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Background
Small bowel neuroendocrine tumors (NETs) are rare GI tumors, constituting approximately 30% of all NETs and 25% of all small bowel neoplasms. These are usually slow-growing tumors that express somatostatin receptors. Vague presentation and slow growth of these tumors lead to long delays in diagnosis, and many patients present with metastases. Early localization remains challenging. Conventional imaging (CT/MR) in early stages is usually negative due to its small size. As the tumor extends locally, it causes mesenteric infiltration with a characteristic desmoplastic reaction on cross-sectional imaging, then hepatic metastasis. Currently, ⁶⁸Ga-DOTATATE PET/CT is now considered the gold standard for early localization, staging, and monitoring of small bowel NET with a huge impact on patient management. Our case-based multimodality pictorial review includes 15 interesting cases of small bowel NETs that highlight the impact of ⁶⁸Ga-DOTATATE PET/CT on patient's management and its superiority over conventional anatomical imaging.

Educational Goals / Teaching Points
Indications of ⁶⁸Ga-DOTATATE PET/CT: Localization of small bowel NETs, initial staging, selection of patients for Peptide Receptor Radionuclide Therapy (PRRT), monitoring of the disease, evaluation of patients with biochemical evidence and symptoms of NETs with negative CT/MRI. Imaging spectrum of various findings including normal physiologic distribution/variation, benign incidental and pathologic abnormalities. Multi-modality comparison and its superiority over conventional CT/MR and octreotide imaging when available. Impact of ⁶⁸Ga-DOTATATE PET/CT on patient management in patients with small bowel NETs with case-based examples.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
⁶⁸Ga-DOTATATE PET CT aids in small bowel NETs localization, differentiates primary tumors from metastasis, evaluates nearby organ involvement, and is reliant on somatostatin receptor levels. We present 15 interesting cases of small bowel NETs.

Conclusion
⁶⁸Ga-DOTATATE PET CT is now considered the gold standard imaging study for management of well-differentiated small bowel NETs. Our case-based multimodality pictorial review highlights the impact of ⁶⁸Ga-DOTATATE PET/CT on patient's management and its superiority over conventional anatomical imaging.