Alshalkhaty Albara, Al-Ward Ruaa, Esmail Abdullah, Abdelrahim Maen
College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.
Department of Neuroendocrinology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas, USA.
Chin Clin Oncol. 2025 Jun;14(3):36. doi: 10.21037/cco-25-18.
Neuroendocrine tumors (NETs) often express somatostatin receptors, which makes Gallium-68 DOTATATE positron emission tomography/computed tomography (68Ga-DOTATATE PET/CT) scan an important diagnostic tool. However, incidental brain uptakes on 68Ga-DOTATATE PET/CT scan pose a significant diagnostic challenge, where these uptakes can represent meningiomas or tumor metastasis.
This case report presents two cases of patients with low-grade NETs that had incidental brain uptake on 68Ga-DOTATATE PET/CT. In the first case, a 48-year-old female with a history of bronchial carcinoid tumor and Cushing's syndrome had incidental uptake near the right skull, which magnetic resonance imaging (MRI) confirmed as a stable meningioma. In the second case, a 65-year-old female with a grade 1 gastric NET had incidental uptake in the right temporal and left occipital lobes; however, follow-up MRI was negative. Given the affinity of meningiomas for somatostatin analogues, such findings can complicate the interpretation of PET/CT results.
Previous studies reported a prevalence of Incidental brain uptake on 68Ga-DOTATATE PET/CT scan between 1.6% to 11%. The prevalence of meningioma was between 1.6% to 9%. In minor cases, the uptake revealed other causes such as varix abnormalities and metastasis. MRI is considered essential for differentiating meningioma from tumor metastasis, although some cases of meningioma can be missed while showing on PET/CT. Incidental brain uptake on 68Ga-DOTATATE PET/CT scan, while usually suggestive of meningioma, requires follow-up with MRI to confirm the diagnosis and prevent unwarranted aggressive treatments. Awareness of the diagnostic challenges is crucial for the appropriate management of patients with NETs.
神经内分泌肿瘤（NETs）常表达生长抑素受体，这使得镓-68 DOTATATE 正电子发射断层扫描/计算机断层扫描（68Ga-DOTATATE PET/CT）成为一种重要的诊断工具。然而，68Ga-DOTATATE PET/CT 扫描时偶然出现的脑部摄取情况带来了重大的诊断挑战，这些摄取可能代表脑膜瘤或肿瘤转移。
本病例报告展示了两例低度 NETs 患者，其在 68Ga-DOTATATE PET/CT 扫描时出现了偶然的脑部摄取。第一例，一名 48 岁女性，有支气管类癌肿瘤和库欣综合征病史，在右侧颅骨附近出现偶然摄取，磁共振成像（MRI）证实为稳定的脑膜瘤。第二例，一名 65 岁女性，患有 1 级胃 NET，在右侧颞叶和左侧枕叶出现偶然摄取；然而，后续 MRI 检查结果为阴性。鉴于脑膜瘤对生长抑素类似物的亲和力，此类发现会使 PET/CT 结果的解读变得复杂。
先前的研究报告称，68Ga-DOTATATE PET/CT 扫描时偶然脑部摄取的发生率在 1.6%至 11%之间。脑膜瘤的发生率在 1.6%至 9%之间。在少数情况下，摄取显示出其他原因，如静脉曲张异常和转移。MRI 被认为对于区分脑膜瘤和肿瘤转移至关重要，尽管有些脑膜瘤病例在 PET/CT 上显示时可能会被漏诊。68Ga-DOTATATE PET/CT 扫描时偶然的脑部摄取，虽然通常提示脑膜瘤，但需要进行 MRI 随访以确诊并避免不必要的积极治疗。认识到这些诊断挑战对于 NETs 患者的恰当管理至关重要。
