Teaching NeuroImages: Advanced imaging of neurosarcoidosis with 68Ga-DOTATATE PET/CT

A 45-year-old man presented with increasing visual impairment. MRI showed a nonspecific lesion at the cavernous sinus; an additional 68Ga-DOTATATE PET/CT showed an extraordinarily high 68Ga-DOTATATE uptake of the lesion (figure). Stereotactic brain biopsy was performed and revealed an initial manifestation of neurosarcoidosis. 68Ga-DOTATATE targets the somatostatin receptor (SSR), which is expressed by tumor cells in malignancies such as neuroendocrine tumors and meningioma, but also by activated macrophages,1 as present in neurosarcoidosis. Targeted radionuclide therapies using SSR ligands labeled with beta-emitting isotopes might offer additional therapeutic options in patients with treatment-refractory neurosarcodosis,2 as also effectively applied in SSR-positive malignancies.

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