (A–F) and liver metastases (G–L).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 64-year-old man was presented with abdominal pain and weight loss. The abdominal CT scan revealed a mass lesion in pancreatic body and tail, multiple peripancreatic lymph nodes and multiple space-occupying lesions in liver. Tru-cut biopsies from pancreas and liver showed G3 NEC. The Ga-68 DOTANOC PET/CT scan for staging showed the lesion in the pancreas approximately 69<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>mm with intense somatostatin receptor (SSTR) activity (SUVmax<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>58.1) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A–C), multiple peripancreatic lymph nodes and gross metastatic lesions in both hepatic lobes reaching approximately 77<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>108<span class="elsevierStyleHsp" style=""></span>mm (SUVmax<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>40.9) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>G–I). The patient received 3 cycles of chemotherapy containing cisplatin and etoposide. A follow-up Ga-68 DOTANOC PET/CT showed shrinkage in the pancreatic lesion to approximately 60<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>62<span class="elsevierStyleHsp" style=""></span>mm and increased uptake (SUVmax<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>72.9) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D–F). The hepatic lesions were also shrunk to 58<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>73<span class="elsevierStyleHsp" style=""></span>mm and the uptake was enhanced (SUVmax<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>49.7) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>J–L). The first biopsy from liver (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) showed NEC with high cellularity and synaptophysin positivity (inset A) with ki67 proliferation index of 35% (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A and B). A new tru-cut biopsy from liver after chemotherapy showed NEC with low cellularity and synaptophysin positivity (inset C) with ki67 index less than 1% (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C and D). The patient received three more cycles of chemotherapy after this finding. At the end of the therapy another Ga-68 DOTANOC PET/CT was performed and similar findings were observed as the interim PET/CT except some more necrotic areas inside the lesions. The patient was referred to peptide receptor-targeted radionuclide therapy with 177Lu-DOTANOC. After two cures of 200<span class="elsevierStyleHsp" style=""></span>mci 177Lu-DOTANOC a significant decrease in SSTR activity and necrosis inside the primary and metastatic lesions (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) was observed revealing the response to therapy. The hematological findings of the patient did not allow us to continue the radionuclide therapy and the patient died 1 year later. (The SUV was calculated using the following formula: SUV<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>Tissue concentration (Bq/g)/[Injected dose (Bq)/Body weight (g)).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Neuroendocrine gastroenteropancreatic tumors (GEP-NETs) originate from neuroendocrine cells of the embryological gut dividing into NET grade (G)1, NET G2 and poorly differentiated neuroendocrine carcinoma (NEC) G3 according to Ki-67 proliferation index.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> In therapy management surgery in resectable disease, somatostatin analogs, peptide receptor-targeted radionuclide therapy (PRRT), chemotherapy, targeted molecular therapies for advanced/metastatic disease and locoregional ablative therapies for liver metastasis can be considered.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> For preoperative staging somatostatin receptor (SSTR) imaging with Ga-68 DOTA-NOC/-TOC/-TATE PET/CT should take place, which has been reported to affect the management of disease in 60% of patients.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3</span></a> SSTR expression can be quantified by the SUV measurement of the tumoral tissue and may be used to predict the prognosis of the disease by showing that a higher SUVmax is associated with a better outcome.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> Dual isotope PET/CT imaging with radiolabelled somatostatin analogs and F-18 FDG may be useful for showing the different tumor characteristics in especially metastatic disease and to overcome the limitation of biopsy from only a single site.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">During the course of the disease dedifferentiation is a well-known phenomenon, which means a change in the aggressiveness of the tumor from less aggressive to more aggressive with a rise in Ki-67 index, decreased uptake on the SSTR functional imaging and increased uptake on F18 FDG imaging.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,7</span></a> Recently Basu et al. reported three patients with grade II NET, whom, after therapy with either everolimus or chemotherapy containing capecitabine and temozolamide showed an increase of Ga-68 DOTATATE uptake in the follow-up scan without anatomical disease progression. They asserted that, this finding may represent a redifferentiation process in the tumor showing enhanced tracer uptake signifying the SSTR expression and can raise the possibility of PRRT in the later course of the disease.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> In our case we observed a similar finding in primary and metastatic lesions in liver; decrease in lesion size with an enhanced SSTR activity.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Although this finding which combines with a proof of decrease in Ki-67 index in hepatic biopsy specimen reminds a possible redifferentiation process after chemotherapy, a well-known issue, tumor heterogeneity makes difficult to acknowledge this hypothesis. Couvelard et al. assessed the heterogeneity of Ki-67 proliferation index, microvascular density and SSTR 2, inside single or between synchronous or metachronous liver metastases of pancreatic endocrine tumors. They reported that there is no more variation in the index of proliferation between synchronous metastases than inside single metastasis allowing to confine the sampling to only one metastatic site and expression of SSTR 2 is homogeneous and may help to predict the response to various somatostatin receptor analogs.