Evaluation of [68Ga]Ga-DATA-TOC for imaging of neuroendocrine tumours: comparison with [68Ga]Ga-DOTA-NOC PET/CT

Purpose Recently, the new hybrid chelator DATA (6-amino-1,4-diazepine-triacetate) has been introduced, which has the advantage of high yield and radiolabelling of DATA-based octreotide derivative (TOC) at room temperature in contrast to tetraazacyclododecane-1,4,7,10-tetraacetate (DOTA) that needs 95 degrees C for effective labelling. However, the diagnostic potential of DATA-TOC has not been studied with other chelators in humans. The aim of this study was to compare the diagnostic efficacy of [Ga-68]Ga-DATA-TOC with [Ga-68]Ga-DOTA-NOC (which is the current standard for imaging neuroendocrine tumours (NET)) in patients of gastroenteropancreatic neuroendocrine tumours (GEP-NETs). Methods Fifty patients (thirty-one males and nineteen females) with biopsy-proven GEP-NETs were included in the study. Patients age ranged from 14 to 75 years (mean 46.11 years). All patients underwent two PET studies with [Ga-68]Ga-DATA-TOC and [Ga-68]Ga-DOTA-NOC. Images were evaluated visually and semi-quantitatively using maximum standardized uptake values (SUVmax) of tumour, mediastinum and liver. Tumour-to-liver (T/L) and tumour-to-mediastinum (T/M) SUVmax ratios were computed. For the purpose of comparison, patient-wise as well as lesion-wise analysis was carried out. The nonparametric-related samples Wilcoxon signed-rank test was used for comparison of the SUVmax values and ratios. Results On visual evaluation, the biodistribution and image quality of [Ga-68]Ga-DATA-TOC was similar to [Ga-68]Ga-DOTA-NOC. Physiological liver uptake was lower in [Ga-68]Ga-DATA-TOC as compared with [Ga-68]Ga-DOTA-NOC, 7.65 +/- 5.37 vs 8.94 +/- 5.95 (p = 0.009), respectively. On a patient-wise analysis, both [Ga-68]Ga-DATA-TOC and [Ga-68]Ga-DOTA-NOC were lesion-positive in the 44 patients (88%) and were negative in the 6 patients (12%). On a lesion-based analysis, [Ga-68]Ga-DATA-TOC had 98.6% concordance with [Ga-68]Ga-DOTA-NOC (232 out of 235 lesions detected). The target tumour SUVmax on [Ga-68]Ga-DATA-TOC and [Ga-68]Ga-DOTA-NOC were 36.63 +/- 32.24 and 40.82 +/- 36.89, respectively (p = 0.097). The T/L SUVmax ratios were not significantly different (5.99 +/- 5.52 vs 5.67 +/- 4.96, p = 0.77). Conclusion [Ga-68]Ga-DATA-TOC PET/CT imaging produced results that were comparable with [Ga-68]Ga-DOTA-NOC. It, thus, has potential utility as an effective and safe alternative to Ga-68-DOTA-NOC with the added benefit of ease, cost-effective and improved yield of instant kit-type synthesis.