Sharjeel Usmani  ( Department of Nuclear Medicine, Kuwait Cancer Control Center (KCCC), Khaitan, Kuwait. )
Sanad Al-Mohtab  ( Department of Nuclear Medicine, Kuwait Cancer Control Center, Kuwait. )
Farah Luai Albader  ( Department of Nuclear Medicine , Kuwait Cancer Control Center, Kuwait, )
Fareeda al Kandari  ( Department of Nuclear Medicine, Kuwait Cancer Control Center (KCCC), Khaitan Kuwait. )

68Ga-DOTA NOC PET-CT imaging has been shown to have high accuracy for the evaluation of neuroendocrine tumours. We report a case of a 3-year-old boy who presented with a right paravertebral soft tissue mass. Biopsy showed ganglioneuroblastoma. The patient was referred for 68Ga-DOTA NOC for staging. 68Ga-DOTA NOC PET/CT images showed somatostatin-avid large right paravertebral soft tissue mass representing the primary lesion, along with increased radiotracer localization at multiple metastatic lytic bone lesions in the axial and appendicular skeleton. 68Ga-DOTA NOC PET-CT is helpful in the evaluation of the disease extent of neuroendocrine tumours including ganglioneuroblastoma

 

Keywords: 68Ga-DOTA NOC PET-CT, ganglioneuro blastoma, neuroendocrine tumours, PET/CT.

 

DOI: 10.47391/JPMA.07-23

 

A 3-year-old boy presented with a right paravertebral soft tissue mass. Biopsy revealed ganglioneuroblastoma. The patient was referred for 68Ga-DOTA NOC PET/CT for staging and showed a large right paravertebral soft tissue mass with increased radiotracer localization of        (SUVmax 8.2) invading the right 6th and 7th ribs. Multiple foci of increased radiotracer localization were noted at the right mandible showing lytic lesion on CT (SUVmax 5.1), posterior aspect of the right acetabulum (SUVmax 2.4), as well as the proximal and distal end of the left femur (SUVmax 2.1) (Figure:1). Additionally, multiple lytic lesions were seen at iliac bone with no tracer uptake. Findings were consistent with Somatostatin-avid paravertebral mass representing the primary site with multiple osseous metastatic disease involvement.

Ganglioneuroblastoma is a rare variant of peripheral neuroblastic tumours (neuroblastoma) and is the commonest solid extracranial tumour among children. After leukaemia and brain tumours, it is the third most common childhood malignancy. It can occur anywhere in the sympathetic nervous system and almost exclusively in children, with some adult cases reported1. Somatostatin receptors are expressed in most of these rare paediatric tumours and therefore, can be visualized with somatostatin receptor imaging techniques. 111In-DTPA-Octreotide single photon emission tomography (SPECT) imaging was initially investigated in children with solid tumours for diagnosis and post-therapy follow-up. Positron emission tomography (PET) imaging with 68Ga labeled DOTA conjugated peptides has gained great interest and momentum in recent years due to their significantly higher affinity for somatostatin receptor subtype 2 compared to 111In-DTPA-Octreotide. Few studies have demonstrated the safety of 68Ga-DOTATOC PET/CT in children and young adults, as well as the high accuracy for detection of somatostatin receptor type 2 positive tumours. PET/CT with 68Ga- labeled DOTA-peptides is known to be an excellent whole body imaging technique that complements conventional radiological imaging (MRI and CT) in the diagnosis and staging of neuroendocrine tumours and in particular, the diagnosis and follow-up of neuroblastoma2,3. However, the low incidence rate of ganglioneuroblastoma dictates that further studies are needed to reach a definite conclusion regarding the role of 68Ga- labeled DOTA-peptides PET/CT in the accuracy of staging and post-therapy follow-up of paediatric ganglioneuroblaastoma.

 

 

References

 

1.      Fatimi SH, Bawany SA, Ashfaq A. Ganglioneuroblastoma of the posterior mediastinum: a case report. J Med Case Rep. 2011;5:322.

2.      Abongwa C, Mott S, Schafer B, McNeely P, Abusin G, O'Dorisio T,et.al. Safety and accuracy of 68Ga-DOTATOC PET/CT in childrenand young adults with solid tumors. Am J Nucl Med Mol Imaging. 2017 ;7:228-235.

3. Maaz AUR, O'Doherty J, Djekidel M. 68Ga-DOTATATE PET/CT for Neuroblastoma Staging: Utility for Clinical Use. J Nucl Med

Technol. 2021;49:265-268