Value of 68Ga-DOTATATE PET/CT in differentiating pancreatic neuroendocrine tumors from uncinate process of pancreas

doi:10.16150/j.1671-2870.2026.02.010

Abstract

Abstract:

Objective To observe the differences in ⁶⁸Ga-DOTATATE uptake among pancreatic neuroendocrine tumor (NET), the tissues of the pancreatic uncinate process, and other pancreatic tumors in ⁶⁸Ga-DOTATATE PET/CT images, and to analyze their diagnostic performance. Methods A retrospective study was conducted on 133 consecutively enrolled patients who underwent ⁶⁸Ga-DOTATATE PET/CT between January 2020 and June 2022 for suspected NET (58 cases were pathologically diagnosed with pancreatic NET, 12 cases with other pancreatic tumors, and 63 cases were confirmed as having non-pancreatic tumors during follow-up). Clinical data were retrospectively analyzed, and a total of 158 target regions with high ⁶⁸Ga-DOTATATE uptake were obtained and divided into three groups: physiological uptake in the pancreatic uncinate process, pancreatic NET, and other pancreatic tumors. Differences in maximum and mean standardized uptake values (SUVmax and SUVmean) among these groups were compared. The ratios of uptake in the target region to the spleen (SUVmax-T/SUVmax-S, SUVmean-T/SUVmean-S) or the liver (SUVmax-T/SUVmax-L, SUVmean-T/SUVmean-L) were calculated. The receiver opera-ting characteristic (ROC) curve analysis was used to assess the diagnostic ability of different parameters for various pancreatic lesions. Results ⁶⁸Ga-DOTATATE uptake in pancreatic NET was significantly higher than those in the physiological uptake in the uncinate process and other pancreatic tumors (SUVmax values were 54.87±35.77, 27.70±51.55, and 8.94±3.04, respectively, all P<0.05; SUVmean values were 32.76±23.04, 14.79±28.15, and 6.28±2.11, respectively, all P<0.05). The uptake of ⁶⁸Ga-DOTATATE in other pancreatic tumors was higher than that in the uncinate process, and except for SUVmax, there were no statistically significant differences in other parameters between the two groups (P>0.05). The SUVmax-T/SUVmax-S ratio accurately differentiated pancreatic NET from non-pancreatic NET (other pancreatic tumors or physiological uptake in the pancreatic uncinate process), with an AUC of 0.929, a sensitivity of 0.855, a specificity of 0.948, and an optimal cutoff value greater than 0.802. Conclusions Physiological uptake can be observed in the pancreatic uncinate process on ⁶⁸Ga-DOTATATE PET/CT. Parameters related to the SUVmax-T/SUVmax-S and SUVmean-T/SUVmean-S ratios can accurately distinguish pancreatic NET from the physiological uptake in the pancreatic uncinate process and other pancreatic tumors.

Key words: Neuroendocrine tumors, Pancreatic uncinate process, ⁶⁸Ga-DOTATATE, PET/CT, Receiver operating characteristic

CLC Number:

R445
R735.9

LI Xiang, HUANG Xinyun, GUO Rui, LI Biao, ZHOU Yilei. Value of ⁶⁸Ga-DOTATATE PET/CT in differentiating pancreatic neuroendocrine tumors from uncinate process of pancreas[J]. Journal of Diagnostics Concepts & Practice, 2026, 25(02): 193-199.

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References 19

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Characteristics	Total（n=133）
Gender
Male	61 (45.87%)
Female	72 (54.14%)
Age (years)	48.86 ± 12.72
Diameter of pancreatic NET (cm)	3.51± 2.31
Location of pancreatic NET
Head and neck	24 (41.86%)
Body and tail	44(58.14%)
Pancreatic PET/CT target region(n =158)
Pancreatic NET	58(36.71%)
Non‑NET pancreatic tumor	12(7.6%)
Physiological uptake in uncinate process	88(55.69%)

Item	Pancreatic NET(n=58)	non‑NET pancreatic tumor(n=12)	Physiological uptake in uncinate process (n=88)	P value ^a)	P value ^b)	P value ^c)
SUVmax	54.87±35.77	27.70±51.55	8.94±3.04	0.001	0.019	<0.001
SUVmean	32.76±23.04	14.79±28.15	6.28±2.11	<0.001	0.084	<0.001
SUVmax-T/SUVmax-L	4.82±3.47	2.35±4.79	0.81±0.3	0.002	0.054	<0.001
SUVmean-T/SUVmean-L	6.46±11.91	1.95±4.1	0.9±0.34	0.054	0.643	<0.001
SUVmax-T/SUVmax-S	2.15±1.91	0.89±1.75	0.28±0.11	0.002	0.125	<0.001
SUVmean-T/SUVmean-S	1.77±1.64	0.64±1.35	0.27±0.11	0.001	0.26	<0.001

Item	AUC (95%CI)	P value	Sensitivity	Specificity	Cut-off value
SUVmax	0.949 (0.903-0.995)	<0.001	0.891	0.976	16
SUVmean	0.907 (0.840-0.975)	<0.001	0.836	0.988	10.81
SUVmax-T/SUVmax-L	0.924 (0.866-0.982)	<0.001	0.891	0.952	1.259
SUVmean-T/SUVmean-L	0.887 (0.813-0.960)	<0.001	0.818	0.952	1.416
SUVmax-T/SUVmax-S	0.964 (0.932-0.996)	<0.001	0.855	0.999	0.648
SUVmean-T/SUVmean-S	0.916 (0.855-0.976)	<0.001	0.818	0.976	0.531

Item	AUC (95%CI)	P value	Sensitivity	Specificity	Cut-off value
SUVmax	0.833(0.677-0.989)	<0.001	0.891	0.75	14.725
SUVmean	0.821(0.665-0.978)	0.001	0.891	0.75	7.550
SUVmax-T/SUVmax-L	0.829(0.670-0.987)	<0.001	0.891	0.75	1.259
SUVmean-T/SUVmean-L	0.838(0.690-0.986)	<0.001	0.855	0.833	1.193
SUVmax-T/SUVmax-S	0.853(0.699-1)	<0.001	0.764	0.917	0.861
SUVmean-T/SUVmean-S	0.855(0.703-1)	<0.001	0.836	0.833	0.494

Value of ⁶⁸Ga-DOTATATE PET/CT in differentiating pancreatic neuroendocrine tumors from uncinate process of pancreas

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