[68Ga]Ga-DOTANOC Uptake at Pancreatic Head/Uncinate Process: Is It a Persistent Diagnostic Pitfall Over Time?

Elena Tabacchi; Emilia Fortunati; Giulia Argalia; Lucia Zanoni; Diletta Calabrò; Silvi Telo; Davide Campana; Giuseppe Lamberti; Claudio Ricci; Riccardo Casadei; Stefano Fanti; Valentina Ambrosini

doi:10.3390/cancers14143541

[68Ga]Ga-DOTANOC Uptake at Pancreatic Head/Uncinate Process: Is It a Persistent Diagnostic Pitfall Over Time?

Cancers (Basel). 2022 Jul 21;14(14):3541. doi: 10.3390/cancers14143541.

Authors

Elena Tabacchi¹, Emilia Fortunati², Giulia Argalia², Lucia Zanoni¹, Diletta Calabrò^{2

3}, Silvi Telo^{2

4}, Davide Campana^{5

6}, Giuseppe Lamberti⁶, Claudio Ricci^{7

8}, Riccardo Casadei^{7

8}, Stefano Fanti^{1

2}, Valentina Ambrosini^{1

2}

Affiliations

¹ Nuclear Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
² Nuclear Medicine, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy.
³ Nuclear Medicine Unit, Ospedale Guglielmo da Saliceto, Azienda USL di Piacenza, 29121 Piacenza, Italy.
⁴ Nuclear Medicine Unit, AUSL Romagna, 47521 Cesena, Italy.
⁵ Oncology, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
⁶ DIMES, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy.
⁷ Pancreatic Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
⁸ DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy.

Abstract

Purpose: [68Ga]Ga-DOTA-peptide uptake in the pancreatic head/uncinate process (UP) is a frequent PET/CT finding. Although mostly physiologic, it can represent a pitfall in PET/CT reading, especially when focal. An increased frequency of UP uptake has been reported in patients (pts) affected by diabetes mellitus (DM). The aim of the study is to describe the frequency of [68Ga]Ga-DOTANOC UP uptake to evaluate its variations over time and its possible correlation with DM.

Methods: In September 2017, a monocentric prospective observational electronic archive was initiated at our center to collect clinical and imaging data of pts undergoing [68Ga]Ga-DOTANOC PET/CT. Among the pts enrolled in the first 6 months (Sept 2017 to Feb 2018), those presenting [68Ga]Ga-DOTANOC PET/CT uptake at UP level were included. Pts with UP lesions already documented on CT/MRI or those that underwent surgical excision of UP before PET/CT were excluded from the analysis. [68Ga]Ga-DOTANOC UP uptake was classified as diffuse or focal and compared with the pattern observed in previous PET/CT scans performed at our center. An increased frequency of UP uptake was also correlated with the presence of DM.

Results: In the first 6 months, 253 pts were enrolled in the archive and 172 out of them were included in the analysis. UP increased uptake was frequently observed (77/172, 44.8%) and was mostly diffuse (62/77). In 75/172 pts (43.6%), previous [68Ga]Ga-DOTANOC PET/CT scans were available (overall 268 scans; number of previous PET per pt range: 1-20) and were retrospectively reviewed. Despite the fact that, in most pts, the uptake pattern was stable over time (54/75 pts, 72%), it changed in approximately one third of cases (21/75, 28%). Among DM pts (29/172), only 10/29 (34.4%) presented increased UP uptake.

Conclusions: UP [68Ga]Ga-DOTANOC uptake is a frequent non-malignant finding (slightly higher than previously reported), mostly presenting with a diffuse pattern. However, contrary to previous reports, our data show that the pattern of uptake may vary over time in approximately one third of the cases and it is not more frequently observed in pts with DM.

Keywords: PET/CT; [68Ga]Ga-DOTANOC; head pancreas; neuroendocrine tumors; uncinate process.

Grants and funding

This article received no external funding.