0:01

83-year-old mane with a history

0:03

of IAL neuroendocrine tumor that was previously resected,

0:08

presented with back pain

0:10

and was found to have an osseous lesion.

0:13

This pett with dotatate was performed for S staging.

0:18

So looking at the meep, we can see

0:20

that there are several areas of tracer uptake

0:23

that are not in physiologic distribution,

0:26

including the posterior pelvis in the liver

0:30

and right Hemi abdomen.

0:33

This patient has been presented previously

0:35

and has some pitfalls that we'll not cover.

0:38

In this video, we're gonna only discuss what is pertinent

0:42

to the disease.

0:45

Looking at the PET imaging alone

0:48

and as we scroll through the abdomen, we can identify

0:52

that within the liver there are two sides

0:55

of abnormal tresor uptake

0:57

in the posterior right hepatic globe.

1:01

But if we look at the CT, we

1:04

don't really have a good correlate.

1:08

Now granted this is a non enhanced CT

1:10

and is a low dose, so it could be because of that.

1:14

As I mentioned previously, molecular imaging allows us

1:18

to identify areas of disease that have not

1:22

developed morphologic changes yet.

1:25

So aside from that, as we scroll through,

1:29

we see that in the PET imaging alone there is a lower

1:34

degree of uptake in the peritoneum

1:39

that on CT correspond with a little bit of nodularity

1:43

and saddle stranding.

1:45

And this is consistent with peritoneal disease.

1:49

Scrolling down, we can see

1:51

that there are changes from surgery

1:53

looking within the bone windows.

1:56

And to localize these area of very intense uptake,

2:01

you can see that there's a lytic lesion

2:03

with sub tissue component that corresponded

2:07

with the newly identified, uh,

2:10

metastasis from these patients.

2:12

Uh, neuroendocrine tumor.

2:15

In this case, these were the areas of disease.

2:19

Sometimes when we see findings that don't have a correlate,

2:22

particularly in the liver, we may want to recommend an MRI

2:26

to be able to identify these lesions

2:30

and establish a modality for closer follow-ups.

2:35

If not Dotatate PET CT would be appropriate

2:38

for following this patient.

2:40

As we can see that the disease is dotatate avid

2:44

and is visible on pet,

2:47

this patient had a liver MRI with VIS to better

2:53

evaluate the liver findings.

2:55

And here we can see that there are two subs, centimeter

2:58

Arterially enhancing nodules in the right HEPA lobe.

3:03

One is here and

3:08

the other one is here.

3:10

And these correlate with a lesion seen on the pity

3:15

and were consistent with metastasis.

DOTATATE Case: Ileal NET

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Interactive Transcript

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

0:01

83-year-old mane with a history

0:03

of IAL neuroendocrine tumor that was previously resected,

0:08

presented with back pain

0:10

and was found to have an osseous lesion.

0:13

This pett with dotatate was performed for S staging.

0:18

So looking at the meep, we can see

0:20

that there are several areas of tracer uptake

0:23

that are not in physiologic distribution,

0:26

including the posterior pelvis in the liver

0:30

and right Hemi abdomen.

0:33

This patient has been presented previously

0:35

and has some pitfalls that we'll not cover.

0:38

In this video, we're gonna only discuss what is pertinent

0:42

to the disease.

0:45

Looking at the PET imaging alone

0:48

and as we scroll through the abdomen, we can identify

0:52

that within the liver there are two sides

0:55

of abnormal tresor uptake

0:57

in the posterior right hepatic globe.

1:01

But if we look at the CT, we

1:04

don't really have a good correlate.

1:08

Now granted this is a non enhanced CT

1:10

and is a low dose, so it could be because of that.

1:14

As I mentioned previously, molecular imaging allows us

1:18

to identify areas of disease that have not

1:22

developed morphologic changes yet.

1:25

So aside from that, as we scroll through,

1:29

we see that in the PET imaging alone there is a lower

1:34

degree of uptake in the peritoneum

1:39

that on CT correspond with a little bit of nodularity

1:43

and saddle stranding.

1:45

And this is consistent with peritoneal disease.

1:49

Scrolling down, we can see

1:51

that there are changes from surgery

1:53

looking within the bone windows.

1:56

And to localize these area of very intense uptake,

2:01

you can see that there's a lytic lesion

2:03

with sub tissue component that corresponded

2:07

with the newly identified, uh,

2:10

metastasis from these patients.

2:12

Uh, neuroendocrine tumor.

2:15

In this case, these were the areas of disease.

2:19

Sometimes when we see findings that don't have a correlate,

2:22

particularly in the liver, we may want to recommend an MRI

2:26

to be able to identify these lesions

2:30

and establish a modality for closer follow-ups.

2:35

If not Dotatate PET CT would be appropriate

2:38

for following this patient.

2:40

As we can see that the disease is dotatate avid

2:44

and is visible on pet,

2:47

this patient had a liver MRI with VIS to better

2:53

evaluate the liver findings.

2:55

And here we can see that there are two subs, centimeter

2:58

Arterially enhancing nodules in the right HEPA lobe.

3:03

One is here and

3:08

the other one is here.

3:10

And these correlate with a lesion seen on the pity

3:15

and were consistent with metastasis.

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: Ileal NET