Akademik Veri Yönetim Sistemi
ACTA ENDOCRINOLOGICA-BUCHAREST, cilt.19, sa.1, ss.104-107, 2023 (SCI-Expanded)
A 57 years old woman was diagnosed with well -differentiated lung neuroendocrine tumor (NET) by laboratory assessment, computed tomography (CT), contrast-enhanced magnetic resonance imaging (MRI) and bronchoscophy with transbroncial biopsy of nodular lung lesion located in the right lower lobe. Staging Ga-68 positron emission tomography-CT (PET-CT) showed two pathological uptake regions in the superior segment of the right lung lower lobe (SUVmax: 80.61) and 6th thoracic vertebral body (SUVmax: 3.70). Contrast-enhanced MRI findings suggested that vertebral lesion may be compatible with atypical hemangioma or osseous metastasis due to T1 isointensity, T2 hyperintensity and contrast-enhancement on the lesion. Therefore, characteristic imaging findings of hemangioma were seen on axial and sagittal or coronal sections of CT, respectively called as 'polka dot' and 'corduroy cloth'. Thus the mild vertebral Ga-68 DOTATATE uptake was accepted as false positive finding. Surgical intervention was decided. She underwent a right lung lobectomy. The last follow-up of the patient was done 2 years after the initial diagnosis. The follow-up Ga-68 DOTATATE PET-CT revealed no pathological increased uptake in the whole-body except the 6th vertebra showing similar uptake (SUVmax: 3.50) with the previous scan without size increase on CT. The patient was asymptomatic with normal serum chromogranin A level.computed tomography (CT) has been demonstrated to have higher image quality and sensitivity than single photon emission computed tomography (SPECT)-CT (1). A GaTate PET-CT imaging has good sensitivity and specificity in detection of primary NETs and to determine the recurrent or metastatic disease from NET. However, it is also noticed that inflammatory, granulomatous or degenerative processes and some benign pathologies involving vertebral hemangioma may cause false positives (2-5). In such patients, differentiation of vertebral hemangioma from bone metastasis is critical to make an appropriate patient management (5). When we search English literature we found four case reports mentioning the coexistence of NET and vertebral hemangioma in patients who underwent GaTate PET-CT. The GaTate uptake in vertebral hemangioma was seen in three of these cases, but there was no uptake in one of them (6-9). This case report presents multimodal imaging findings of a 57-year-old female patient with well -differentiated lung NET. This case highlights the contribution of the combined evaluation of metabolic and anatomical information to avoid misjudgment. To the best of our knowledge this is the first report of the GaTate-avid vertebral hemangioma in a pulmonary NET case.