When metastases are suspected based on US, the sensitivity and specificity of PET/CT in the detection of hepatic metastases is 97% and 75%, respectively, which is higher, compared with contrast-enhanced CT alone with sensitivity and specificity of 88% and 17%, respectively [42]. DOTATATE PET/CT Skull Base to Mid-Thigh In patients with primary NET, Ga-68-DOTATATE PET/CT demonstrates sensitivity of 80% to 100% and of specificity 82% to 100% [8]. Specifically, Ga-68-DOTATATE PET/CT is more sensitive than FDG-PET/CT, with sensitivities of 72% to 100% versus 54% to 78%, respectively [8]. Ga-68-DOTATATE PET/CT is not used in assessment metastases from primary cancers other than NET. Octreotide Scan with SPECT or SPECT/CT Chest and Abdomen Sensitivity of In-111 somatostatin receptor scan with SPECT or SPECT/CT varies depending on the specific histologic type of the primary NET. For example, detection rates are >75% in small-cell-lung cancer and carcinoid metastases and 40% to 75% in insulinoma and medullary thyroid cancers [46]. Image-Guided Biopsy Liver Percutaneous image-guided biopsy may be necessary to establish the diagnosis, particularly when the imaging features on a CT or MRI examination indicate a possibility of malignancy. In some liver lesions, such as lymphoma, histopathologic analysis is the only technique that can make a definitive diagnosis [20]. Various techniques exist Liver Lesion-Initial Characterization for guidance of the biopsy, where US and CT are the most commonly utilized modalities for biopsy guidance. When a biopsy is performed to diagnose or rule out malignancy in indeterminate lesions, the overall technical success rate under grayscale US guidance is 74%, which can be increased to 100% under CEUS guidance [21,22]. The percentage of tumor cells in the biopsy sample is greater with a higher number of collected biopsy samples [23].
Liver Lesion Initial Characterization. When metastases are suspected based on US, the sensitivity and specificity of PET/CT in the detection of hepatic metastases is 97% and 75%, respectively, which is higher, compared with contrast-enhanced CT alone with sensitivity and specificity of 88% and 17%, respectively [42]. DOTATATE PET/CT Skull Base to Mid-Thigh In patients with primary NET, Ga-68-DOTATATE PET/CT demonstrates sensitivity of 80% to 100% and of specificity 82% to 100% [8]. Specifically, Ga-68-DOTATATE PET/CT is more sensitive than FDG-PET/CT, with sensitivities of 72% to 100% versus 54% to 78%, respectively [8]. Ga-68-DOTATATE PET/CT is not used in assessment metastases from primary cancers other than NET. Octreotide Scan with SPECT or SPECT/CT Chest and Abdomen Sensitivity of In-111 somatostatin receptor scan with SPECT or SPECT/CT varies depending on the specific histologic type of the primary NET. For example, detection rates are >75% in small-cell-lung cancer and carcinoid metastases and 40% to 75% in insulinoma and medullary thyroid cancers [46]. Image-Guided Biopsy Liver Percutaneous image-guided biopsy may be necessary to establish the diagnosis, particularly when the imaging features on a CT or MRI examination indicate a possibility of malignancy. In some liver lesions, such as lymphoma, histopathologic analysis is the only technique that can make a definitive diagnosis [20]. Various techniques exist Liver Lesion-Initial Characterization for guidance of the biopsy, where US and CT are the most commonly utilized modalities for biopsy guidance. When a biopsy is performed to diagnose or rule out malignancy in indeterminate lesions, the overall technical success rate under grayscale US guidance is 74%, which can be increased to 100% under CEUS guidance [21,22]. The percentage of tumor cells in the biopsy sample is greater with a higher number of collected biopsy samples [23].