Images in a 65-year-old man with small cell lung cancer who was
previously treated with carboplatin and etoposide and radiation therapy
to the brain and thoracic lymph nodes. The patient presented with
progression of disease. (A) Whole-body fluorodeoxyglucose
(FDG) PET image (left) and fused axial FDG PET/CT scans (right) show
intense FDG uptake in the bilateral adrenal lesions (arrowheads) and
upper abdominal lymphadenopathy (white arrow), a peritoneal nodule (gray
arrow), and a right femoral bone lesion (black arrow). FDG uptake in the
bilateral paramediastinal region corresponds to the postradiation
change. (B) Gallium 68 tetraazacyclododecane tetraacetic
acid–octreotate (DOTATATE) whole-body PET scan (left) and fused
axial PET/CT scans (right) obtained 17 days after FDG PET/CT show
intense radiotracer uptake (ie, greater than the uptake in the liver) in
the adrenal lesions (arrowheads) and upper abdominal lymph nodes (white
arrow), a peritoneal nodule (gray arrow), and moderate radiotracer
uptake (ie, similar to the uptake in the liver) in the bone (black
arrow). Note a lack of DOTATATE uptake in the mediastinum in the areas
of postradiation inflammatory changes, indicating high specificity of
DOTATATE PET/CT for tumors compared with FDG PET/CT.