case_images: PMC3628260_01
case_images: Whole body 68Ga-DOTANOC PET MIP (maximum intensity projection) image of a 53-year-old female diagnosed with a primary neuroendocrine tumor of the pancreas, showing area of intense radiotracer uptake within the abdomen (bold arrow). Also noted are areas of abnormal tracer uptake in an arborizing fashion distal to the area of primary abnormality (arrows)
case_images: IJNM-27-35-g001.jpg
case_images: PMC3628260_01_IJNM-27-35-g001.jpg
case_images: F1
case_images: In view of the disease progression, a staging PET/CT using 68Ga-DOTANOC was performed [Figure 1].
case_images: Sequential unenhanced CT, 68Ga-DOTANOC PET, and fused PET/CT images are shown. Upper row images display the primary pancreatic mass, which is homogenously enlarged and bulky, (a) and shows intense tracer avidity (b, SUVmax-53). Fused PET/CT image shows the tumor with uptake compatible with a pancreatic neuroendocrine tumor (c). Middle row images are axial sections to define the abnormal arborizing uptake seen on the MIP image. CT image shows enlarged mesenteric vessels (d, arrow) although a contrast-enhanced examination was not performed. Increased tracer uptake is noted in the area corresponding to enlarged blood vessels (e). Axial PET/CT section reveals enlarged primary inferior mesenteric vessels and its branches showing intense tracer uptake suggestive of tumor thrombus (f). Lower row images represent distal sections of the vasculature with similar findings (g-i). No areas of nodal of visceral tracer uptake were identified that may suggest metastatic disease. Hence, a diagnosis of primary pancreatic neuroendocrine tumor with mesenteric vessel thrombosis could be confirmed with 68Ga-DOTANOC PET/CT imaging
case_images: IJNM-27-35-g002.jpg
case_images: PMC3628260_01_IJNM-27-35-g002.jpg
case_images: F2
case_images: Also seen was an arborizing area of abnormal tracer uptake within the abdomen, which was subsequently traced to mesenteric vessels [Figure 2].