Purpose or Case Report: 68-Gallium DOTATATE PET is frequently utilized for the assessment of neuroendocrine tumors. Its application in the management of neuroblastoma has been briefly documented in the literature. We describe four years of institutional experience of its use for the evaluation and follow-up of neuroblastoma.
Methods & Materials: Demographics, clinical presentation, treatment plan before and following 68-Gallium DOTATATE PET, Krenning scores, pathology reports, and other imaging studies (e.g., I123-MIBG, FDG-PET, 18F-DOPA, etc.) were evaluated from March 2021 to October 2025.
Results: Seven patients underwent 18 68-Gallium DOTATATE PET scans. There were 5 females and 2 males. Mean age of the population was 3.78 years (5 months – 9 years). There were 2 pathologically proven ganglioneuroblastoma (GNB) and 5 neuroblastoma (NBL) cases. One GNB case had a mature background, and the other case was intermixed on histology. All NBL cases were poorly differentiated. Two patients had favorable diagnoses and two had unfavorable diagnoses on pathology. Mean Krenning score of all the cohort was 2.56. Mean Krenning score for the GNB cases was 2.33 compared to 2.6 for NBL. Patients with favorable histology had significantly lower mean Krenning score (1.71) compared to those with unfavorable histology (3.22). Five patients had M International Neuroblastoma Risk Group (INRG) staging, 1 had L stage and one had MS stage. Mean Krenning score for the M INRG stage was 3.
27.8% of scans led to a migration to a different treatment regimen. Change from non-treatment to treatment, treatment to non-treatment, or surgery occurred each after 5.6% of scans. Further investigations were initiated after the scan in 11.1% of cases, and no change in treatment occurred in 44.4% of scans.
Four cases had negative or equivocal I123-MIBG scans before their positive DOTATATE scans. One case had a negative FDG-PET scan at time of the positive DOTATATE scan. The other 13 cases had positive I123-MIBG and/or FDG-PET scans at the time of the DOTATATE scans.
Conclusions: Over 55% of 68-Gallium DOTATATE PET scans resulted in a change in neuroblastoma patients’ treatment plans or prompted further investigations. Higher Krenning scores were associated with unfavorable tumor histology and more aggressive disease. DOTATATE scans displayed positive results compared to other imaging modalities, making it a valuable tool in the management of NBL.