Comparison of [¹¹¹In]pentetreotide‐SPECT and [¹⁸F]FDOPA‐PET in the localization of extra‐adrenal paragangliomas: the case for a patient‐tailored use of nuclear imaging modalities

Abstract

The sensitivity of SRS for localizing parasympathetic PGLs is lower than originally reported, and [¹⁸F]FDOPA-PET is better than SRS for localizing small lesions. SRS should be replaced by [¹⁸F]FDOPA-PET as the first-line imaging procedure in H&N PGL, especially in patients at risk of multifocal disease (predisposing mutations and or previous history of surgery).

Modern Nuclear Imaging for Paragangliomas: Beyond SPECT

“…These results are in line with those obtained by Charrier et al, who found a sensitivity of 97% for 18 F-FDOPA PET/ CT versus 67% for SST scintigraphy (34). This lower sensitivity of SST scintigraphy probably is related to the limited resolution of SPECT.…”

“…In a prospective study by Fottner et al, all sympathetic paragangliomas associated with SDH mutations were positive with 123 I-MIBG, whereas 2 extraadrenal paragangliomas were not detected with 18 F-FDOPA PET despite the centimeter size of the lesions (54). 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).…”

“…The results of PET in HNPs have rarely been addressed in isolation (34,53,54,56,65,66,68,(79)(80)(81). Hoegerle et al have compared 18 F-FDOPA PET/CT and MRI in 10 patients (79).…”

“…SPECT with 111 In-DTPA-pentetreotide is the current scintigraphy modality of reference in HNPs. However, its sensitivity needs to be revised downward in patients with hereditary syndromes because some additional lesions can be at the millimeter stage and not detectable by conventional scintigraphy (34).…”

The Challenges of Treating Paraganglioma Patients with 177Lu-DOTATATE PRRT: Catecholamine Crises, Tumor Lysis Syndrome and the Need for Modification of Treatment Protocols

“…In-Octreotide is a somatostatin analog with modest sst2 binding that has been reported to have a good sensitivity for head and neck paragangliomas, up to 90 % [7], but a lower sensitivity for detecting paragangliomas overall (74 % reported by Charrier in 2011) with a sensitivity as low as 20 % for abdominal paragangliomas [8]. Ga-DOTATATE PET/CT sensitivity of 80 % in the detection of pheochromocytomas and paragangliomas, superior to 123 I-MIBG [11], and Naswa Ga-DOTANOC in 26 head and neck paraganglioma patients [13].…”