Sacral Insufficiency Fracture on 68Ga-DOTATATE PET/CT

Area of Science:

• Nuclear medicine
• Oncology
• Radiology

Background:

• 68Ga-DOTATATE PET/CT is a key imaging modality for neuroendocrine tumors (NETs), including detecting skeletal metastases.
• Inflammatory conditions can present as false-positive findings on 68Ga-DOTATATE PET/CT scans.
• Sacral insufficiency fractures are a potential cause of false-positive uptake in the sacrum.

Observation:

• A 47-year-old male with pancreatic neuroendocrine tumor underwent 68Ga-DOTATATE PET/CT.
• The scan revealed abnormal 68Ga-DOTATATE uptake in the right sacral region.
• Subsequent MRI confirmed the presence of a sacral insufficiency fracture.

Findings:

• 68Ga-DOTATATE uptake in the sacrum on PET/CT can be indicative of a sacral insufficiency fracture.
• This finding highlights the potential for false-positive results in inflammatory conditions.
• Differentiating fracture uptake from true tumor metastasis is crucial for accurate diagnosis.

Implications:

• Awareness of false positives is essential when interpreting 68Ga-DOTATATE PET/CT scans in the sacral region.
• Integrating MRI findings is critical for accurate diagnosis and avoiding misinterpretation of inflammatory pathologies as metastatic disease.
• This case underscores the importance of correlating imaging findings with clinical context and other diagnostic modalities.