Increased 177Lu-DOTATATE uptake in Paget disease

A 45-year-old female patient was referred for peptide receptor radionuclide therapy of liver metastases of neuroendocrine origin; the patient had undergone 2 years earlier surgical resection of a grade 2 neuroendocrine neoplasm of ampulla of Vater infiltrating the duodenal submucosa and muscular layers and the neighboring pancreatic tissue. Post-therapy whole-body scan performed to evaluate in vivo radiopharmaceutical distribution confirmed high accumulation in liver lesions and revealed increased uptake in the hip bone. Bone scan and corresponding CT images demonstrated changes of Paget disease in the same district.