68Ga-DOTATATE Uptake in an Intraosseous Hemangioma, as a Potential Cause of False-Positive PET/CT Finding, Simulating Tumoral Involvement

Abstract

We present the case of a 32-year-old man with a history of hypophosphatemia and multiple bone fractures, being evaluated at our center for a potential mesenchymal tumor. 68 Ga-DOTATATE PET/CT revealed a highly 68 Ga-DOTATATE-avid lesion in the ethmoidal sinus extending to the nasal cavity. Following resection, histologic examination of the specimen confirmed the diagnosis of "intraosseous hemangioma," a potential cause of false-positive finding of 68 Ga-DOTATATE PET/CT imaging in patients being evaluated for occult malignancies, especially at the traumatic/ fractured sites.

Cardiac hemangioma mimicking a neuroendocrine tumor on 68 Ga Dotatate PET/CT

“…There have been reports of cardiac hemangiomas showing moderate 18 F FDG-avidity, [2][3][4] as well as noncardiac hemangiomas showing 68 Ga Dotatate avidity (up to SUV of 39.8 in an intraosseous hemangioma). 5,6 However, cardiac hemangioma showing 68 Ga Dotatate binding has not been reported previously; in fact, cardiac hemangiomas are typically cold in such studies. 7 This case is the first F I G U R E 2 Gross and microscopic pathology characteristics.…”

“…Our case is a rare presentation of cardiac hemangioma with 68 Ga Dotatate avidity. There have been reports of cardiac hemangiomas showing moderate 18 F FDG‐avidity, 2–4 as well as noncardiac hemangiomas showing 68 Ga Dotatate avidity (up to SUV of 39.8 in an intraosseous hemangioma) 5,6 . However, cardiac hemangioma showing 68 Ga Dotatate binding has not been reported previously; in fact, cardiac hemangiomas are typically cold in such studies 7 .…”

The Role of [68Ga]Ga-DOTA-SSTR PET Radiotracers in Brain Tumors: A Systematic Review of the Literature and Ongoing Clinical Trials

“…Most lesions were meningiomas (93%), followed by pituitary adenomas (4.2%). Less common SSTR2-positive brain tumors were also described, including: brain metastases (15 patients, 1.7%) from breast cancer (6 patients) [ 54 , 55 , 64 ], neuroendocrine neoplasms (NEN) (2 patients) [ 70 , 76 ], gastric cancer (1 patient) [ 40 ], head and neck cancer (1 patient) [ 54 ], lymphoma (1 patient) [ 54 ], rectal cancer (1 patient) [ 54 ], renal cell carcinoma (1 patient) [ 54 ], thyroid cancer (1 patient) [ 48 ], and uterine cancer (1 patient) [ 54 ]; pituitary carcinomas (3 patients, 0.2%) [ 47 , 67 , 75 ]; granulomatous inflammation (2 patients, 0.2%) [ 40 , 42 ]; lymphoma (2 patients, 0.2%) [ 40 , 58 ]; glomus jugulare (1 patient, 0.1%) [ 73 ]; hemangioma (1 patient, 0.1%) [ 78 ]; and schwannoma (1 patient, 0.1%) [ 74 ]. DOTATATE (54.5%) was utilized more frequently than DOTATOC (45.5%).…”

False-Positive Uptake in Splenic Hemangioma on 68Ga-DOTATATE PET/CT

“…However, several sources of false-positive uptake have been characterized in the literature, most commonly in vertebral and other intraosseous hemangiomas. [1][2][3][4] False-positive uptake within nodal hemangiomas, 5 anastomosing hemangiomas, 6 as well as a case of suprasellar hemangioblastoma 7 have also been reported. Other sources of false-positive uptake include meningiomas, degenerative bone disease, fractures, reactive nodes, prostatitis, splenosis, and physiologic prominent uptake in the pancreatic uncinate process.…”

“…68 Ga-DOTATATE PET/CT is a commonly used modality for the detection of neuroendocrine tumors. However, several sources of false-positive uptake have been characterized in the literature, most commonly in vertebral and other intraosseous hemangiomas 1–4 . False-positive uptake within nodal hemangiomas, 5 anastomosing hemangiomas, 6 as well as a case of suprasellar hemangioblastoma 7 have also been reported.…”