Objective:

To evaluate the changes in intratumoral spatial heterogeneity in a pediatric patient with high-risk neuroblastoma using [68Ga]Ga-DOTA-NOC PET/CT during dinutuximab beta treatment.

Approach:

• Imaging and Treatment: Baseline imaging revealed a left retroperitoneal primary tumor and extensive skeletal metastases. Following four cycles of induction chemotherapy combined with dinutuximab beta, a post-therapeutic PET/CT was performed to assess changes.

Key Findings:

• Post-treatment imaging showed structural regression of the primary tumor and resolution of skeletal lesions.
• A focal region within the primary tumor exhibited increased radiotracer uptake, indicating a viable, poorly differentiated neuroblastoma subclone.
• Histopathological evaluation confirmed the presence of both poorly differentiated neuroblastoma and differentiating ganglioneuroblastoma components.

Interpretation:

Limitations:

• The study is based on a single case, limiting the generalizability of the findings.
• Further research is needed to understand the implications of SSTR expression changes in response to immunotherapy.

Conclusion: