0:00

83 year female who had a CT chest perform

0:04

for follow up of lung nodules.

0:07

The first lung nodule is this one in the right lower lobe

0:11

that I'm showing both in the lung window

0:15

and also soft tissue window,

0:16

and you can see is smooth

0:20

without speculations.

0:23

So one is in the right lower lobe

0:26

and the other one was in the mid medial aspect

0:30

of the right middle lobe.

0:32

The second one has some eccentric pan calcifications.

0:37

So here the differential diagnosis

0:42

includes primary malignancies such

0:45

as synchronous carcinoid tumors,

0:47

or could be other benign entities such as hematoma.

0:52

So for these one could do tissue sampling

0:56

and less invasively, we could perform a Dotatate PET CT to

1:01

prove if these are indeed neuroendocrine tumors

1:06

or carcinoids.

1:08

So this patient had a pet CT with dotatate

1:11

and we're gonna review it as well.

1:14

So looking at the me to begin with,

1:18

we see in the chest three areas of abnormal trace uptake

1:23

with different degrees of activity or intensity.

1:29

The rest of the body, I'm not gonna mention

1:30

because there were no additional findings.

1:34

So focusing ourselves on the first

1:37

nodule we discussed in the right lower lobe, we see

1:41

that there is focal uptake in that lung nodule

1:46

that is otherwise stable in size from the prior,

1:50

which was done a month apart.

1:53

The second nodule also shows tracer uptake

1:56

and it's seen here anteriorly.

1:58

We, it's a little bit mis registered

2:00

because of breathing motion,

2:02

but this intensity corresponds to the LAN Nole confirming

2:07

that these nodules are of neuroendocrine origin.

2:13

This third side of uptake that was picked up was in the

2:18

right hylum, which was not seen on the prior ct,

2:23

as this is not correspondent to an enlarged lymph node

2:27

for this sampling of the lymph node would be, uh,

2:30

recommended and important for appropriate staging.

2:34

An additional finding in this case was a compression

2:37

deformity at L one,

2:41

and you can see that there's low level of uptake here,

2:46

and this is indeterminate in the sense that

2:50

both metastatic disease

2:52

and inflammatory changes can show data.

2:56

Data uptake. In this case, this

2:58

Was favored to represent inflammation

3:02

rather than metastatic disease.

3:05

In this case, this patient

3:08

has synchronous carcinoid tumors with a question

3:12

of novel involvement in the right hilum, which can be

3:16

confirmed or excluded on EVAs with tissue sampling.

DOTATATE Case: Lung Carcinoid

HIDE

Prev Next

Interactive Transcript

Pro Tip: Click on a word in the transcript to jump to that point in the video

0:00

83 year female who had a CT chest perform

0:04

for follow up of lung nodules.

0:07

The first lung nodule is this one in the right lower lobe

0:11

that I'm showing both in the lung window

0:15

and also soft tissue window,

0:16

and you can see is smooth

0:20

without speculations.

0:23

So one is in the right lower lobe

0:26

and the other one was in the mid medial aspect

0:30

of the right middle lobe.

0:32

The second one has some eccentric pan calcifications.

0:37

So here the differential diagnosis

0:42

includes primary malignancies such

0:45

as synchronous carcinoid tumors,

0:47

or could be other benign entities such as hematoma.

0:52

So for these one could do tissue sampling

0:56

and less invasively, we could perform a Dotatate PET CT to

1:01

prove if these are indeed neuroendocrine tumors

1:06

or carcinoids.

1:08

So this patient had a pet CT with dotatate

1:11

and we're gonna review it as well.

1:14

So looking at the me to begin with,

1:18

we see in the chest three areas of abnormal trace uptake

1:23

with different degrees of activity or intensity.

1:29

The rest of the body, I'm not gonna mention

1:30

because there were no additional findings.

1:34

So focusing ourselves on the first

1:37

nodule we discussed in the right lower lobe, we see

1:41

that there is focal uptake in that lung nodule

1:46

that is otherwise stable in size from the prior,

1:50

which was done a month apart.

1:53

The second nodule also shows tracer uptake

1:56

and it's seen here anteriorly.

1:58

We, it's a little bit mis registered

2:00

because of breathing motion,

2:02

but this intensity corresponds to the LAN Nole confirming

2:07

that these nodules are of neuroendocrine origin.

2:13

This third side of uptake that was picked up was in the

2:18

right hylum, which was not seen on the prior ct,

2:23

as this is not correspondent to an enlarged lymph node

2:27

for this sampling of the lymph node would be, uh,

2:30

recommended and important for appropriate staging.

2:34

An additional finding in this case was a compression

2:37

deformity at L one,

2:41

and you can see that there's low level of uptake here,

2:46

and this is indeterminate in the sense that

2:50

both metastatic disease

2:52

and inflammatory changes can show data.

2:56

Data uptake. In this case, this

2:58

Was favored to represent inflammation

3:02

rather than metastatic disease.

3:05

In this case, this patient

3:08

has synchronous carcinoid tumors with a question

3:12

of novel involvement in the right hilum, which can be

3:16

confirmed or excluded on EVAs with tissue sampling.

Report

Faculty

Elisa Franquet Elia, MD

Assistant Professor of Radiology

UMass Chan Medical School

Lesson

Introduction to PET/CT Imaging

Lesson

FDG Use in PET/CT

Lesson

FDG: Common Pitfalls and Benign Lesions

Lesson

FDG Use in Hematologic Malignancies

Lesson

FDG Use in Lung Cancer

Lesson

FDG Use in Head & Neck Cancer

Lesson

FDG Use in Breast Cancer

Lesson

FDG Use in Immunotherapy

Lesson

DOTATATE Use in PET/CT

Lesson

DOTATATE and FDG Use in Neuroendocrine Tumors

Lesson

PSMA Use in PET/CT

Lesson

PSMA Use in Prostate Cancer

DOTATATE Case: Lung Carcinoid