Detection of “Incidentalomas” on Brain and Body⁶⁸Ga-DOTATOC-PET Scans: A Retrospective Study and Case Illustration

Abstract

Background/Aim: One of the main limitations of standard imaging modalities is microscopic tumor extension, which is often difficult to detect on magnetic resonance imaging (MRI) and computer tomography (CT) in the early stages of the tumor. ( 68)Ga-DOTA(0)-Phe(1)-Tyr(3)-octreotide positronemission tomography/computed tomography ( 68 Ga-DOTATOC PET/CT) has shown efficacy in detecting lesions previously undiagnosed by neuroimaging modalities, such as MRI or CT, and has enabled the detection of multiple benign tumors (like multiple meningiomas in a patient presenting with a single lesion on MRI) or additional secondary metastatic locations. Patients and Methods: We retrospectively reviewed data from the Cannizzaro Hospital on brain and body 68 Ga-DOTATOC PET/CT "incidentalomas", defined as tumors missed on CT or MRI scans, but detected on 68 Ga-DOTATOC PET/CT scans. "Incidentalomas" were classified into "brain" and "body" groups based on their location. The standardized uptake values (SUVs) were compared between the two groups. Results: A total of 61 patients with "incidentalomas" documented on the 68 Ga-DOTATOC PET/CT were identified: 18 patients with 25 brain lesions and 43 patients with 85 body lesions. The mean SUV at baseline was 9.01±7.66 in the brain group and 14.8±14.63 in the body group. Conclusion: We present the first series on brain and body "incidentalomas" detected on 68 Ga-DOTATOC PET/CT. Whole-body 68 Ga-DOTATOC PET/CT may be considered in selected patients with brain tumors with high expression of somatostatin receptors to assist radiosurgical or surgical planning and, simultaneously, provide accurate followup with early detection of potential metastases.Somatostatin receptor subtype 2 (SSTR2)-based positron emission tomography (PET), in the form of Gallium-68 DOTA-Phe1-Tyr3-Octreotide ( 68 Ga-DOTATOC), Gallium 68 ( 68 Ga) 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)-octreotate ( 68 Ga-DOTATATE), and 68 Ga-Labeled(1,4,7,10-tetraazacyclododecane-N,N',N'',N'''tetraacetic acid)-1-NaI3-octreotide ( 68 Ga-DOTANOC), has been reported as a useful diagnostic tool in patients with meningiomas, with level II evidence for its use in tumor contouring for radiotherapy planning (1). While planning stereotactic radiosurgery (SRS) for patients with meningiomas, the primary treatment goal is to target all clonogenic tumor cells within the lesion and plan a clinical target volume (CTV), defined as the tumor volume comprising the gross tumor volume (GTV), and subclinical malignant disease (2). However, the main limitation of this technique relates to the 5867

Innovations in craniovertebral junction training: harnessing the power of mixed reality and head-mounted displays

“…27 Additionally, mixed reality has emerged as a modality of interactive academic content consumption. 28 The utility of mixed reality as a training tool has particular appeal because it combines the immersiveness and potential of VR with the intuitiveness and orientation of AR. The HoloLens 2, specifically as the medium of mixed reality, has been used to assess the clinical evaluation skills of medical students with good accuracy.…”

Management of recurrent giant hemangiopericytoma: illustrative cases

“…This imaging modality may be of particular benefit in the setting of HPC, given the lesion’s likelihood of recurrence and metastasis. 35 …”

An unusual presentation of ossified spinal meningioma: case report and literature review

“…In addition, 18F-FDG PET/CT is not a routine examination for the diagnosis of OSM. However, recent studies have shown that new specific tracers, such as 68Ga-DOTA-SSTR and 68Ga-DOTATOC, can improve the diagnostic accuracy of meningiomas and assist radiosurgical or surgical planning ( 41 , 42 ).…”