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Dietary Intervention to Reduce Physiological Gallbladder Uptake and Improve Interpretation of F-18 NOTANOC PET/CT
*Corresponding author: Dr. Abhishek Behera, Department of Nuclear Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Faridabad, Haryana, India. abhishek_behera88@yahoo.co.in
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Received: ,
Accepted: ,
How to cite this article: Behera A, Prabhu M, Panwar K, Srivastava A. Dietary Intervention to Reduce Physiological Gallbladder Uptake and Improve Interpretation of F-18 NOTANOC PET/CT. Indian J Nucl Med. 2026;41:407-8. doi: 10.25259/IJNM_103_25.
Abstract
A recently diagnosed case of Grade 1 neuroendocrine tumour (NET) of the duodenum (D2) underwent 18F-NOTANOC PET/CT imaging. Intense physiological gallbladder uptake was noted, potentially masking periampullary lesions – a known limitation compared to 68Ga-DOTANOC. To mitigate this, the patient was given a liquid fatty meal (milk mixed with butter; a solid meal was avoided to allow better enteric visualisation), and a repeat scan of the upper abdomen was performed 30 min later. The follow-up imaging showed marked clearance of gallbladder tracer activity with visible gallbladder contraction, enhancing regional visualization. This case demonstrates a simple yet effective dietary method to overcome a key interpretive challenge of 18F-NOTANOC imaging.
Keywords
18F-NOTANOC
Computed tomography
Neuroendocrine tumours
Positron emission tomography
A newly diagnosed Grade 1 duodenal NET underwent 18F-NOTANOC positron emission tomography computed tomography (PET/CT) imaging 2 h postinjection.[1-4]
Fig 1a-d show images before fatty meal administration. (a) Maximum Intensity projection (MIP) image demonstrating intense physiological uptake in the gallbladder (blue arrow), potentially obscuring periampullary lesions. (b and c) Axial PET/CT and CT images shows physiological gallbladder activity (arrow), limiting visibility of radiotracer uptake in gall bladder and adjacent anatomical structures. (d) Coronal PET/CT fusion image confirming intense gallbladder tracer retention. Fig 1e-h show images 30 minutes after administration of liquid fatty meal (milk mixed with butter).[5,6] (e) Axial PET MIP demonstrating significant clearance of gallbladder activity. (f and g) Axial PET/CT and CT show contracted gallbladder with reduced tracer retention, enhancing periampullary region radiotracer uptake visualisation. (h) Coronal PET/CT fusion again illustrates reduced physiological gall bladder radiotracer uptake post-meal. This case highlights a simple dietary intervention to reduce gallbladder masking in 18F-NOTANOC imaging.
Author contribution:
AB: Contributed to conceptualisation, data acquisition, interpretation, and drafting of the manuscript; MP: Contributed to critical review and revision of the manuscript; KP and AS: Contributed to data acquisition (imaging/scan performance). All authors approved the final manuscript.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for their images and other clinical information to be reported in the journal. The patient understand that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
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