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. 2011 Jun;45(2):125-31.
doi: 10.1007/s13139-011-0083-y. Epub 2011 May 3.

Role of (18)F-FDG PET/CT, (123)I-MIBG SPECT, and CT in Restaging Patients Affected by Malignant Pheochromocytoma

Antonio Cantalamessa  1 , Federico Caobelli  2 , Barbara Paghera  3 , Antonio Caobelli  1 , Francesca Vavassori  1
Affiliations

Role of (18)F-FDG PET/CT, (123)I-MIBG SPECT, and CT in Restaging Patients Affected by Malignant Pheochromocytoma

Antonio Cantalamessa et al. Nucl Med Mol Imaging. 2011 Jun.

Abstract

Purpose: Pheochromocytoma (PH) is a rare catecholamine-secreting tumor that arises from chromaffin tissue within the adrenal medulla and extra-adrenal sites; commonly it is sporadic, and malignant PH accounts for about 10% of all cases. Several imaging modalities have been used for the diagnosis and staging of this tumor: functional imaging using radio-labelled metaiodobenzylguanidine and, more recently, (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET/CT), which offers substantial sensitivity and specificity to correctly detect metastatic PH and helps to identify patients suitable for treatment with radiopharmaceuticals. The aim of our study was to compare CT, (18)F-FDG PET/CT, and (123)I-metaiodobenzylguanidine single photon emission tomography ((123)I-MIBG SPECT) as feasible methods to restage patients diagnosed histologically with PH.

Methods: We retrospectively evaluated 38 patients (27 females and 11 males; mean age: 44 ± 15 years) with malignant PH documented histologically after surgical intervention. These patients underwent CT, (18)F-FDG PET/CT, and (123)I-MIBG SPECT.

Results: (18)F-FDG PET/CT showed positive results for neoplastic tissue in 33/38 patients (86.8%) and negative in 5/38 (13.2%), in concordance with CT alone. (123)I-MIBG SPECT was positive in 30/38 patients (78,9%) and negative in 8/38 (21.1%). No differences in lesion numbers were found between (18)F-FDG PET/CT and CT, whereas a difference could be demonstrated between (18)F-FDG PET/CT and (123)I-MIBG SPECT.

Conclusion: (18)F-FDG PET/CT could more accurately restage patients with PH than CT and (123)I-MIBG SPECT, also in the absence of a staging study.

Keywords: MIBG; PET; Paraganglioma; Pheochromocytoma; SPECT.

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Figures

Fig. 1
Fig. 1
18F-FDG PET/CT images of a patient with various bone and lymph node metastases are reported and a voluminous abdominal lymph node is shown. Coronal, sagittal, and transaxial fused images are shown
Fig. 2
Fig. 2
18F-FDG PET/CT images of a patient with a voluminous lesion with a central necrosis involving the right adrenal gland are shown. The original site of the tumor was the left adrenal gland. Coronal, sagittal, and transaxial fused images are shown
Fig. 3
Fig. 3
18F-FDG PET/CT fused images (a) of a patient with a lesion involving the 7th cervical vertebra are shown in comparison with CT images (b) and 123I-MIBG SPECT findings (c). The lesion is not evident on 123I-MIBG SPECT, suggesting an early dedifferentiation has occurred
See this image and copyright information in PMC

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