Nucl Med Mol Imaging.  2020 Feb;54(1):43-47. 10.1007/s13139-019-00626-6.

Spleen Scan for ⁶⁸Ga-DOTATOC PET-Positive Pancreatic Tail Lesion: Differential Diagnosis of Neuroendocrine Tumor from Accessory Spleen

• Ryoo HG
• Choi H
• Cheon GJ

• KMID: 2507677
• DOI: http://doi.org/10.1007/s13139-019-00626-6

Abstract

⁶⁸Ga-DOTATOC PET/CT is widely used as a functional imaging technique in the detection and characterization of neuroendocrine tumors (NETs). Pancreatic NET and intrapancreatic accessory spleen (IPAS) have similar radiologic characteristics in anatomical imaging and usually show high uptake of 68Ga-DOTATOC. Thus, it is challenging to make a differential diagnosis between NET and IPAS when the tumor-like lesion is located in the pancreatic tail. Here, we present a case of ⁶⁸Ga-DOTATOC PET-positive pancreatic tail lesion with high arterial enhancement on CT and MRI. Since 99mTc-labeled damaged red blood cell does not accumulate on NET, a negative spleen scan finding was a crucial diagnostic step to decide surgical resection, which was histologically proven as insulinoma. Our case shows a promising role of additional use of spleen scan with SPECT/CT for the differential diagnosis of ⁶⁸Ga-DOTATOC PET-positive pancreatic NET from the accessory spleen.

Keyword

⁶⁸Ga-DOTATOC PET; Spleen scan; Neuroendocrine tumor; Accessory spleen