PMC4729020_01
131I MIBG whole-body (a) anterior and (b) posterior images show physiological tracer distribution but for increased pelvic tracer activity. Subsequent SPECT/CT and CT (c and d) sagittal (e and f) transaxial (g and h) coronal images of pelvic region show non-tracer-avid soft-tissue mass involving bladder and prostate, while visualized tracer activity in the pelvis was localized to accumulated urine in bladder
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F1
The patient underwent 131I MIBG whole-body and subsequently 68Ga DOTANOC PET/CT to look for functional status as well as other possible lesions. 131I MIBG whole-body scan [Figure 1] showed physiological tracer distribution except increased pelvic activity.
68Ga DOTANOC PET/CT maximum intensity projection (MIP) image (a) shows large tracer activity in pelvis with dilated left ureter. Fused PET/CT and CT coronal (b-c and f-g) and transaxial images (d-e and h-i) show SSTR-expressing heterogeneous soft-tissue mass (~8.0 x 6.4 cm) with coarse calcification (arrow) in the prostate, infiltrating posterior wall of the urinary bladder and extending into bladder lumen with metastatic involvement of the right common iliac, internal iliac (arrow head), and bilateral external iliac lymph nodes
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F2
Subsequent single-photon emission computed tomography/computed tomography (SPECT/CT) pelvis revealed a non-tracer-avid soft-tissue mass involving the bladder and prostate, while visualized activity on planar images was localized to accumulated urine in the bladder. 68Ga DOTANOC PET/CT [Figure 2] revealed a somatostatin receptor (SSTR)-expressing heterogeneous soft-tissue mass (~8.0 x 6.4 cm) with coarse calcification in the prostate, infiltrating the posterior wall of the urinary bladder and extending into the bladder lumen, with metastatic involvement of the right common iliac, internal iliac, and bilateral external iliac lymph nodes.