Imaging recommendation · Abdomen · Pelvis

Neuroendocrine tumor (NET) — staging and surveillance imaging

Q: What's the alternative imaging for neuroendocrine tumor (net) — staging and surveillance imaging when high-grade / poorly-differentiated net (ki-67 > 20%)?

NM — FDG-PET-CT (loss of somatostatin receptor expression) (iv contrast).

Q: What's the alternative imaging for neuroendocrine tumor (net) — staging and surveillance imaging when liver-dominant metastatic disease — characterization?

MRI — MRI liver with hepatobiliary contrast (Eovist) (iv contrast).

Q: What's the alternative imaging for neuroendocrine tumor (net) — staging and surveillance imaging when cardiac involvement (carcinoid heart)?

MRI — Echocardiogram + cardiac MRI (see valve-disease) (iv contrast).

Q: What's the alternative imaging for neuroendocrine tumor (net) — staging and surveillance imaging when post-prrt (lu-177 dotatate) response?

NM — Repeat DOTATATE PET-CT + CT/MRI at 3 months (iv contrast).

Recommended: Ga-68 DOTATATE PET-CT + multiphase CT/MRI is the preferred imaging study for neuroendocrine tumor (net) — staging and surveillance imaging. DOTATATE PET-CT is the most sensitive whole-body study for well-differentiated NETs (somatostatin receptor positive).

Recommended study

Ga-68 DOTATATE PET-CT + multiphase CT/MRI

NM IV contrast Preferred Abdomen · Pelvis Outpatient Reviewed 2026-05

DOTATATE PET-CT is the most sensitive whole-body study for well-differentiated NETs (somatostatin receptor positive). Complement with multiphase CT (pancreas protocol) or MRI with hepatobiliary phase for anatomic mapping and liver lesion characterization. Poorly-differentiated / high-grade NETs (Ki-67 > 20%): FDG-PET may be more sensitive than DOTATATE.

If the default doesn't apply

High-grade / poorly-differentiated NET (Ki-67 > 20%)

NM FDG-PET-CT (loss of somatostatin receptor expression) IV contrast

Liver-dominant metastatic disease — characterization

MRI MRI liver with hepatobiliary contrast (Eovist) IV contrast

Cardiac involvement (carcinoid heart)

MRI Echocardiogram + cardiac MRI (see valve-disease) IV contrast

Post-PRRT (Lu-177 DOTATATE) response

NM Repeat DOTATATE PET-CT + CT/MRI at 3 months IV contrast

Watch-outs

Octreoscan vs DOTATATE

DOTATATE has supplanted Octreoscan / In-111 pentetreotide — higher sensitivity, lower dose, faster protocol. Reserve Octreoscan only when DOTATATE unavailable.

False-positive DOTATATE

Inflammation, accessory spleen, normal pancreatic uncinate uptake mimic NET — correlate with anatomic imaging.

Pearls

Krenning score (1–4) on DOTATATE predicts eligibility for PRRT therapy.
Carcinoid syndrome implies liver metastases (or primary outside portal drainage — bronchial, ovarian).
Pancreas-protocol CT: arterial + portal venous; NETs are typically arterial-enhancing.
Surveillance interval: every 6–12 months for stable disease; tighter post-PRRT.