SSTR antagonist [68Ga]Ga-DOTA-LM3 differentiates intrapancreatic accessory spleen from neuroendocrine tumor in a patient presenting indeterminate MRI and SSTR agonist [68Ga]Ga-DOTATATE.

A 46-year-old woman presented with upper abdominal pain and was initially suspected to have a pancreatic neuroendocrine tumor (NET) based on MRI signs. However, a SSTR2-targeted PET/CT scan using [68Ga]Ga-DOTATATE showed intense radiotracer uptake in the pancreatic nodule, similar to the adjacent spleen. To further differentiate between the two, a [68Ga]Ga-DOTA-LM3 PET/CT scan was performed, which showed no increased uptake in the pancreatic nodule, indicating a lower likelihood of neoplasia. A laparoscopic distal pancreatectomy confirmed the presence of an intrapancreatic accessory spleen (IPAS). This case highlights the challenges in differentiating pancreatic NETs from IPAS and suggests that [68Ga]Ga-DOTA-LM3 PET/CT may be helpful in making this distinction. [Extracted from the article]