EANM 2012 guidelines for radionuclide imaging of phaeochromocytoma and paraganglioma

Abstract

Purpose Radionuclide imaging of phaeochromocytomas (PCCs) and paragangliomas (PGLs) involves various functional imaging techniques and approaches for accurate diagnosis, staging and tumour characterization. The purpose of the present guidelines is to assist nuclear medicine practitioners in performing, interpreting and reporting the results of the currently available SPECT and PET imaging approaches. These guidelines are intended to present information specifically adapted to European practice. Methods Guidelines from related fields, issued by the European Association of Nuclear Medicine and the Society of Nuclear Medicine, were taken into consideration and are partially integrated within this text. The same was applied to the relevant literature, and the final result was discussed with leading experts involved in the management of patients with PCC/PGL. The information provided should be viewed in the context of local conditions, laws and regulations. Conclusion Although several radionuclide imaging modalities are considered herein, considerable focus is given to PET imaging which offers high sensitivity targeted molecular imaging approaches.

Could 68Ga-somatostatin analogues replace other PET tracers in evaluating extra-adrenal paragangliomas?

“…A specific correlation between the gene involved and tumour location has been reported [1]. Most often, extra-adrenal PGLs are benign and progress slowly.…”

“…Extra-adrenal PGLs of the sympathetic chains usually cause symptoms of catecholamine over-secretion. Conversely, parasympathetic head and neck (H&N) and thoracic PGLs are almost always non-secreting tumours which are discovered on imaging studies or revealed by symptoms of compression or infiltration of the adjacent structures [1].…”

“…Most often, extra-adrenal PGLs are benign and progress slowly. The rate of distant spread is wide, depending on tumour location, size and genetic background [1].…”

“…Recent European Association of Nuclear Medicine (EANM) guidelines for nuclear medicine imaging of PGLs provided a practical algorithm for selecting the most appropriate imaging procedure based on a tailored approach, taking into account genetic mutation, location of the PGL and presence of metastases, starting from the assumption that there is no 'gold standard' imaging technique for all patients with extra-adrenal PGL [1][2][3]. 18 F-DOPA positron emission tomography (PET)/CT is suggested as first-line imaging method in H&N and abdominal non-metastatic extra-adrenal PGLs; this method may be useful in metastatic PGLs in the absence of succinate dehydrogenase B (SDHB) gene mutations or when genetic status is unknown [1,4]. 111 In-Pentetreotide single photon emission computed tomography (SPECT)(/CT) may be used as firstline evaluation of H&N PGLs in the absence of 18 F-DOPA PET/CT.…”

“…18 F-Fluorodeoxyglucose (FDG) PET/CT is especially sensitive in the setting of SDH-and von Hippel-Lindau disease (VHL)-related sympathetic extra-adrenal PGLs and it seems to be the imaging modality of choice for SDHB-related metastatic PGLs; this method may also provide useful prognostic information. 18 F-Fluorodopamine and 11 Chydroxyephedrine PET are both accurate methods in evaluating patients with extra-adrenal and metastatic PGL but, to date, these techniques have limited availability [1]. The diagnostic performance of PET or PET/CT with various radiopharmaceuticals is clearly superior to that of radioiodinated metaiodobenzylguanidine (MIBG) scintigraphy in patients with extra-adrenal and metastatic PGL; however, MIBG scintigraphy maintains a unique role in selecting patients suitable for 131 I-MIBG therapy [5].…”