Comparison of 6-¹⁸F-Fluorodopamine PET with ¹²³I-Metaiodobenzylguanidine and ¹¹¹In-Pentetreotide Scintigraphy in Localization of Nonmetastatic and Metastatic Pheochromocytoma

Abstract

We compared functional imaging modalities including PET with 6-18 F-fluorodopamine ( 18 F-DA) with 123 I-metaiodobenzylguanidine ( 123 I-MIBG) and somatostatin receptor scintigraphy (SRS) with 111 In-pentetreotide in nonmetastatic and metastatic pheochromocytoma (PHEO). Methods: We studied 25 men and 28 women (mean age 6 SD, 44.2 6 14.2 y) with biochemically proven nonmetastatic (n 5 17) or metastatic (n 5 36) PHEO. Evaluation included anatomic imaging with CT or MRI and functional imaging that included at least 2 nuclear medicine modalities: 18 F-DA PET, 123 I-MIBG scintigraphy, or SRS. Sensitivity of functional imaging versus anatomic imaging was assessed on a per-patient and a per-region basis. Results: For this available cohort, on a per-patient basis overall sensitivity (combined for nonmetastatic and metastatic PHEO) was 90.2% for 18 F-DA PET, 76.0% for 123 I-MIBG scintigraphy, and 22.0% for SRS. On a per-region basis, overall sensitivity was 75.4% for 18 F-DA PET, 63.4% for 123 I-MIBG scintigraphy, and 64.0% for SRS. Conclusion: If available, 18 F-DA PET should be used in the evaluation of PHEO, because it is more sensitive than 123 I-MIBG scintigraphy or SRS. If 18 F-DA PET is not available, 123 I-MIBG scintigraphy (for nonmetastatic or adrenal PHEO) and SRS (for metastatic PHEO) should be the first alternative imaging methods to be used.

18F-FDOPA PET and PET/CT Accurately Localize Pheochromocytomas

“…18 F-labeled radiopharmaceuticals with longer half-lives and active uptake in neuroendocrine cells can eliminate these limitations. 18 F-fluorodopamine has recently been evaluated for detection of pheochromocytoma and has provided improved results (7)(8)(9). In this study, we evaluated 3,4-dihydroxy-6-18 F-fluoro-phenylalanine ( 18 F-FDOPA).…”

Modern Nuclear Imaging for Paragangliomas: Beyond SPECT

“…This possibility of missing certain retroperitoneal tumors has also been noted in 3 other studies (34,53,56). 18 F-FDA PET is highly sensitive but may also miss some tumors (24,60).…”

“…Studies that have included a high number of extraadrenal, multiple, or hereditary paragangliomas found reduced sensitivity for MIBG (52%-75%) (24,53,56,60). Furthermore, MIBG may miss additional HNPs in hereditary syndromes.…”

“…Imaging may need to be repeated later. The sensitivity of SST scintigraphy with 111 In-DTPA-pentetreotide is lower than that of 131 I/ 123 I-MIBG in pheochromocytomas and sympathetic paragangliomas (24)(25)(26). The sensitivity of 111 In-DTPApentetreotide is also inferior to MIBG in metastatic paragangliomas, even though 111 In-DTPA-pentetreotide can provide additional information in some patients with rapidly progressing metastatic paraganglioma (24)(25)(26)(27).…”

“…The sensitivity of SST scintigraphy with 111 In-DTPA-pentetreotide is lower than that of 131 I/ 123 I-MIBG in pheochromocytomas and sympathetic paragangliomas (24)(25)(26). The sensitivity of 111 In-DTPApentetreotide is also inferior to MIBG in metastatic paragangliomas, even though 111 In-DTPA-pentetreotide can provide additional information in some patients with rapidly progressing metastatic paraganglioma (24)(25)(26)(27). However, considering parasympathetic paragangliomas, several studies have demonstrated the superiority of 111 In-DTPApentetreotide scintigraphy over 131 I/ 123 I-MIBG, with sensitivities of 89%-100% and 18%-50%, respectively (28)(29)(30)(31)(32)(33).…”