Gallium-68 PET/CT Scan

The Ga-68 DOTATATE PET/CT Scan is a new generation scan that has improved sensitivity compared to the traditional nuclear scan using indium-111 octreotide SPECT scan. Studies have shown that the Gallium-68 scan shows about 50% more sites of abnormality than the indium-111 scan.  Most patients will be followed with serial MRI and/or CT scans; there are specific indications or decision points when a Ga-68 study may be indicated.  A NET specialist is your best resource for this discussion.

FDA Approval:  On June 1, 2016, the FDA approved a Gallium-68 Kit, "Netspot" (Advanced Accelerator Applications USA).  The approval of this kit will allow any Nuclear Medicine Facility with PET-CT scanning ability (available at most departments) to perform Gallium-68 scans. This is a major diagnostic advance for NET patients and physicians. On June 1, 2017, this study is available at the UCSD and Scripps Nuclear Medicine Departments.  Medicare coverage started January 1, 2017. Patients with other insurance providers will need to check with their insurers (coverage will usually be checked by the Nuclear Medicine facility).  

Things to consider before getting a Gallium-68 Scan (editorial comments):
1.  How might the findings affect treatment decisions?  For example, if you have known metastatic disease; e.g., in your liver, and no known other sites of disease, will the treatment decisions you are currently considering be different if other areas of tumor are detected?  Drug therapies (oral or injected agents) will treat all lesions in your body; having the scan may not change the drug treatment decision.  If you are considering a surgical option; e.g., surgical removal of multiple liver lesions, will the surgery still be recommended/performed if a Gallium-68 scan shows multiple bone lesions or lesions at other sites?  
2.  If you have an unknown primary tumor the effectiveness of Ga-68 Scanning was reported in two sub-groups of patients:
     Group One:  Suspected NET based on symptoms or elevated serotonin and other imaging studies don't show a tumor.  In this (small) group the Gallium 68 scans didn't detect a primary.
     Group Two:  Known NET tumor (metastatic disease) but no known primary.  In this group the Gallium-68 scan detected a primary tumor in about 70% of cases. 
3.  If it is important for you to know the extent of your disease, then a Gallium-68 scan is the most sensitive and specific imaging study.