Fig. 3
A patient with well-differentiated pancreatic NET (G3, Ki67 40%). 68Ga-DOTATATE PET (A) and 18F-FDG PET (B) showed heterogeneously tracer avid pancreatic mass with some areas (the medial component of the mass) demonstrating relatively higher 18F-FDG-avidity compared to 68Ga-DOTATATE avidity (circles). Large volume hepatic metastases were also noted with several areas demonstrating higher avidity on 18F-FDG PET (brackets). Due to high-grade pathology and a large-volume disease with some areas of heterogeneity on baseline scans, the patient was deemed not suitable for treatment with 177Lu-DOTATATE and therefore treated with chemotherapy. Restaging studies following 4 cycles of chemotherapy showed marked partial response on 68Ga-DOTATATE PET (C) with disease demonstrating more homogenous and higher tracer avidity (bracket). Contemporaneous 18F-FDG PET (D) showed marked partial response in the pancreas (circle) and resolution of metabolic activity in the liver except for one lesion which also demonstrated 68Ga-DOTATATE avidity (arrows). At this time point, the patient was deemed suitable for treatment with 177Lu-DOTATATE to consolidate the response to the prior treatment