Ga-DOTATOC Uptake by Stellate Ganglia, Mimicking a Right Cervical Metastasis of Neuroendocrine Tumors: A Case Report.

Ga-DOTATOC PET/CT is a functional imaging modality that has revolutionized the evaluation of well-differentiated neuroendocrine tumors (NETs) by targeting somatostatin receptors. This technique has largely replaced conventional gamma camera imaging with 111In-labeled octreotide due to its superior sensitivity and resolution. While the physiologic distribution, normal variations, and common pitfalls associated with Ga-DOTATOC imaging are well documented, rare but clinically significant pitfalls can still occur. We present a case highlighting one such pitfall: focal Ga-DOTATOC uptake at the cervicothoracic junction, specifically within the stellate ganglia, which mimicked metastatic involvement of a NET. Initially, the uptake was interpreted as a potential right cervical metastasis. To clarify this finding, a follow-up Ga-DOTATOC PET/CT was performed, which demonstrated no evidence of cervical metastases, thereby confirming the initial uptake as a physiologic variation rather than pathological activity. This case underscores the dynamic variability of Ga-DOTATOC uptake within the stellate ganglia in the same patient over time. On occasion, the intensity of physiologic uptake in these structures can be pronounced enough to mimic metastatic disease, posing a diagnostic challenge. Awareness of this rare phenomenon is essential to avoid misdiagnosis and unnecessary interventions.