Translate
Subscribe to Blog via Email
Ronny Allan
In my post entitled “If you can see it, you can detect it“, I listed the different types of scanning techniques and technology to find evidence of disease in Neuroendocrine Tumours (NETs). Of course, while scans, blood and (current) marker tests can give some pretty big and important clues, “tissue is the issue” to determine type.
Even after formal diagnosis, seeing all the tumours can be a challenge with NETs. In the article I quoted above, I indicated that scans for NETs can be analogous to picking ‘horses for courses‘. For example, most NETs have somatostatin receptors and can often be seen better on functional scans e.g. somatostatin receptor scintigraphy (SRS) or somatostatin receptor PET (SSTR-PET), combined with the use of radionuclides designed specifically for this purpose e.g. In 111, Tc99m, Ga68, Cu64. So, while you might see them on one scan, you may not see them on the other and vice versa (….. there are variables at play here). Now you see them, now you don’t!
There are other functional scans for various NET types, such as FDG PET which tends to be used for higher grade NETs and Neuroendocrine Carcinomas and those at the boundary of Grades 2 and 3 may also benefit. You can read about these scan types plus more by clicking here.
Even when they can be seen on conventional imaging e.g. CT, MRI, there are still some factors involved in getting the optimum view. For example, NETs are known for their hypervascularity, so viewing them on CT in the “late arterial phase” of a triple phase CT scan should present the best view. This is a really complex area and may not apply to every scenario. It’s my experience that some radiologists and personnel who order the scans are not aware of this requirement for NETs. This issue is graphically displayed below (click the picture for the source). Now you see them, now you don’t!
The MRI is said to be more sensitive for liver lesions, although the CT should be sufficient for many. The CT is said to be better than MRI for certain primary tumours including Small Intestine NETs (SI NET). I also noted some studies claiming the MRI may be better to pick up small liver tumours than a nuclear scan. So, for some people, a CT and/or an MRI may be an option for routine surveillance.
This link will explain some of the difficulties in identifying liver metastases using conventional imaging, this includes the use of particular types of contrast material (e.g. Evoist) on MRI – click here
The other CT issue which some of you may have encountered is a “fatty liver“. Diffuse hepatic steatosis is the technical name for fatty liver. It appears to be a common imaging finding (~25% of the population) and can lead to difficulties assessing the liver appearances, especially when associated with the less common focal fatty sparing. This is a complex area, and you should consult your specialist about how this might affect your imaging. Now you don’t see it (properly).
My own experience
When I was first diagnosed, my CT scans looked pretty clear. In fact, when you look at the lead picture in my post “If you can see it, you can detect it“, that’s a picture of my liver from a diagnostic CT scan, showing a big tumour staring you right in the face. So, CT was very successful in leading to my diagnosis. A follow-on Octreotide scan confirmed the staging, adding two more hotspots above the diaphragm (unusual for a SI NET). Following primary surgery, liver surgery and lymph node surgery, CTs and SRS/SSTR PET have done the job.
After my liver surgery in 2011, my surgeon said there were 6 sub-centimetre deposits left behind. My liver disposition was much more conspicuous on intraoperative ultrasound than my diagnostic CTs, and with significant right sided disease. I did try to track these remnant lesions over the years, I found it much easier in the first four year after diagnosis. Reading my surveillance CT scans in the last few years, I started to think they were disappearing, a nice thought.
My last three CT scans have been really interesting with the latest one on 6th November stating there was “no evidence of hepatic metastatic disease“. But before you jump for joy on my behalf, read on. Prior to that, April 2019 results said “barely visible as hypervascular blushes during arterial phase on the CT and this has not changed since April 2018. The November 2019 CT said, “diffuse fatty infiltration with no obvious focal lesions”. The same radiologist consultant carried out all my scans for the first 5 years after diagnosis and has mentioned the appearance of a fatty liver before, suggesting MRI would show the liver better (I had an MRI once to check on a chest lump but that was negative. I’m not too keen on MRIs due to some metal inside me!). The 2018 CT said, “no focal liver lesions”. Way back to 2017 and there is mention of “subtle hyperenhancement in the right lobe of the liver 11mm (seen only on arterial phase)”. I could go on …… Now you see them, now you don’t!
I’m not getting too excited about these CT results because my Ga68 PET/CT in June 2018 stated, “there are multiple foci of tracer uptake within both lobes of the liver, predominately in the right“. So, they were still loitering mid 2018 but overall, they don’t seem to be doing much (thankfully). The Ga68 PET scan results prompted my original surgeon to point out they were definitely more conspicuous on nuclear scan than on CT.
I had another Ga68 PET/CT in July 2021. You can read about my experience of that by clicking here.
Top 10 Posts & Pages in the last 48 hours (auto updates) (Click the titles to read them)
Thanks for reading.
Personal Facebook. Like this page please.
Blog Facebook. Like this page please.
Awareness Facebook Like this page please.
Sign up for my newsletters – Click Here
My Diagnosis and Treatment History
Check out my online presentations
Check out my WEGO Health Awards
Check out my Glossary of Terms – click here
Please Share this post for Neuroendocrine Cancer awareness and to help another patient
A Spotlight on Neuroendocrine Cancer Syndromes – Carcinoid Syndrome
What is Carcinoid Syndrome? Carcinoid syndrome (CS) is the most frequent hormonal complication accompanying neuroendocrine neoplasms (NENs) and is defined by chronic diarrhoea and/or flushing in the
Somatostatin Receptor Positive Advanced Bronchial Neuroendocrine Tumors – PRRT vs Everolimus
I was delighted to see this clinical trial which looks at the efficacy of PRRT (Lu177) vs the efficacy of Everolimus (Afinitor). The latter is
Opinion: Let’s attack Cancer metaphors
Since I started blogging, I’ve read dozens of articles on the subject of ‘cancer metaphors’ and in particular their use in describing cancer experiences with
A review of November 2023 on RonnyAllan.NET – Living with Neuroendocrine Cancer
November is always busier as I help spread awareness for 10th Nov (remembering that every day is 10th Nov on my site!). I also managed
European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for Digestive Neuroendocrine Carcinoma
This ENETS guidance paper, developed by a multidisciplinary working group, provides up-to-date and practical advice on the diagnosis and management of digestive neuroendocrine carcinoma, based
Neuroendocrine Cancer – Clinical Esoterica
One of the key awareness messages for Neuroendocrine Cancer is the hormonal syndromes that can often accompany the diagnosis for many people. As it’s a
Neuroendocrine Cancer – The F Words
When I first created my blog in April 2014, I had to find some material to lead up to my 84 mile walk (at the
Laughter is the best medicine
Laughter is important. This is a remastered version of one of my early blog posts. It centred on a ‘get-well’ card I received recuperating in
European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for gastric neuroendocrine tumours (NETs) G1–G3
The ENETS 2023 guideline for gNETs are combined with the guidelines for Duodenal NET (dNET) due to their close relationship in anatomical terms. Gastric neuroendocrine
A cup of tea
I would also mention those who contributed to my “Tea Fund” which resides on PayPal. You don’t need a PayPal account as you can select a card but don’t forget to select the number of units first (i.e. 1 = £4, 2 = £8, 3 = £12, and so on), plus further on, tick a button to NOT create a PayPal account if you don’t need one. Clearly, if you have a PayPal account, the process is much simpler
Through your generosity, I am able to keep my sites running and provide various services for you. I have some ideas for 2023 but they are not detailed enough to make announcements yet.
This screenshot is from every single post on my website and depending on which machine you are using, it will either be top right of the post or at the bottom (my posts are often long, so scroll down!)
