Fig. 1
Discordant 68Ga-DOTATATE and 18F-FDG PET due to a second malignancy. A patient with a small intestinal NET, initially of G1 with Ki-67 2% but subsequently converted to G3 with Ki-67 30% based on later liver biopsy, with contemporaneous 68Ga-DOTATATE PET (A) and 18F-FDG PET (C) demonstrating concordant tracer avid known liver disease but extensive and heterogeneous 18F-FDG-avid/non-68Ga-DOTATATE avid in the axial and proximal appendicular skeleton, also demonstrated on sagittal fused PET/CT (B and D). Given the absence of skeletal uptake on the 68Ga-DOTATATE PET and high 18F-FDG uptake, bone marrow biopsy was performed demonstrating excess myeloid blasts consistent with early acute myeloid leukemia. Interestingly, blood counts were not significantly deranged at that time. No evidence of NET metastasis was identified on the bone marrow trephine