Fig. 4

A patient with progressive metastatic pancreatic NET (G2, Ki67 10%) with glucagon hypersecretion with no prior treatments. ¹⁸F-FDG PET (A) and ⁶⁸Ga-DOTATATE PET (B) showed a tracer avid lesion in the tail of the pancreas (arrowheads) and multiple hepatic metastases (brackets). As all lesions demonstrated intense ⁶⁸Ga-DOTATATE uptake with no ¹⁸F-FDG-avid/non-⁶⁸Ga-DOTATATE-avid disease, the disease was considered suitable for ¹⁷⁷Lu-DOTATATE treatment. Restaging imaging 3 months after 4 cycles of ¹⁷⁷Lu-DOTATATE showed complete metabolic response on ¹⁸F-FDG PET (C) and partial response on ⁶⁸Ga-DOTATATE PET (D). Restaging ¹⁸F-FDG PET (E) and ⁶⁸Ga-DOTATATE PET (F) 18 months later showed the development of an intensely ¹⁸F-FDG-avid/non-⁶⁸Ga-DOTATATE-avid lesion in the dome of the liver (arrows), therefore the patient was deemed to be not suitable for retreatment with ¹⁷⁷Lu-DOTATATE but considered for liver-directed therapy