Case presentaion:

• Male.
• 50 y.o.
• Diagnosed with a non hormone-producing, well-differentiated neuroendocrine tumor of the small intestine. A wide resection of the small intestine was practiced. Intraoperative examination of the gut did not disclose any other tumors in the intestinal mucosa. The patient recovered well and remained asymptomatic.
•  One year after the surgery his cancer surgeon ordered an abdomial CT scan that was inhterpreted as unremarkable.
• Three months later he was also examined by this cancer endocrinologists whom in turn also decide to order a somatosin receptor scintigraphy.

Teaching points:

• SPECT should be a customary practice in cancer centers, either when using cancer tracer (e.g., In-111 or Tc-99m octreotide, I-131 sodium iodide, I-131 MIBG, Ga-67 citrate, Tc-99m(V) DMSA, Tc-99m MIBI) or not (e.g., Tc-99m MDP).
• In recognition of the incremental value of image fusion, Nuclear Medicne technologists should always consider the potential medical necessity to retrospectively fuse non-concurrently obtained SPECT and CT or MR images.
• Nuclear Medicine technologists should always follow a rigorous protocol to facilitate future image coregistration, including careful and reproducible patien positioning and using (radio-opaque and radioactive) external markers in a routinely fashion for every SPECT acquisition.