Images in a 68-year-old man with metastatic pheochromocytoma treated with
four cycles of lutetium 177 (177Lu) tetraazacyclododecane
tetraacetic acid octreotate (DOTATATE). A right adrenal pheochromocytoma
was resected 2 years previously, with subsequent development of hepatic,
osseous, and pulmonary metastasis and inferior vena cava (IVC) tumor
thrombus. Selected gallium 68 (68Ga) DOTATATE PET/CT fusion
images show a DOTATATE-avid (A) pulmonary metastasis
(arrow), (B) IVC tumor thrombus (arrow), and
(C) hepatic metastasis (arrow). Following completion of
off-label 177Lu-DOTATATE therapy, (D) the
pulmonary metastases (arrow), (E) IVC tumor thrombus, and
(F) hepatic metastasis decreased in radiotracer uptake
level. Central photopenia indicating tumor necrosis increased with the
treated hepatic metastasis (E, arrow). SUVmax =
maximum standardized uptake volume.