Tracer — DOTATATE PET/CT
⁶⁸Ga-DOTATATE PET/CT Cases
Somatostatin receptor imaging for neuroendocrine tumors, paraganglioma, and theranostic eligibility. The gatekeeper scan for PRRT.
Krenning ScorePRRT EligibilityNeuroendocrine TumorsParagangliomaTheranosticsFlip-Flop Phenomenon
Well-differentiated NETs overexpress somatostatin receptors 2 and 5, making DOTATATE PET highly sensitive. Krenning scoring at each lesion site determines PRRT eligibility.
Cases Coming Soon
Ileal NET — Staging & PRRT Eligibility
Carcinoid syndromeMesenteric desmoplastic reactionHepatic metastasesKrenning scoringPRRT eligibility
Cases Coming Soon
Pancreatic NET
Insulinoma — often DOTATATE-negativeNon-functioning pNETUncinate vs pathologic massSurgical planning
Cases Coming Soon
Pulmonary & Other NETs
Typical vs atypical carcinoidBronchial carcinoidThymic NETUnknown primary NET
Cases Coming Soon
Grade & DOTATATE Avidity
G1 — highest avidityG2 — variableG3 — often negativeKi-67 correlation
⚠️ Pitfalls & Normal Variants — Cases Coming Soon
NET Pitfalls
Uncinate process — intense physiologic uptakePituitary gland — always intenseAdrenal glandsAccessory spleenSpleen as reference — NEVER use
DOTATATE PET is highly sensitive for SDHB/SDHD-related paragangliomas and head & neck paragangliomas. Superior to MIBG for many subtypes.
Cases Coming Soon
Head & Neck Paraganglioma
Carotid body tumorJugulotympanicVagal paragangliomaBilateral diseaseSDH mutations
Cases Coming Soon
Adrenal Pheochromocytoma
Unilateral vs bilateralMEN2A associationVHL-relatedDOTATATE vs MIBG comparison
Cases Coming Soon
Extra-Adrenal & Metastatic
Retroperitoneal paragangliomaOrgan of ZuckerkandlMetastatic diseaseTheranostic planning
⚠️ Pitfalls & Normal Variants — Cases Coming Soon
Paraganglioma Pitfalls
Normal adrenal medulla uptakeLymph node vs paragangliomaMIBG-positive DOTATATE-negative variantsAccessory spleen mimicry
DOTATATE PET is the gatekeeper for PRRT. All sites of disease must demonstrate Krenning ≥4 uptake. Before/after pairs illustrate treatment response.
Cases Coming Soon
Pre-PRRT Eligibility Assessment
Krenning score per siteLiver reference standardAll lesions must be ≥4NETTER-1 eligibility criteria
Cases Coming Soon
Post-PRRT Response Assessment
SUV reductionNew lesionsMixed responseWhen to re-treat
Cases Coming Soon
Flip-Flop Phenomenon
G1→G3 dedifferentiationDOTATATE-negative FDG-avidBoth tracers neededRebiopsy before changing management
⚠️ Pitfalls & Normal Variants — Cases Coming Soon
Theranostics Pitfalls
Spleen as reference — always use liverSingle low-Krenning lesion excludes PRRTPost-PRRT stunningPseudo-progression on early post-therapy scan
DOTATATE has intense physiologic uptake in multiple organs. Knowing these patterns is essential before reading any case.
Cases Coming Soon
Physiologic Uptake — High Intensity
Spleen — highest of all organsKidneysAdrenal glandsPituitary glandLiver — use as reference
Cases Coming Soon
Physiologic Uptake — Variable
Uncinate process of pancreasThyroid glandSalivary glandsBowel — variable
Cases Coming Soon
Benign Lesions with Uptake
MeningiomaAccessory spleenBreast tissueInflammation
Key References & Resources