Fig. 4.

Patient B’s course of disease. Functional imaging scans for Patient B. ¹⁸F-FDG PET/CT (a) scan before ¹⁷⁷Lu-DOTATATE therapy showing high metabolic activity of both the retroperitoneal tumor and liver and bone metastases including bone marrow lesions. ¹²³I-MIBG scintigraphy (b) before ¹⁷⁷Lu-DOTATATE therapy showing weak uptake in only part of the lesions, therefore excluding ¹³¹I-MIBG therapy as a treatment option. ¹¹¹In-octreotide SPECT scan (c) before ¹⁷⁷Lu-DOTATATE therapy showing all avid uptake of this tracer by all the lesions demonstrated on ¹⁸F-FDG PET/CT scan (a) favoring ¹⁷⁷Lu-DOTATATE therapy. ¹⁸F-FDG PET/CT scan (d) after 2 cycles of ¹⁷⁷Lu-DOTATATE therapy showing severe disease progression with multiple new liver and diffuse skeletal involvement