Performances of Functional and Anatomic Imaging Modalities in Succinate Dehydrogenase A- Related Metastatic Pheochromocytoma and Paraganglioma

Mayank Patel¹, Abhishek Jha¹, Alexander Ling², Clara C Chen³, Corina Millo⁴, Mickey J M Kuo^{1

5}, Matthew A Nazari¹, Sara Talvacchio¹, Kailah Charles¹, Markku Miettinen⁶, Jaydira Del Rivero⁷, Alice P Chen⁸, Naris Nilubol⁹, Frank I Lin¹⁰, Ali Cahid Civelek¹¹, David Taïeb¹², Jorge A Carrasquillo^{10

13}, Karel Pacak¹

Affiliations

¹ Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20814, USA.
² Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20814, USA.
³ Nuclear Medicine Department, Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20814, USA.
⁴ Positron Emission Tomography Department, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20814, USA.
⁵ Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
⁶ Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD 20814, USA.
⁷ Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
⁸ Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
⁹ Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
¹⁰ Targeted Radionuclide Therapy Section, Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
¹¹ Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, MD 21287, USA.
¹² Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, 13273 Marseille, France.
¹³ Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.

PMID: 36010880
PMCID: PMC9406057
DOI: 10.3390/cancers14163886

Performances of Functional and Anatomic Imaging Modalities in Succinate Dehydrogenase A- Related Metastatic Pheochromocytoma and Paraganglioma

Mayank Patel et al. Cancers (Basel). 2022.

. 2022 Aug 11;14(16):3886.

doi: 10.3390/cancers14163886.

Authors

Affiliations

¹ Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20814, USA.
² Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20814, USA.
³ Nuclear Medicine Department, Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20814, USA.
⁴ Positron Emission Tomography Department, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20814, USA.
⁵ Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
⁶ Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD 20814, USA.
⁷ Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
⁸ Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
⁹ Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
¹⁰ Targeted Radionuclide Therapy Section, Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
¹¹ Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, MD 21287, USA.
¹² Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, 13273 Marseille, France.
¹³ Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.

PMID: 36010880
PMCID: PMC9406057
DOI: 10.3390/cancers14163886

Abstract

The study identifies the importance of positron emission tomographic (PET) and anatomic imaging modalities and their individual performances in detecting succinate dehydrogenase A (SDHA)-related metastatic pheochromocytoma and paraganglioma (PPGL). The detection rates of PET modalities-⁶⁸Ga-DOTATATE, ¹⁸F-FDG, and ¹⁸F-FDOPA-along with the combination of computed tomography (CT) and magnetic resonance imaging (MRI) are compared in a cohort of 11 patients with metastatic PPGL in the setting of a germline SDHA mutation. The imaging detection performances were evaluated at three levels: overall lesions, anatomic regions, and a patient-by-patient basis. ⁶⁸Ga-DOTATATE PET demonstrated a lesion-based detection rate of 88.6% [95% confidence interval (CI), 84.3-92.5%], while ¹⁸F-FDG, ¹⁸F-FDOPA, and CT/MRI showed detection rates of 82.9% (CI, 78.0-87.1%), 39.8% (CI, 30.2-50.2%), and 58.2% (CI, 52.0-64.1%), respectively. The study found that ⁶⁸Ga-DOTATATE best detects lesions in a subset of patients with SDHA-related metastatic PPGL. However, ¹⁸F-FDG did detect more lesions in the liver, mediastinum, and abdomen/pelvis anatomic regions, showing the importance of a combined approach using both PET modalities in evaluating SDHA-related PPGL.

Keywords: 18F-FDG; 68Ga-DOTATATE; CT; MRI; PET; SDHA; metastatic; paraganglioma; pheochromocytoma.

PubMed Disclaimer

Conflict of interest statement

The authors declare no perceived conflict of interest.

Figures

**Figure 1**
These are maximum intensity projection image PET/CTs for Patient 3. (A) ⁶⁸Ga-DOTATATE identified the most PPGL lesions, followed by (B) ¹⁸F-FDG, and the fewest lesions were identified on (C) ¹⁸F-FDOPA.

See this image and copyright information in PMC

References

1. Jochmanova I., Pacak K. Pheochromocytoma: The First Metabolic Endocrine Cancer. Clin. Cancer Res. 2016;22:5001–5011. doi: 10.1158/1078-0432.CCR-16-0606. - DOI - PMC - PubMed
1. Amar L., Pacak K., Steichen O., Akker S.A., Aylwin S.J.B., Baudin E., Buffet A., Burnichon N., Clifton-Bligh R.J., Dahia P.L.M., et al. International consensus on initial screening and follow-up of asymptomatic SDHx mutation carriers. Nat. Rev. Endocrinol. 2021;17:435–444. doi: 10.1038/s41574-021-00492-3. - DOI - PMC - PubMed
1. Crona J., Taieb D., Pacak K. New Perspectives on Pheochromocytoma and Paraganglioma: Toward a Molecular Classification. Endocr. Rev. 2017;38:489–515. doi: 10.1210/er.2017-00062. - DOI - PMC - PubMed
1. Alrezk R., Suarez A., Tena I., Pacak K. Update of Pheochromocytoma Syndromes: Genetics, Biochemical Evaluation, and Imaging. Front Endocrinol. 2018;9:515. doi: 10.3389/fendo.2018.00515. - DOI - PMC - PubMed
1. Bourgeron T., Rustin P., Chretien D., Birch-Machin M., Bourgeois M., Viegas-Pequignot E., Munnich A., Rotig A. Mutation of a nuclear succinate dehydrogenase gene results in mitochondrial respiratory chain deficiency. Nat. Genet. 1995;11:144–149. doi: 10.1038/ng1095-144. - DOI - PubMed

Grants and funding

LinkOut - more resources

Full Text Sources
- Europe PubMed Central
- MDPI

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Performances of Functional and Anatomic Imaging Modalities in Succinate Dehydrogenase A- Related Metastatic Pheochromocytoma and Paraganglioma

Affiliations

Performances of Functional and Anatomic Imaging Modalities in Succinate Dehydrogenase A- Related Metastatic Pheochromocytoma and Paraganglioma

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources