Procedure: NM PET/CT GA DOTATATE

Exam Date: 9/11/2019 10:35 AM

Reason for Study: Hx neuroendocrine tumor follow-up.

TECHNIQUE: Approximately 63 minutes after the intravenous

injection of 5.25 mCi Ga-68 DOTATATE via a left antecubital vein,
whole body PET and non-iv-contrast-enhanced CT for attenuation
correction and anatomic localization was performed from the skull
vertex to the proximal thighs. At the time of the examination patient
weight was determined to be 66.3 kg. All SUVs of the index lesions
presented are maximum values based on whole-body weight unless
otherwise specified.

COMPARISON: Ga-68 PET/CT dated 5/3/2019.

Chromogranin A: 41 nmol/L (7/2/2019)

FINDINGS:

HEAD AND NECK: Redemonstration of a 8 mm gallium-68 avid, SUV

4.3 compared to prior SUV 4.9, left cervical level 6 stable when
compared to prior exam.

CHEST: No somatostatin receptor positive lesion is identified within

the chest. Again seen is a fat containing right Bochdalek
diaphragmatic hernia.
There is small pericardial effusion worse when compared to prior
exam. There is triple vessel coronary atherosclerotic disease. Small
symmetric gynecomastia is similar when compared to prior exam.

ABDOMEN AND PELVIS: Redemonstration of postoperative changes

reflecting partial hepatectomy, splenectomy and distal
pancreatectomy. There is intense gallium-68 uptake along the
pancreatectomy suture, SUV 33.6 compared to prior to and 9.4
corresponding to an ill-defined soft tissue density.

Gallium-68 hepatic lesions are also present similar when compared to

prior examination. Representative examples are as follows:
  Hepatic segment 4B, SUV 9.6 compared to prior SUV 11.5,
measures 1.2 cm.
 Hepatic segment 2, SUV 8.1 compared to prior SUV 7.5 difficult
to measure.

There is redemonstration of confluent lymphadenopathy encasing the

superior mesenteric artery, SUV 38.7 compared to prior SUV 44.9,
measures approximately 3.8 x 3.9 cm compared to 5.3 x 4.9 cm.
Other Gallium 68 avid lymph nodes are as follows:
 Right retrocrural, SUV 10.1 compared to prior SUV 7.8.
 Left para-aortic (PET image 133) SUV 49.3 (prior SUV 37.9).
 Left periaortic (PET image 142) SUV 44.3 (prior SUV 35.6).
 Left lower mesentery SUV 20.4 (prior 15.0).

Redemonstration of severe left hydronephrosis with left renal

parenchymal thinning, similar when compared to prior exam.

MUSCULOSKELETAL: There is redemonstration of multiple gallium-

68 avid osseous lesions (approximately 10) with interval changes as
follows:
 Left skull base/ in the vicinity of the jugular canal, SUV 13, similar
when compared to prior exam.
 Right proximal humeral diaphysis, SUV 9.4 compared to prior SUV
10.3.
 Left anterior scapula, SUV 8.7 compared to prior SUV 11.6.
 L1 vertebral body, SUV 20.6 compared to prior SUV 21.9.

IMPRESSION:

1. Redemonstration postoperative changes reflecting right

hepatectomy, splenectomy and distal pancreatectomy. Minimal
decrease tumor burden with persisting gallium-68 avid disease is
noted along the pancreatectomy surgical margin compatible
recurrent/residual disease versus metastatic lymphadenopathy.
2. Redemonstration of gallium-68 avid metastatic lymphadenopathy
above and below the diaphragm without significant interval change on
CT although, some of the SUV values have slightly increased as
detailed above.
3. Redemonstration of hepatic and osseous metastatic disease not
significantly changed when compared to prior exam.
4. Other incidental findings are outlined the body report.