Interesting images
Incidental Ga-68 DOTATATE uptake in an aggressive vertebral hemangioma
Captación incidental de Ga-68 DOTATATE en un hemangioma vertebral agresivo
Selin Kesim
, Kevser Oksuzoglu, Salih Ozguven
Corresponding author
Department of Nuclear Medicine, Marmara University Pendik Research and Training Hospital, Muhsin Yazıcıoğlu Street, TR-34899, Üstkaynarca, Pendik, Istanbul, Turkey
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El corte coronal de la TC (B) y de fusión PET/TC (C), sagital de la TC (D) y de fusión PET/TC (E) mostraron el signo característico de «tela de pana» o de «barras de cárcel» producido por la desmineralización del hueso, con la aparición de estrías verticales. El corte axial correspondiente de la TC (G) muestra claramente el aspecto de «dibujo de puntos» debido al engrosamiento de las trabéculas vertebrales, y las imágenes axiales de la PET (F) y de fusión PET/TC (H) muestran una moderada captación de [<span class="elsevierStyleSup">68</span>Ga]Ga DOTATATE (SUVmáx<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5,8), con compromiso del cuerpo vertebral y de elementos posteriores izquierdos de la sexta vértebra dorsal, hallazgos compatibles con un hemangioma vertebral agresivo (flechas).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Kesim, K. Oksuzoglu, S. 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Coronal slices of the studies performed at the beginning of the diagnosis (A) showing supradiaphragmatic lymph node involvement with a large cluster in supraclavicular, bilateral latero-cervical, bilateral axillary, mediastinal, retrocrural, retroperitoneal, bilateral common and external iliac and left femoral regions. In addition, he showed signs of splenic infiltration with no other extranodal foci. After three cycles of chemotherapy (interim) (B) where no pathological deposits of the tracer are visualized in ganglionic or extranodal chains and reported as Deauville 1. At the end of the treatment (C) he maintains the complete metabolic response already described in the previous study.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.P. Cózar Santiago, A. Cánoves Llombart, R. Sanz Llorens, M. Soler López, A. Escrivá Torres, J. Ferrer Rebolleda" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M.P." 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Coronal CT (B), fused PET/CT (C), sagittal CT (D), and fused PET/CT (E) images depicted characteristic “corduroy” or “jail bar” sign caused by bone demineralization with vertical striation. Corresponding axial CT (G) image clearly demonstrated “polka dot” appearance due to the thickened vertebral trabeculae and PET (F), fused PET/CT (H) images showed moderate Ga-68 DOTATATE uptake (SUVmax = 5.8) involving the body and left posterior elements of the sixth dorsal vertebrae, consistent with aggressive vertebral hemangioma (arrows).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 57-year-old woman, who had complaints of backache, chronic diarrhea and increased Chromogranin A levels, was referred to Ga-68 DOTATATE PET/CT to investigate a possible neuroendocrine tumor. There was no pathological Ga-68 DOTATATE uptake in the liver, stomach, pancreas, or intestine suggestive of neuroendocrine tumor. Interestingly, Ga-68 DOTATATE PET/CT images showed moderate Ga-68 DOTATATE uptake on T6 vertebral body extending through left posterior elements with polka dot appearance caused by thickened trabeculae on the corresponding CT images, consistent with aggressive vertebral hemangioma (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Vertebral hemangiomas are benign primary vascular tumors of bone, commonly located in the spine. Although most patients are asymptomatic, some lesions could have aggressive course, extend into the epidural space or involve the posterior elements leading to spinal compression and neurological deficits. The characteristic imaging pattern is coarsened vertical trabeculae on CT images and hyperintensity on T1- and T2-weighted magnetic resonance images.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Ga-68 DOTATATE is a somatostatin analogue with high affinity for somatostatin receptor subtype 2, and thus Ga-68 DOTATATE PET/CT is an established imaging method for neuroendocrine tumors. Inflammatory diseases or malignancy could demonstrate increased Ga-68 DOTATATE uptake in the skeleton due to the low expression of somatostatin receptors in osteoblasts. The precise mechanism of Ga-68 DOTATATE uptake in benign bone lesions have not clearly identified yet. Increased Ga-68 DOTATATE uptake in bone hemangiomas is limited to case reports and is assumed to be secondary to the expression of SSTR receptors in endothelial cells<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a>. However, these lesions are not always Ga-68 DOTATATE-avid<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>. Increased Ga-68 DOTATATE uptake in aggressive bone hemangiomas should be kept in mind as a potential pitfall while evaluating Ga-68 DOTATATE PET/CT images.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interests</span><p id="par0020" class="elsevierStylePara elsevierViewall">All the authors state that there were no conflicts of interests when the manuscript was written.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interests" ] 1 => array:2 [ "identificador" => "xack723465" "titulo" => "Acknowledgement" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Kesim S, Oksuzoglu K, Ozguven S. Captación incidental de Ga-68 DOTATATE en un hemangioma vertebral agresivo. Rev Esp Med Nucl Imagen Mol. 2021. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.remn.2021.11.005">https://doi.org/10.1016/j.remn.2021.11.005</span></p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 775 "Ancho" => 1500 "Tamanyo" => 133415 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Coronal MIP (A) images of Ga-68 DOTATATE PET/CT was negative for a neuroendocrine tumor, however, demonstrated increased uptake localized in the sixth thoracic vertebrae. Coronal CT (B), fused PET/CT (C), sagittal CT (D), and fused PET/CT (E) images depicted characteristic “corduroy” or “jail bar” sign caused by bone demineralization with vertical striation. Corresponding axial CT (G) image clearly demonstrated “polka dot” appearance due to the thickened vertebral trabeculae and PET (F), fused PET/CT (H) images showed moderate Ga-68 DOTATATE uptake (SUVmax = 5.8) involving the body and left posterior elements of the sixth dorsal vertebrae, consistent with aggressive vertebral hemangioma (arrows).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "68Ga DOTATATE uptake in hemangioma simulating metastasis on PET imaging: CT helps characterize bone hemangioma that could be wrongly interpreted as skeletal metastases on 68Ga DOTATATE PET imaging" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Vertenten" 1 => "L. Goethals" 2 => "F. De Geeter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5334/jbsr.1772" "Revista" => array:4 [ "tituloSerie" => "J Belg Soc Radiol." "fecha" => "2019" "volumen" => "103" "paginaInicial" => "38" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "(68)Ga DOTATATE uptake in vertebral hemangioma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Brogsitter" 1 => "T. Hofmockel" 2 => "J. Kotzerke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/RLU.0000000000000282" "Revista" => array:6 [ "tituloSerie" => "Clin Nucl Med." "fecha" => "2014" "volumen" => "39" "paginaInicial" => "462" "paginaFinal" => "463" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24152639" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "68Ga DOTATATE PET/CT uptake in spinal lesions and MRI correlation on a patient with neuroendocrine tumor: potential pitfalls" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. Klinaki" 1 => "A. Al-Nahhas" 2 => "N. Soneji" 3 => "Z. Win" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/RLU.0b013e31827a2325" "Revista" => array:5 [ "tituloSerie" => "Clin Nucl Med." "fecha" => "2013" "volumen" => "38" "paginaInicial" => "449" "paginaFinal" => "453" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack723465" "titulo" => "Acknowledgement" "texto" => "<p id="par0025" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000004200000003/v2_202401190458/S2253808921001750/v2_202401190458/en/main.assets" "Apartado" => array:4 [ "identificador" => "47121" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Interesting image" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000004200000003/v2_202401190458/S2253808921001750/v2_202401190458/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808921001750?idApp=UINPBA00004N" ]
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