Fig. 12

A patient with small intestinal NET (G1, Ki67 2%) with serial ⁶⁸Ga-DOTATATE PET images performed at 6-monthly intervals for disease surveillance was commenced on long-acting somatostatin analog therapy between the base-line scan (A) and 6-month scan, as indicated by the loss of thyroidal uptake (arrowhead) between these scans. Despite the possibility of “pseudoprogression” related to altered biodistribution following the introduction of SSAs, asymptomatic status and relatively stable measurable lesions on CT, rising chromogranin-A levels suggested progressive disease, which was confirmed by increasing intensity of metastasis in the thoracic region between the baseline (A, arrow) and 6-month (B, arrow) scans, and progression of peritoneal metastases in the pelvis between the 6- and 12-month (C, arrowheads) scans and an increasing number of liver lesions, most apparent on the 24-month scan (D, bracket)