case_images: PMC11828640_01
case_images: 68
  Ga-DOTATATE PET/CT scan with (
  A
  ) maximum intensity projection image and (
  B
  ) fused axial and coronal images showed somatostatin receptor (SSTR) expressing duodenal neuroendocrine tumor (NET;
  blue arrows
  ), pancreatic NET (
  purple arrow
  ), and metastatic mesenteric lymph node (
  red arrow
  ). (
  C
  )
  99m
  Tc-MIBI scan with planar images at early-15 minutes and delayed-2 hours show tracer retention in the left inferior thyroid region. (
  D
  ) Single photon emission computed tomography (SPECT)/computed tomography (CT) of
  99m
  Tc-MIBI scan with fused axial and axial CT images showed tracer localization to subcentimeter-sized soft-tissue lesion in left inferior paratracheal region (
  green arrow
  ) indicating the parathyroid tumor. (
  E
  ) Magnetic resonance imaging (MRI) with coronal T1 postcontrast image showing 0.5 x 0.7 cm lesion in the right half of pituitary gland associated with hypoenhancement pattern suggestive of microadenoma (
  yellow arrow
  ). The patient received four cycles of
  177
  Lu-DOTATATE peptide receptor radionuclide therapy (PRRT). (
  F
  ) Post-PRRT,
  68
  Ga-DOTATATE PET/CT scan showed reduction in size and SSTR uptake of duodenal and mesenteric NET lesions as compared with baseline
  68
  Ga-DOTATATE PET/CT scan (
  A
  and
  B
  ), suggestive of a favorable response to PRRT.
case_images: 10-1055-s-0044-1791818-i2480001-1.jpg
case_images: PMC11828640_01_10-1055-s-0044-1791818-i2480001-1.jpg
case_images: FI2480001-1
case_images: The patient underwent 68 Ga-DOTATATE PET/CT scan, which showed somatostatin receptor (SSTR) expressing duodenal lesions, pancreatic lesion, and SSTR expressing mesenteric lymph node as shown in Fig. 1A and B . Subsequently, the patient underwent [ 99m Tc]Tc-sestamibi scan with single photon emission computed tomography (SPECT)/computed tomography (CT), which showed a tumor in the left inferior parathyroid as shown in Fig. 1C and D . Magnetic resonance imaging (MRI) of head region showed a hypoenhancement pattern lesion in the right half of the pituitary gland, which was suggestive of microadenoma ( Fig. 1E ) leading to the clinical and imaging diagnosis of MEN1 syndrome in 2022. PRRT from 2022 to 2023 with a total cumulative dose of 800 mCi (200 mCi per cycle at an interval of 8-12 weeks). Post-PRRT, 68 Ga-DOTATATE PET/CT scan ( Fig. 1F ) showed a reduction in size and SSTR uptake in duodenal and mesenteric NET lesions as compared with baseline 68 Ga-DOTATATE PET/CT scan ( Fig. 1A and B ), suggestive of a favorable response to PRRT.