Krenning Score on Your — DOTATATE or DOTANOC Report

The Krenning score is a grading system that nuclear medicine physicians use to describe how much radiotracer a tumour absorbs on a DOTATATE or DOTANOC scan. The scale runs from 0 to 4, comparing the tumour's uptake to the uptake in your normal liver. It is used because somatostatin receptor-based therapies can only target tumours that absorb the tracer reliably, so the score gives your oncologist a standardised way to assess whether the tumour has enough receptors for that type of treatment to be considered.

EANM and SNMMI guidance describes adequate uptake as a key requirement for PRRT eligibility, and a score of 3 or 4 is generally considered to indicate adequate uptake. A score of 2 falls into a zone where other factors influence the decision. A score of 0 or 1 suggests uptake is insufficient for PRRT to target reliably. Your oncologist makes the final eligibility decision, because the score is one factor among several — your tumour type, stage, and overall health all contribute.

A score of 2 means your tumour is absorbing the radiotracer at roughly the level of normal liver. It sits at the lower boundary of what is considered in eligibility assessments for PRRT. Whether that is adequate in your case depends on your oncologist's full assessment, not the number alone. It does not mean PRRT is impossible, and it does not mean you are out of options. Ask your oncologist to explain what the score means alongside your other results.

Somatostatin receptor expression can change over time, and a repeat scan may show a different score. However, this is not a reliable or predictable effect, and there is no established approach for improving the score through a specific intervention. Whether a repeat scan is useful in your situation is a question for your oncologist. Do not delay or decline other treatments while waiting for a score to change, unless your oncologist has specifically advised that approach for your case.

They describe the same underlying biology but are not identical terms. Saying a tumour is somatostatin receptor positive means it expresses those receptors at all — which could correspond to any Krenning grade from 1 upwards. The Krenning score goes further by grading how intensely the uptake is, which is what determines whether the expression is strong enough for PRRT. A tumour can be receptor positive at a level that is too low to qualify for PRRT, which is why the specific grade matters.

The nuclear medicine physician who reports your scan assigns the Krenning score based on what they see on the images. Your oncologist then uses that score — alongside your clinical history, your cancer type, your stage, and your other test results — to decide what it means for your treatment plan. Both are involved, but it is your oncologist who translates the score into a treatment recommendation. If you have questions about what the score means for your situation, your oncologist is the right person to ask.