A 65-year-old man presented with intermittent abdominal pain for three months. Abdominal ultrasonography revealed a mass in the body of the pancreas. Moreover, abdominal contrast-enhancing computed tomography revealed a homogenously enhancing mass in the body of the pancreas. Scan findings were in favor of the neuroendocrine tumor, and the serum chromogranin level was slightly raised (111. 9 ng/ml, normal <98). He had no history of vomiting, jaundice, melena, hematemesis, constipation, diarrhea, weight gain, weight loss, loss of appetite, and fever. He also had no symptoms related to the excessive production of catecholamines, such as hypertension. The patient was referred for Ga-68 DOTANOC positron emission tomography-computed tomography (Ga-68 DOTANOC PET-CT) for further evaluation. The scan was done to rule out metastatic disease or other synchronous lesions to plan surgical excision. The Ga-68 DOTANOC PET-CT revealed a pancreatic lesion with no other abdominal lesions. We noted multiple tracer avid soft tissue lesions on both sides of the neck that were not diagnosed previously. This case report demonstrates a rare case with multiple paragangliomas diagnosed by the Ga-68 DOTANOC PET-CT. This finding could lead to changes in patient management.

Background: Role of molecular imaging by PET-CT using Ga-68 DOTANOC in neuroendocrine tumors. The objective was to analyze retrospectively the utility of Ga-68 DOTANOC in PET-CT imaging in the management of neuroendocrine tumors.Materials and Methods: PET-CT study was done in 21 patients of neuroendocrine tumors [NET's], which included 14 males & 10 females, aged 7 to 62 yrs. They underwent PET-CT study after IV injection of 74-48 MBq of Ga-68 DOTANOC. Pt. was given oral contrast .Images were acquired 1 hr. later on PET-T scanner [Biograph 64 slice scanner, Siemens, Germany].Results: The NET's included 4 cases of phaeochromocytoma, 4 cases of MTC, 4 cases of carcinoid, 1 case of MEN-, 3 cases of paraganglioma, 1 case of neuroblastoma, 4 cases of gastroenteropancreatic NET's which included duodenal, retroperitoneal, esophageal & pancreatic tumors. Each case was analysed with respect to the clinical context which revealed Ga-8 DOTANOC avid in 3 cases of pheochromocytoma, 1 case of neuroblastoma, 3 cases of medullary carcinoma of thyroid, 1 case of MEN I, 3 cases of carcinoid, 3 cases of gastroenteropancreatic tumors i.e. duodenal, pancreas, esophagus, 2 cases of paraganglioma. There was no radiopharmaceutical concentration in 1 case of pheochromocytoma, one case of medullary carcinoma of thyroid and one case of carcinoid and one case of paraganglioma. The interesting aspects of this molecular imaging will be demonstrated in form of clinical case.Conclusion: This early experience of PET-CT using Ga- 68 DOTANOC in diverse patients of neuroendocrine tumors provide further insight into Ga-68 labeled positron imaging and for radionuclide therapy in metastatic neuroendocrine tumors.

Background: With a view for the production of radiopharmaceutical existing GMP requirements and the reduction of the radiation exposure for the employees, radiolabeling of somatostatin analogues with 68Ga or 177Lu using robotically cassette systems are object of intense investigations. We describe the Modular-Lab Pharm Tracer module processed preparation of 68Ga-DOTATOC using the SnO2-based iThemba LABS 68Ge/68Ga generator.Materials and Methods: The generator (50 mCi) was eluted with 0.6 mol/L HCl. Elution efficiency was expressed as the 68Ga activity at time of elution, expressed as percentage of the 68Ge activity on the generator column.68Ge content was measured using gamma spectrometry. Endotoxin testing was performed using the Endosafe PTS.Results: The synthesis of 68Ga-DOTATOC resulted in radiochemical yields of 80% (d.c) and purities of >98% by heating 33.3mg (23, 42 mmoL) peptide at pH 3.5–.0 for 5 min at 95Co in 1.5 ml 0.6 moL HCl. The Sep-ak C18 cartridge was implemented as a “safety net system”. This eliminates the need for prepurification of eluate.Conclusion: Produced under GMP conditions and in combination with the evaluated Modular-Lab Pharm Tracer synthesis device this combination provides the opportunity for a full functional GMP production.

