Widespread micronodular hepatic metastases of neuroendocrine tumor detected by [(68)Ga]DOTATATE PET/CT

Neuroendocrine tumors (NET) encompass a diverse, heterogeneous group of neoplasms that originate from the secretory cells of the neuroendocrine system. These neoplasms typically express the somatostatin receptor (SSTR), which can be targeted by molecular agents for imaging and therapy. This is particularly advantageous for imaging NETs that are indolent, slow-growing, and less well detected by [(18)F]FDG and for the detection of occult disease not easily identified by anatomic imaging. Herein, we present a case in which [(68)Ga]DOTATATE PET/CT was used to diagnose the etiology of biochemical recurrence in NET that was not apparent on MRI. The importance of understanding deviations from the normal biodistribution of the radiotracer is emphasized as key in interpreting nuclear medicine studies and establishing the diagnosis. Imaging the SSTR is of particular interest given the recent FDA approval of [(68)Cu]DOTATATE as a new and possibly more available molecular radiotracer.