PMC8339957_01
Staging imaging; 123I-MIBG scintigraphy (A), 111In-Pentetreotide scintigraphy (B), 18F-FDG PET/CT (C), 68Ga-DOTATATE SPECT-CT PET/CT (D), Contrast-enhanced CT (E).
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A 18F-FDG PET/CT showed marked hypermetabolism (SUVmax 36) and central necrosis of the right intra-auricular mass. 111In-pentetreotide SPECT/CT demonstrated a high avidity of the cardiac lesion ( Figure 1 ).
Post-treatment 117Lu-DOTATATE maximum intensity projection (MIP) and axial fusion images. Post-treatment images 1 (A), 2 (B), # 3 (C) and 4 (D).
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SPECT/CTs ( Figure 2 ) performed following each treatment showed incremental anatomical response. 68Ga-DOTATATE PET/CT obtained at three months after the last treatment confirmed the partial response with the main cardiac lesion measuring 5.5 x 4.7 x 6.0 cm compared to 8.5 x 7.2 x 8.8 cm initially (32% reduction in largest dimension).
18F-FDG and 68Ga-DOTATATE PET/CT maximum intensity projection (MIP) imaging evolution; Staging (A, B) Pre-treatment (C), 3 months post-treatment (D), 7 months post-Treatment (E).
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Unfortunately, the follow-up 68Ga-DOTATATE PET/CT ( Figure 3 ) at seven months after the last induction cycle showed a significant increase of the primary tumor size (6.8 x 5.6 x 6.8 cm) equivalent to 117 cc, the development of mediastinal adenopathy and diffuse bone metastatic infiltration.