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CC BY 4.0 · World J Nucl Med
DOI: 10.1055/s-0044-1801384
Case Report

An Unusual Observation in Metastatic Neuroendocrine Neoplasm: Diffuse Pattern Hepatic [68Ga]Ga-DOTATATE Uptake Related to Micro-metastatic Disease and Discordance between Dual-Tracer PET-CT Findings and MIB-1 Labelling Index

Parth Baberwal
1   Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Mumbai, Maharashtra, India
2   Homi Bhabha National Institute, Mumbai, Maharashtra, India
,
Sunita N. Sonavane 
1   Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Mumbai, Maharashtra, India
2   Homi Bhabha National Institute, Mumbai, Maharashtra, India
,
Sandip Basu 
1   Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Mumbai, Maharashtra, India
2   Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Abstract

Neuroendocrine neoplasms (NENs) are a rare and diverse group of neoplasms that can originate from neuroendocrine cells in any organ. We herein present a patient with Grade II neuroendocrine tumor (NET) of the pancreas with bilobar liver metastasis and a MIB-1 labelling index of 15%, who underwent various systemic and targeted therapies. On follow-up, dual-tracer PET-CT imaging with [68Ga]Ga-DOTATATE PET/CT showed new onset skeletal metastases and diffuse pattern SSTR (somatostatin receptor) expression in the left lobe of the liver (Krenning score 3), contrasted by absent uptake on [18F]FDG. Magnetic resonance imaging of the liver confirmed sub-centimetric left liver lobe lesions, further biopsy of which suggested Grade-III NET exhibiting high Ki-67 (55–60%). Thus, a discordance was observed between Ki-67 and the dual-tracer PET-CT findings, emphasizing the complexity of NEN imaging (with possibility of differentiation even in a relatively high Ki-67) and the importance of using multiple tracers for accurate assessment in guiding evidence-based management strategy.

Keywords

metastasis - NET - DOTATATE - FDG - PET - discordance - de-differentiation - dual-tracer PET


Publication History

Article published online:
08 January 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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