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Multimodality imaging in a patient with adrenocortical carcinoma leading to peptide receptor radionuclide therapy.

In the recommended staging system for adrenocortical carcinoma, nuclear medicine modalities are optional. In cases of distorted postoperative anatomy and when postoperative infection/inflammation mimics malignancy, functional imaging is helpful. We present a case of a patient with adrenocortical carcinoma where F-18 FDG dual time point imaging and somatostatin receptor scintigraphy were used in the diagnostic work up after surgery complicated by infection, until end-stage palliative peptide receptor radionuclide therapy. The estimated uptake on somatostatin receptor scintigraphy is traditionally done visually on planar images. We suggest a more objective, semiquantitative approach by comparing the tumor uptake with a standard reference.