Multifocal Urinary Bladder Paragangliomas with Negative ⁶⁸Ga-DOTATATE Uptake and Positive ¹²³I-MIBG Uptake

We report a case of an adult male patient with multifocal urinary bladder paragangliomas, which were negative on ⁶⁸Ga-DOTATATE PET/CT scan, but positive on ¹²³I-MIBG SPECT/CT scan. While the ⁶⁸Ga-DOTA analog PET/CT exhibits superior performance in diagnosis and staging of pheochromocytoma and paraganglioma, our case demonstrates negative somatostatin receptor expression in this rare entity and indicates that ¹²³I-MIBG SPECT/CT still plays a vital role in characterization of bladder paraganglioma.