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Background: Somatostatin receptor (SSR) targeting radiotracer 68Ga-DOTATATE is used for Positron Emission Tomography (PET)/Computed Tomography (CT) imaging to assess patients with Pheochromocytoma and paraganglioma (PPGL), rare types of Neuroendocrine tumor (NET) which can metastasize thereby becoming difficult to quantify. The goal of this study is to develop an artificial intelligence (AI) model for automated lesion segmentation on whole-body 3D DOTATATE-PET/CT and to automate the tumor burden calculation. 132 68Ga-DOTATATE PET/CT scans from 38 patients with metastatic and inoperable PPGL, were split into 70, and 62 scans, from 20, and 18 patients for training, and test sets, respectively. The training set was further divided into patient-stratified 5 folds for cross-validation. 3D-full resolution nnUNet configuration was trained with 5-fold cross-validation. The model's detection performance was evaluated at both scan and lesion levels for the PPGL test set and two other clinical cohorts with NET (n = 9) and olfactory neuroblastoma (ONB, n = 5). Additionally, quantitative statistical analysis of PET parameters including SUVmax, total lesion uptake (TLU), and total tumor volume (TTV), was conducted. Results: The nnUNet AI model achieved an average 5-fold validation dice similarity coefficient of 0.84 at the scan level. The model achieved dice similarity coefficients (DSC) of 0.88, 0.6, and 0.67 at the scan level, the sensitivity of 86%, 61.13%, and 61.64%, and a positive predictive value of 89%, 74%, and 86.54% at the lesion level for the PPGL test, NET and ONB cohorts, respectively. For PPGL cohorts, smaller lesions with low uptake were missed by the AI model (p < 0.001). Anatomical region-based failure analysis showed most of the false negative and false positive lesions within the liver for all the cohorts, mainly due to the high physiologic liver background activity and image noise on 68Ga- DOTATATE PET scans. Conclusions: The developed deep learning-based AI model showed reliable performance for automated segmentation of metastatic PPGL lesions on whole-body 68Ga-DOTATATE-PET/CT images, which may be beneficial for tumor burden estimation for objective evaluation during therapy follow-up. https://www.clinicaltrials.gov/study/NCT03206060, https://www.clinicaltrials.gov/study/NCT04086485, https://www.clinicaltrials.gov/study/NCT05012098. [ABSTRACT FROM AUTHOR]

Abstract Background Somatostatin receptor (SSR) targeting radiotracer 68Ga-DOTATATE is used for Positron Emission Tomography (PET)/Computed Tomography (CT) imaging to assess patients with Pheochromocytoma and paraganglioma (PPGL), rare types of Neuroendocrine tumor (NET) which can metastasize thereby becoming difficult to quantify. The goal of this study is to develop an artificial intelligence (AI) model for automated lesion segmentation on whole-body 3D DOTATATE-PET/CT and to automate the tumor burden calculation. 132 68Ga-DOTATATE PET/CT scans from 38 patients with metastatic and inoperable PPGL, were split into 70, and 62 scans, from 20, and 18 patients for training, and test sets, respectively. The training set was further divided into patient-stratified 5 folds for cross-validation. 3D-full resolution nnUNet configuration was trained with 5-fold cross-validation. The model’s detection performance was evaluated at both scan and lesion levels for the PPGL test set and two other clinical cohorts with NET (n = 9) and olfactory neuroblastoma (ONB, n = 5). Additionally, quantitative statistical analysis of PET parameters including SUVmax, total lesion uptake (TLU), and total tumor volume (TTV), was conducted. Results The nnUNet AI model achieved an average 5-fold validation dice similarity coefficient of 0.84 at the scan level. The model achieved dice similarity coefficients (DSC) of 0.88, 0.6, and 0.67 at the scan level, the sensitivity of 86%, 61.13%, and 61.64%, and a positive predictive value of 89%, 74%, and 86.54% at the lesion level for the PPGL test, NET and ONB cohorts, respectively. For PPGL cohorts, smaller lesions with low uptake were missed by the AI model (p

This case report follows a 63-year-old female patient with a history of a gastroenteropancreatic (GEP) neuroendocrine tumor of the terminal ileum who developed ovarian metastasis and later progressed to peritoneal carcinomatosis. The patient was found to have worsening metastasis on CT that was subsequently confirmed with (68Ga)-DOTATATE PET/CT imaging. This case outlines the rare metastatic nature of a primary ileal neuroendocrine tumor and emphasizes the efficacy of (68Ga)-DOTATATE PET/CT imaging in the localization, progression, and treatment of neuroendocrine metastatic disease.

