Uncommon Concurrent Retinal and Cerebral Metastasis in High-risk Neuroblastoma: Diagnostic Utility of 68Ga-DOTATATE PET/CT Despite Negative 18F-FDG PET/CT.

A 5-year-old girl with high-risk neuroblastoma underwent surveillance 18F-FDG PET/CT. The scan revealed two metabolically silent lesions-one in the right retina and one in the brain-without abnormal 18F-FDG uptake. Subsequent 68Ga-DOTATATE PET/CT demonstrated intense to moderate, focal radiotracer accumulation in both lesions, consistent with somatostatin receptor expression. One month later, brain MRI confirmed progressive enlargement of both lesions. Integrating clinical, imaging, and temporal data, a diagnosis of concurrent retinal and cerebral metastases from neuroblastoma was established. Unfortunately, the patient succumbed to progressive intracranial disease two months after initial detection.