68Ga-DOTATATE PET/CT Uptake in Prostate With an Incidental Finding of Prostatic Acinar Adenocarcinoma and Metastatic Neuroendocrine Cancer to the Liver.

ABSTRACT: A 69-year-old man with history of metastatic neuroendocrine tumor presented for initial staging with 68Ga-DOTATE PET/CT. 68Ga-DOTATATE PET/CT showed incidental focal increased DOTATATE uptake in the left apical prostate tissue, which was thought to be of benign etiology. Digital rectal examination later was consistent with a palpable nodule along with elevated prostate-specific antigen of 7.0 ng/mL. MRI of prostate demonstrated a 3.8-cm lesion followed by a targeted biopsy that revealed prostatic acinar adenocarcinoma. Chronic inflammatory cell infiltrates were also noted on biopsy, and this may have been the cause of increased DOTATATE uptake seen on 68Ga-DOTATATE PET/CT study.

Ga-68 DOTATATE PET/CT and F-18 FDG PET/CT in the evaluation of low and intermediate versus high-grade neuroendocrine tumors.

OBJECTIVE: We investigated the role of Ga-68 DOTATATE PET/CT in comparison to F-18 FDG PET/CT in patients with low and intermediate versus high-grade neuroendocrine tumors (NETs). METHODS: We identified 81 patients who underwent Ga-68 DOTATATE PET/CT at our institution between May 2017 and December 2018 and met inclusion criteria of biopsy-proven NET with known Ki-67 index, histologic grade, or differentiation. Patients were divided into two groups. Control group included Ki-67 ≤20%, grade 1 or 2, or well-differentiated tumors. Experimental group included Ki-67 >20%, grade 3, or poorly-differentiated tumors. RESULTS: Mean age was 57 years, with 36 males and 45 females. Most common primary sites were small bowel, pancreas, and lung. Most common distant metastatic sites were liver and bone. In the control group (n = 67), median Ki-67 was 4% (range 1-30%). 55/67 (82.1%) DOTATATE and 6/11 (54.5%) FDG scans were positive (P = 0.04). Positive scans showed >10 lesions in 25/55 (45.5%) DOTATATE and 1/6 (16.7%) FDG scans (P = 0.18). 40/55 (72.7%) positive DOTATATE and 3/6 (50%) FDG scans showed distant disease (P = 0.25). In the experimental group (n = 14), median Ki-67 was 68% (range 25-95%). All 14 DOTATATE and all nine FDG scans were positive. Positive scans showed >10 lesions in 4/14 (28.6%) DOTATATE and 5/9 (55.6%) FDG scans (P = 0.20). 10/14 (71.4%) positive DOTATATE and 7/9 (77.8%) FDG scans showed distant disease (P = 0.74). CONCLUSION: All patients with high grade, poorly-differentiated NETs had positive DOTATATE PET/CTs. In these patients, DOTATATE PET/CT did not significantly differ from FDG PET/CT in identifying >10 lesions or distant disease.

Use of Marrow Scintigraphy to Confirm Compensatory Marrow Rather than Active Myeloma.

We present the case of a 40-year-old male with multiple myeloma for whom bone marrow scintigraphy was utilized to help differentiate between active bony myelomatous disease versus treated lesions with compensatory marrow uptake. This case demonstrates technetium (Tc-99m) sulfur colloid imaging as an inexpensive technique to quickly distinguish between active focal bone disease and reactive marrow.

Imaging of multiple myeloma and related plasma cell dyscrasias.

Multiple myeloma (MM) is an incurable plasma cell malignancy of the bone marrow. MM has 3 components: diffuse marrow infiltration, focal bone lesions, and soft-tissue (extramedullary) disease. The hallmark biomarker in blood or urine is a monoclonal immunoglobulin, the monoclonal protein. Waldenstrom macroglobulinemia is a similar disease with secretion of IgM. Staging is classically performed with the 1975 Durie-Salmon system, which includes conventional radiographs. Recently updated, the Durie-Salmon Plus staging system includes CT, MRI, and (18)F-FDG PET/CT. The hallmark radiographic lesion of symptomatic MM is a well-demarcated, focal osteolytic bone lesion. The number of focal bone lesions correlates inversely with outcome. Extramedullary disease is typically an aggressive, poorly differentiated form of MM that confers inferior outcome, with median survival of less than 1 y if present at diagnosis. Achievement of a complete response on (18)F-FDG PET before stem-cell transplantation correlates with a superior outcome.

Successful surgical management of a neonate with a saddle pulmonary embolus.

A female neonate presented with evidence of a massive ventilation-perfusion mismatch. She was subsequently found to have a saddle pulmonary embolus. The infant successfully underwent surgical pulmonary embolectomy.