Gallium-68 a positron emitter radionuclide, with great impact on the nuclear medicine, has been widely used in positron emission tomography (PET) diagnosis of various malignancies in humans during more recent years especially in neuroendocrine tumors (NETs). The vast number of 68Ge/68Ga related generator productions, targeting molecule design (proteins, antibody fragments, affibodies, peptides and small molecules), as well as existing numerous human clinical trials at the registration, continuation and completion levels, are indicative of great importance and future impact of gallium-68 radiopharmaceuticals in human health. A concise review on the recent production and application of 68Ga-tracers with the emphasis on the peptides, biomolecules and also small molecules available for clinical applications, clinical trials or preclinical studies are presented. The importance of Ga-68 radionuclide as a the ranostic radionuclide with potential coupling application with therapeutic radioisotopes (such as 90Y and 177Lu) is increasing appreciated. This review describes the present status of availability, application and future horizons on the development of 68Ga-radiopharmaceuticals worldwide.

Objevtive(s): Neuroendocrine tumors are a heterogeneous group of neoplasms that arise from the peptide-producing cells of the neuroendocrine system. Different functional imaging methods have been suggested to diagnose NETs. There is still not enough evidence to recommend 68Ga-DOTATATE as a standard diagnostic tool in NETs. Therefore, the aim of this study was to assess the value of 68Ga-DOTATATE scan in detecting NETs. Methods: This was a cross-sectional study. All patients with a pathologically confirmed NET tumor referred to Masih Daneshvari Hospital affiliated to Shahid Beheshti University of Medical Sciences entered the study. Patients underwent a68 Ga-DOTATATE PET/CT. All statistical analysis were performed by SPSS software version 18. Results: Forty patients with a mean age of 48. 1±, 15. 80 years entered the study. Twenty-one (52. 5%) were male and 19 (47. 5%) female. In the studied patients, neuroendocrine tumor was present in 19 cases (47. 5%) in pancreas and gastrointestinal tract, 9 (22. 5%) in lung, 3 (7. 5%) in mediastinum and adrenal gland, 6 cases (5%) in liver and 3 other sites. There was no significant association between mean age and gender with primary location of the tumor. The mean SUVmax was 11. 62±, 20. 02 and the the mean tumor size was 38. 25±, 31. 35 mm. The mean size of the metastasis was 40. 55±, 24. 53 mm. The mean percentage of ki-67 was 12. 54±, 18. 40. There was no significant correlation between SUVmax of the lesion and age (r=0. 063, P=0. 701), tumor size (r=-0. 63, P=0. 067) or Ki-67 (r=0. 011, P=0. 960). In 20 cases, metastases were reported, of which 14 were (70%) in the liver, 3 in the lungs (15%), 2 in the gastrointestinal and cervical lymph nodes, and 1 in the bones and pancreas(%5). Conclusion: 68 Ga-DOTA-peptide PET/CT could find the primary or metastasis sites of NETs with good quality images. In general, this modality can enhance the management in patients with NETs.

Neuroendocrine tumors (NETs) are rare tumors, but the incidence is increasing with new diagnostics. A 37-year-old man was admitted to our hospital for an incidental 17-mm nodule in the tail of the pancreas. PET/CT shows indeterminate mass in the pancreatic tail with enhanced uptake of 68-Ga-dotatate. NET was suspected and laparoscopic distal pancreatectomy was performed. Pathologic examination 􀁕 􀁈 􀁙 􀁈 􀁄 􀁏 􀁈 􀁇 􀀃 􀁄 􀁑 􀀃 􀁄 􀁆 􀁆 􀁈 􀁖 􀁖 􀁒 􀁕 􀁜 􀀃 􀁖 􀁓 􀁏 􀁈 􀁈 􀁑 􀀃 􀁚 􀁌 􀁗 􀁋 􀀃 􀁄 􀀃 􀁋 􀁈 􀁗 􀁈 􀁕 􀁒 􀁗 􀁒 􀁓 􀁌 􀁆 􀀃 􀁏 􀁒 􀁆 􀁄 􀁗 􀁌 􀁒 􀁑 􀀑 􀀃 􀀷 􀁒 􀀃 􀁗 􀁋 􀁈 􀀃 􀁅 􀁈 􀁖 􀁗 􀀃 􀁒 􀁉 􀀃 􀁒 􀁘 􀁕 􀀃 􀁎 􀁑 􀁒 􀁚 􀁏 􀁈 􀁇 􀁊 􀁈 􀀏 􀀃 􀁗 􀁋 􀁌 􀁖 􀀃 􀁌 􀁖 􀀃 􀁗 􀁋 􀁈 􀀃 􀂿 􀁕 􀁖 􀁗 􀀃 􀁌 􀁑 􀁗 􀁕 􀁄 􀁓 􀁄 􀁑 􀁆 􀁕 􀁈 􀁄 􀁗 􀁌 􀁆 􀀃 􀁄 􀁆 􀁆 􀁈 􀁖 􀁖 􀁒 􀁕 􀁜 􀀃 􀁖 􀁓 􀁏 􀁈 􀁈 􀁑 􀀃 (IPAS) case in which the positive 68-Ga-dotatate uptake reported in the literature. Our case showed that IPAS is one of the reasons of false positive involvement of 68-Ga-dotatate PET/CT. When PET/CT shows an indeterminate mass in the pancreatic tail with enhanced uptake of 68-Ga-dotatate, surgeons should keep IPAS in their mind for differential diagnosis to avoid false treatment.

