Prospective evaluation of (68)Ga-DOTANOC PET-CT in differentiated thyroid cancer patients with raised thyroglobulin and negative (131)I-whole body scan: comparison with (18)F-FDG PET-CT

Eur J Nucl Med Mol Imaging. 2014 Jul;41(7):1354-62. doi: 10.1007/s00259-014-2723-9. Epub 2014 Feb 22.


Purpose: The purpose of the study was to evaluate the role of (68)Ga-DOTANOC PET-CT in differentiated thyroid cancer (DTC) patients with negative (131)I-whole body scan (WBS) along with serially increasing serum thyroglobulin (Tg), and compare the same with (18)F-FDG PET-CT.

Methods: Sixty two DTC patients with serially rising Tg levels and negative (131)I-WBS were prospectively enrolled. All patients underwent (68)Ga-DOTANOC PET-CT and (18)F-FDG PET-CT within an interval of two weeks. PET-CT analysis was done on a per-patient basis, location wise and lesion wise. All PET-CT lesions were divided into four categories-local, nodal, pulmonary and skeletal. Histopathology and/or serial serum Tg level, clinical and imaging follow up (minimum-1 year) were used as a reference standard.

Results: Ga-DOTANOC PET-CT demonstrated disease in 40/62 (65 %) patients and (18)F-FDG PET-CT in 45/62 (72 %) patients, with no significant difference on McNemar analysis (p = 0.226). Per-patient sensitivity and specificity of (68)Ga-DOTANOC PET-CT was 78.4 %, 100 %, and for (18)F-FDG PET-CT was 86.3 %, 90.9 %, respectively. Out of 186 lesions detected by both PET-CTs, 121/186 (65 %) lesions were seen on (68)Ga-DOTANOC PET-CT and 168/186 (90.3 %) lesions on (18)F-FDG PET-CT (p < 0.0001). There were 103/186 (55 %) lesions concordant on both. Excellent agreement was noted between (68)Ga-DOTANOC PET-CT and (18)F-FDG PET-CT for detection of local disease (ĸ = 0.92), while moderate agreement was noted for nodal and pulmonary disease (ĸ = 0.67). (68)Ga-DOTANOC PET-CT changed management in 21/62 (34 %) patients and (18)F-FDG PET-CT in 17/62 (27 %) patients.

Conclusion: Ga-DOTANOC PET-CT is inferior to (18)F-FDG PET-CT on lesion based but not on patient based analysis for detection of recurrent/residual disease in DTC patients with negative WBS scan and elevated serum Tg levels. It can also help in selection of potential candidates for peptide receptor radionuclide therapy.

Publication types

  • Clinical Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Female
  • Fluorodeoxyglucose F18*
  • Follow-Up Studies
  • Humans
  • Iodine Radioisotopes
  • Male
  • Middle Aged
  • Multimodal Imaging
  • Organometallic Compounds*
  • Positron-Emission Tomography*
  • Prospective Studies
  • Thyroglobulin / blood*
  • Thyroid Neoplasms / blood
  • Thyroid Neoplasms / diagnosis*
  • Thyroid Neoplasms / pathology
  • Tomography, X-Ray Computed*
  • Whole Body Imaging*
  • Young Adult


  • 68Ga-DOTANOC
  • Iodine Radioisotopes
  • Organometallic Compounds
  • Fluorodeoxyglucose F18
  • Thyroglobulin