This case report follows a 63-year-old female patient with a history of a gastroenteropancreatic (GEP) neuroendocrine tumor of the terminal ileum who developed ovarian metastasis and later progressed to peritoneal carcinomatosis. The patient was found to have worsening metastasis on CT that was subsequently confirmed with ( 68 Ga)-DOTATATE PET/CT imaging. This case outlines the rare metastatic nature of a primary ileal neuroendocrine tumor and emphasizes the efficacy of ( 68 Ga)-DOTATATE PET/CT imaging in the localization, progression, and treatment of neuroendocrine metastatic disease., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Introduction: Pancreatic neuroendocrine tumors (PNETs) are typically diagnosed using endoscopic ultrasound-guided (EUS) biopsy, which can be associated with complications. Since 2016, DOTATATE PET/CT has emerged as an effective tool to localize and stage PNETs., Methods: Patients with PNETs who underwent R0 resections were identified from the 2004-2019 National Cancer Database PUF. Joinpoint regression and multivariable logistic regression were used to analyze trends in the use of biopsy., Results: Of 16,746 R0 resected PNET patients, 44 ​% underwent diagnostic biopsy. Joinpoint regression showed a significant increase in the use of biopsy from 2004 to 2019 (APC 1.80, p ​< ​0.001). A higher percentage of patients diagnosed after DOTATATE approval underwent biopsy compared to those diagnosed before (48 ​% vs. 42 ​%, p ​< ​0.001). Adjusted analysis showed diagnosis after 2016 was associated with increased odds of biopsy (OR ​= ​1.67, p ​< ​0.001)., Conclusions: Despite technologic advancement with DOTATATE PET/CT, there has been a significant increase in the proportion of resectable PNETs undergoing preoperative biopsy., Competing Interests: Declaration of competing interest The authors report no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Gallbladder paraganglioma is a very rare condition, and only a few cases have been reported in the literature. Herein, we present and discuss the clinical and radiological findings of a 72-year-old woman who complained of heaviness, pain, and on and off watery discharge from the left ear for 1 year and reduced hearing in both ears. She was thoroughly investigated radiologically where multiple paragangliomas were found with the discovery of the very rare gallbladder paraganglioma. There is a need to realize the importance of thorough radiological evaluation in cases of head and neck paraganglioma to look for more such lesions in the body for early identification of patients with familial paraganglioma syndromes. With this practice, gene mutation carriers can be identified early in the course of their disease and brought to surgical attention before their disease becomes extensive and potentially life-threatening.

We present a case of a 53-year-old woman with metastatic neuroendocrine tumor, presumed primary in the small intestine with metastases to the liver and mesenteric lymph nodes. The patient was being treated with lanreotide and followed with somatostatin receptor (SSTR)-targeted 68Ga-labeled 1,4,7,10-tetraazacyclododecane-N,N', N'',N'''-tetraacetic acid-d-Phe(1)-Tyr(3)-octreotate (68Ga-DOTATATE) positron emission tomography – computed tomography (PET/CT). On a follow-up exam, the patient's primary and metastatic disease had improved but she had new 68Ga-DOTATATE-avid lesions in the right breast and right axilla. Subsequent breast imaging workup and biopsy demonstrated a primary breast cancer and axillary lymph node metastasis.

Gallbladder paraganglioma is a very rare condition, and only a few cases have been reported in the literature. Herein, we present and discuss the clinical and radiological findings of a 72-year-old woman who complained of heaviness, pain, and on and off watery discharge from the left ear for 1 year and reduced hearing in both ears. She was thoroughly investigated radiologically where multiple paragangliomas were found with the discovery of the very rare gallbladder paraganglioma. There is a need to realize the importance of thorough radiological evaluation in cases of head and neck paraganglioma to look for more such lesions in the body for early identification of patients with familial paraganglioma syndromes. With this practice, gene mutation carriers can be identified early in the course of their disease and brought to surgical attention before their disease becomes extensive and potentially life-threatening. [ABSTRACT FROM AUTHOR]