Background: Till date, the detection of lesions in the context of biochemical recurrence of prostate cancer (PC) is a major challenge for all imaging modalities and one of the key issues in management. The aim of the present study was to evaluate the role novel generator based PET radiotracer Ga-68 labeled PSMA in PC with biochemical relapse.Materials and Methods: Eight patients with biochemical relapse of prostate cancer mean PSA=9.9 ng/ml (range=1.14 to 31.0 ng/ml) underwent Ga-68 PSMA and conventional imaging for evaluation of relapse. Plain and fused Ga-68 PSMA PET/CT images were viewed for visual interpretation. Radiotracer uptake that was visually considered as PC was semiquantitatively analysed by measuring SUVmax.Results: Lesions characteristic of prostate cancer were detected in five (62.5%) patients using Ga-68 PSMA, this included two patients with PSA levels<2.8 ng/ml. All cases with recurrence in the prostatic bed (two) and one case with prostatic and lymph node metastasis were proven on MRI. In one case with marrow metastasis on Ga-68 PSMA, bone scan was normal but MRI proved the marrow lesion. One case with pleural and lung metastasis was proven on CT.Conclusion: Thus Ga-68 PSMA correctly localized disease in 62.5% of patients with biochemical relapse of PC. Further evaluation in a larger number of patients is planned to establish its true influence on patient management.

Introduction: Recently, [ 68 Ga]Gallium lyophilized kit has been widely practiced as it simplifies the radiolabeling process. Thus, our aim is to develop, formulate and evaluate a single-vial lyophilized kit (EZYKit PSMA) for the preparation and radiolabeling of [ 68 Ga]Ga-PSMA-11. Methods: Two commercially available [ 68 68 Ge/ Ga] Generators used in this study were from ITG and Eckert & Ziegler with a current [ 68 Ga]Gallium elution activity of 222 MBq and 1480 MBq, respectively. Initially, EZYkit-PSMA radiolabeling parameters were optimized, and the Glass Transition Temperature (Tg) of the optimized PSMA-11 formulation was determined. Quality assessment of EZYkit-PSMA, including physical appearance, quantitative assay of the active ingredient, radiochemical purity, pH, sterility, endotoxin, and storage stability, were also established. Results: Optimization of radiolabeling parameters showed that the highest radiochemical purity was achieved with 0. 35 ml and 0. 75 ml of 1. 5 M acetate buffer and 10 µ, g PSMA-11 for both ITG and Eckert & Ziegler Generator, respectively. The quality assessment results of EZYkit-PSMA were within the specifications except for the physical appearance, where it appears to be structurally collapsed. This study discussed two main factors that contributed to the collapsed lyophilized cake. Conclusion: Despite the physical appearance, EZYkit-PSMA was successfully developed, and the quality meets the pharmaceutical standards. EZYkit-PSMA showed high stability over 6 month's storage period in both the fridge and freezer. Overall, using EZYkit-PSMA for radiolabeling with [68Ga]Gallium simplified the whole radiolabeling procedure and reduces process time and error with high labelling yield and efficiency.