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> However in another study it was reported that intratumoral heterogeneity of Ki-67 index is more prominent in larger and higher-grade tumors and multiple liver biopsies from the largest tumor may be needed to predict the course of the disease.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Serial imaging with either anatomical or functional imaging methods may play a more reliable role in follow-up of the disease considering the variability of histopathological evaluation of the proliferation index. We suggest that chemotherapy might have leaded to clonal selection in tumoral lesions in our patient; aggressive component of the tumor responded well to chemotherapy whereas well-differentiated component did not. After chemotherapy the SSTR expression became more avid in all lesions leading us to the option of therapy with PRRT. A significant response was observed in Ga-68 DOTANOC PET/CT after two cures of PRRT defining the good differentiation of the tumoral lesions. Although PRRT is recommended in G1 and G2 NET rather than G3 tumors as a general rule, if high uptake is observed in Ga-68 SSTR imaging after or during conventional therapy, it may be considered as a beneficial therapy option.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">No funding was received for this study.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical information</span><p id="par0035" class="elsevierStylePara elsevierViewall">All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Informed consent was obtained from all individual participants included in the study.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1287027" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1189387" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1287028" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1189388" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 7 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding" ] 8 => array:2 [ "identificador" => "sec0020" "titulo" => "Ethical information" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-07-16" "fechaAceptado" => "2018-10-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1189387" "palabras" => array:4 [ 0 => "Neuroendocrine tumors" 1 => "Peptide receptor radionuclide therapy" 2 => "Ga-68 PET/CT" 3 => "Redifferentiation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1189388" "palabras" => array:4 [ 0 => "Tumores neuroendocrinos" 1 => "Terapia radionucleídica de receptores peptídicos" 2 => "PET/TC con Ga-68" 3 => "Rediferenciación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 64-year-old man with pancreatic grade III neuroendocrine carcinoma underwent Ga-68 DOTANOC PET-CT scan for staging. The pancreatic lesion, multiple peripancreatic lymph nodes and multiple gross metastases in both hepatic lobes were revealed with intense uptake. After 3 cycles of chemotherapy containing cisplatin and etoposide the primary and metastatic lesions were decreased in size, however showing higher uptake on follow-up Ga-68 DOTANOC PET-CT scan. Another biopsy from liver demonstrated a significant decrease in Ki-67 proliferation index from 35% to 1%. The patient received 2 cycles of peptide receptor-targeted radionuclide therapy with Lu-177 DOTANOC.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se realizó una PET-TC DOTANOC con Ga-68 a un varón de 64 años con tumor neuroendocrino de grado III, para estadificación. La lesión pancreática, múltiples ganglios peripancreáticos, y diversas metástasis de gran tamaño en ambos lóbulos hepáticos se mostraron con captación intensa. Tras tres ciclos de quimioterapia con cisplatino y etopósido, el tumor primario y las metástasis disminuyeron de tamaño, aunque se reveló una mayor captación en la PET-TC DOTANOC con Ga-68 de seguimiento. Otra biopsia hepática reflejó un descenso significativo del índice de proliferación de Ki-67, del 35 al 1%. El paciente recibió dos ciclos de terapia con radionúclidos de receptores peptídicos con Lu-177 DOTANOC.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ergül N, Çermik TF, Dursun N. ¿Es posible la rediferenciación de NET tras la quimioterapia? Captación de imágenes de DOTA-Péptidos marcados con <span class="elsevierStyleSup">68</span>Ga como cambio de estrategia en el tratamiento terapéutico. Rev Esp Med Nucl Imagen Mol. 2020;39:30–33.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2014 "Ancho" => 2083 "Tamanyo" => 407510 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Ga-68 DOTANOC PET/CT scan before and after 3 cycles of chemotherapy; decrease in lesion size and increase of uptake in primary lesion (A–F) and liver metastases (G–L).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1739 "Ancho" => 1500 "Tamanyo" => 390050 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Biopsy from liver metastasis before and after 3 cycles of chemotherapy; high cellularity (A, B) and synaptophysin positivity (inset A) and low cellularity (C, D) and synaptopysin positivity (inset C) after therapy.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2497 "Ancho" => 2500 "Tamanyo" => 369271 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Intense uptake in primary (arrows) and metastatic lesions (dashed arrows) in Ga-68 DOTANOC PET/CT scan before PRRT (at the end of chemotherapy) (BT and A–D); decrease in uptake and necrosis in all lesions after PRRT (AT and A–D).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "[1]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuroendocrinegastro-entero-pancreatic tumors: ESMO clinical practice guidelines for diagnosis, treatment and follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. 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