False Uptake of 18F-MFBG and 68Ga-DOTATATE in the Stellate Ganglion in a Pediatric Patient With Neuroblastoma

A 7-year-old girl with high-risk neuroblastoma was enrolled in a clinical trial. 18F-MFBG PET/CT revealed increased radiotracer accumulation anterior to the left first rib. A metastatic lesion could not be ruled out. Subsequent 68Ga-DOTATATE PET/CT also demonstrated abnormal tracer uptake in the same region. Additional imaging and clinical evaluation confirmed the finding to represent physiological uptake in the stellate ganglion. This case illustrates that false-positive uptake on both 18F-MFBG and 68Ga-DOTATATE PET/CT may occur in the stellate ganglion in pediatric patients and should therefore be considered in the differential diagnosis of focal tracer accumulation in the upper thoracic region.