Case Study: Changes in Intratumoral Spatial Heterogeneity Monitored by [68Ga]Ga-DOTA-NOC PET/CT During Dinutuximab Beta Treatment in Pediatric Patients with High-Risk Neuroblastoma

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Neuroblastoma is a common childhood tumor characterized by significant biological heterogeneity and somatostatin receptor expression.
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[68Ga]Ga-DOTA-NOC PET/CT is used to evaluate somatostatin receptor expression and monitor treatment responses in neuroblastoma.
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A 4-year-old male with high-risk neuroblastoma showed tumor regression but increased radiotracer uptake in a focal area after dinutuximab beta treatment.
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Histopathological analysis revealed the increased uptake area contained viable, poorly differentiated neuroblastoma, indicating treatment resistance.
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The findings suggest that elevated SSTR accumulation post-immunotherapy may indicate distinct biological entities requiring careful evaluation.

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