Physiological uptake of Ga-68 DOTATATE at the uncinate process of pancreas

Case contributed by Dr Bruno Di Muzio

Presentation

Increased 5-HIAA. Carcinoid?

Patient Data

Age: 50 years
Gender: Male

Unremarkable CT of the abdomen and pelvis, no pancreatic abnormalities identified. 

Ga-68 DOTA-octreotate (GaTate, DOTA-TATE)

Nuclear medicine

No focal abnormal uptake is seen in the small bowel or pancreas. No abnormal uptake is seen in the lung fields. No nodal or distant metastases.

Further findings: physiologic uptake in the uncinate process of the pancreas. There is a symmetric uptake in the partially calcified mediastinal and hilar lymph nodes representing reactive etiology. The distribution of radiotracer elsewhere is physiologic.

Case Discussion

This case illustrates part of the imaging work up for a neuroendocrine tumor. CT chest, abdomen, and pelvis and GaTate (gallium-68 DOTA-TATE) PET/CT were normal with no underlying carcinoid tumor. 

The increased uptake seen in the pancreatic head is a recognized physiological finding that happens in some of the scans and should be interpreted with caution. SUV quantification is advised to avoid false positives, as the physiological uptake is similar to the uptake in the liver (uptake ratio head to liver SUVav < 1.4) 1.

The 5-HIAA was only mildly elevated in this patient and, in the context of a normal of GaTate PET/CT, carcinoid syndrome was considered unlikely to explain the patient's symptoms (flushing and diarrhea). 

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