Triple Tracer Positivity in Metastatic Lymph Nodes From Well-Differentiated Neuroendocrine Tumor in MEN 1 Syndrome

J Nucl Med Technol. 2020 Feb 28;jnmt.119.237339. doi: 10.2967/jnmt.119.237339. Online ahead of print.

Abstract

Patients with multiple endocrine neoplasia type-1 (MEN-1) usually have combination of endocrine disorders due to lesions in pancreas, parathyroid and pituitary glands. Functional imaging using different tracers in addition to conventional imaging are employed in localizing the primary sites, disease extent and lesions characterization. Here is a diagnosed case of MEN-1 syndrome with interesting incidental imaging findings showing 99mTc-sestamibi and 18F-choline uptakes in addition to 68Ga-DOTANOC uptake in metastatic mediastinal and cervical lymph nodes arising from gastro-entro-pancreatic neuroendocrine tumor (GEP NET). This shows the possibility of imaging the NETs with three different tracers namely - 68Ga-DOTANOC, 99mTc-sestamibi and 18F-fluorocholine.

Keywords: F-18 fluorocholine; Ga-68 DOTANOC; MEN-1; Molecular Imaging; Neuroendocrine; Neuroendocrine tumor; PET/CT; Tc-99m sestamibi.