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Purpose <p>To assess therapeutic response in patients with neuroendocrine tumors (NETs) using quantitative post-therapy <sup>177</sup>Lu-DOTATATE SPECT/CT metrics, such as standardized uptake values (SUVs), metabolic tumor volume (MTV), and total Lutetium uptake (TLuU), and to propose a response classification system based on these indices.</p> Materials and methods <p>In this retrospective study, we analyzed 31 lesions in 7 patients with NETs treated with four cycles of peptide receptor radionuclide therapy (PRRT) with <sup>177</sup>Lu-DOTATATE. Visual interpretation with the Krenning score (K-S) and quantitative analysis (SUVmax, SUVpeak, SUVmean, MTV, TLuU) were performed after each cycle. Volumes of interest (VOI) were segmented using two thresholds: 40% of SUVmax or a fixed cutoff of 2.4. Treatment response was expressed as response ratios (RRs) across PRRT sessions.</p> Results <p>SUVmax and SUVpeak correlated strongly with K-S and were consistent across thresholding methods. MTV and TLuU varied by VOI definition, but the cutoff method produced more stable longitudinal assessments. Lesions with early SUV-based RR reductions at the second PRRT cycle showed continued decline across treatment. Patients were categorized as "Good Responder," "Responder," or "Non-responder" based on quantitative trends, which aligned with visual assessments and CT findings.</p> Conclusion <p>Quantitative post-PRRT SPECT/CT provides objective, reproducible metrics for assessing NET therapy response. A fixed SUV cutoff allows standardized volumetric assessment. Early SUV-based index declines may act as predictive biomarkers of treatment efficacy, supporting personalized theranostic strategies.</p>

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Quantitative indices from post-PRRT SPECT/CT: an exploratory approach to early imaging biomarkers in neuroendocrine tumors

  • 期刊论文

  • 发表日期：

    2026年1月14日

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  • Takanori Bando,
  • Hideki Otsuka,
  • Tamaki Otani,
  • Ryosuke Kasai,
  • Yoichi Otomi,
  • Sana Nagao,
  • Shota Azane,
  • Satoru Takashi,
  • Yamato Kunikane,
  • Masafumi Amano,
  • Yasuyuki Okada,
  • Tetsuji Takayama,
  • Takashi Kawanaka,
  • Hitoshi Ikushima,
  • Masafumi Harada

摘要

Purpose

To assess therapeutic response in patients with neuroendocrine tumors (NETs) using quantitative post-therapy 177Lu-DOTATATE SPECT/CT metrics, such as standardized uptake values (SUVs), metabolic tumor volume (MTV), and total Lutetium uptake (TLuU), and to propose a response classification system based on these indices.

Materials and methods

In this retrospective study, we analyzed 31 lesions in 7 patients with NETs treated with four cycles of peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE. Visual interpretation with the Krenning score (K-S) and quantitative analysis (SUVmax, SUVpeak, SUVmean, MTV, TLuU) were performed after each cycle. Volumes of interest (VOI) were segmented using two thresholds: 40% of SUVmax or a fixed cutoff of 2.4. Treatment response was expressed as response ratios (RRs) across PRRT sessions.

Results

SUVmax and SUVpeak correlated strongly with K-S and were consistent across thresholding methods. MTV and TLuU varied by VOI definition, but the cutoff method produced more stable longitudinal assessments. Lesions with early SUV-based RR reductions at the second PRRT cycle showed continued decline across treatment. Patients were categorized as "Good Responder," "Responder," or "Non-responder" based on quantitative trends, which aligned with visual assessments and CT findings.

Conclusion

Quantitative post-PRRT SPECT/CT provides objective, reproducible metrics for assessing NET therapy response. A fixed SUV cutoff allows standardized volumetric assessment. Early SUV-based index declines may act as predictive biomarkers of treatment efficacy, supporting personalized theranostic strategies.