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. 2009 Dec;94(12):4757-67.
doi: 10.1210/jc.2009-1248. Epub 2009 Oct 28.

Comparison of 18F-fluoro-L-DOPA, 18F-fluoro-deoxyglucose, and 18F-fluorodopamine PET and 123I-MIBG scintigraphy in the localization of pheochromocytoma and paraganglioma

Henri J L M Timmers  1 , Clara C Chen, Jorge A Carrasquillo, Millie Whatley, Alexander Ling, Bastiaan Havekes, Graeme Eisenhofer, Lucia Martiniova, Karen T Adams, Karel Pacak
Affiliations

Comparison of 18F-fluoro-L-DOPA, 18F-fluoro-deoxyglucose, and 18F-fluorodopamine PET and 123I-MIBG scintigraphy in the localization of pheochromocytoma and paraganglioma

Henri J L M Timmers et al. J Clin Endocrinol Metab. 2009 Dec.

Abstract

Context: Besides (123)I-metaiodobenzylguanidine (MIBG), positron emission tomography (PET) agents are available for the localization of paraganglioma (PGL), including (18)F-3,4-dihydroxyphenylalanine (DOPA), (18)F-fluoro-2-deoxy-D-glucose ((18)F-FDG), and (18)F-fluorodopamine ((18)F-FDA).

Objective: The objective of the study was to establish the optimal approach to the functional imaging of PGL and examine the link between genotype-specific tumor biology and imaging.

Design: This was a prospective observational study.

Intervention: There were no interventions.

Patients: Fifty-two patients (28 males, 24 females, aged 46.8 +/- 14.2 yr): 20 with nonmetastatic PGL (11 adrenal), 28 with metastatic PGL (13 adrenal), and four in whom PGL was ruled out; 22 PGLs were of the succinate dehydrogenase subunit B (SDHB) genotype.

Main outcome measures: Sensitivity of (18)F-DOPA, (18)F-FDG, and (18)F-FDA PET, (123)I-MIBG scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI) for the localization of PGL were measured.

Results: Sensitivities for localizing nonmetastatic PGL were 100% for CT and/or MRI, 81% for (18)F-DOPA PET, 88% for (18)F-FDG PET/CT, 78% for (18)F-FDA PET/CT, and 78% for (123)I-MIBG scintigraphy. For metastatic PGL, sensitivity in reference to CT/MRI was 45% for (18)F-DOPA PET, 74% for (18)F-FDG PET/CT, 76% for (18)F-FDA PET/CT, and 57% for (123)I-MIBG scintigraphy. In patients with SDHB metastatic PGL, (18)F-FDA and (18)F-FDG have a higher sensitivity (82 and 83%) than (123)I-MIBG (57%) and (18)F-DOPA (20%).

Conclusions: (18)F-FDA PET/CT is the preferred technique for the localization of the primary PGL and to rule out metastases. Second best, equal alternatives are (18)F-DOPA PET and (123)I-MIBG scintigraphy. For patients with known metastatic PGL, we recommend (18)F-FDA PET in patients with an unknown genotype, (18)F-FDG or (18)F-FDA PET in SDHB mutation carriers, and (18)F-DOPA or (18)F-FDA PET in non-SDHB patients.

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Figures

Figure 1
Figure 1
Functional imaging in patients no. m4 with metastatic SDHB PGL (panel 1), m15 with metastatic SDHB PGL (panel 2), and m6 with metastatic RET PGL (panel 3). Anteriorly reprojected images.
Figure 1
Figure 1
Functional imaging in patients no. m4 with metastatic SDHB PGL (panel 1), m15 with metastatic SDHB PGL (panel 2), and m6 with metastatic RET PGL (panel 3). Anteriorly reprojected images.
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