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Normal Uptake of 68Ga-DOTA-TOC by the Pancreas Uncinate Process Mimicking Malignancy at Somatostatin Receptor PET

Jacobsson, Hans, MD, PhD*,†; Larsson, Patricia, MD*,†; Jonsson, Cathrine, PhD; Jussing, Emma, MPharm; Grybäck, Per, MD, PhD*,†

doi: 10.1097/RLU.0b013e3182485110
Original Articles

Purpose: To characterize a commonly occurring increased uptake by the uncinate process of the pancreas at PET/CT using 68Ga-DOTA-d-Phe1-Tyr3-octreotide (68Ga-DOTA-TOC). This tracer has replaced 111In pentetreotide (OctreoScan®) for somatostatin receptor scintigraphy at our laboratory.

Methods: Fifty of our first 74 PET/CT examinations with 68Ga-DOTA-TOC could be evaluated in retrospect. None of these patients had surgery or showed any pathology in the pancreas head at the concomitant CT.

Results: Thirty-five of the 50 examinations (70%) showed an uptake by the uncinate process sufficiently intense to be interpreted as pathologic and simulating a tumor. Mean SUVmax was 9.2. Mean SUVmean using an isoactivity cut-off of >75% and >50% was 7.8 and 6.0, respectively. Volume calculations of the uncinate process activity using these definitions gave 0.9 mL and 4.2 mL, respectively.

Conclusion: There is a frequent physiological uptake of 68Ga-DOTA-TOC by the pancreas uncinate process. This may be caused by an accumulation of pancreatic polypeptide-containing cells expressing somatostatin receptors. If there is a normal finding at concomitant diagnostic CT, this uptake should be regarded as physiological.

From the Departments of *Radiology, †Nuclear Medicine, and ‡Neuroradiology, Karolinska University Hospital Solna, Stockholm, Sweden.

Received for publication July 28, 2011; revision accepted December 21, 2011.

Conflict of interest and sources of funding: none declared.

Reprints: Hans Jacobsson, MD, PhD, Department of Radiology, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden. E-mail:

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.