Ga-68 DOTATATE PET/CT in the evaluation of paragangliomas and other indeterminate lesions in the head and neck

Kuker, Russ; Wang, Jiaqiong; Nagornaya, Natalya; Bhatia, RitaG; Quencer, Robert M.; Serafini, Aldo N.

doi:10.4103/ijnm.ijnm_66_22

Cited by 3 publications

(8 citation statements)

References 56 publications

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“…In recent years, functional imaging methods have been developed, such as 18 F-FDA and 18 F-FDG PET/CT, 18 F-DOPA PET, and 123 I-MIBG, that specifically identify the paragangliomas using agents that target catecholamine synthesis, storage and secretion [38]. 18 F-DOPA PET has a sensitivity of 90%, and a specificity of 79% for head and neck paragangliomas, being very sensitive-up to 100% for multifocal tumors [37]. The disadvantage of 18 F-DOPA PET is the extremely low sensitivity for SDHB-related metastasesonly 20%-while for non-SDHB ones, it performs extremely well, identifying up to 94% of them [38,39].…”

Section: Imagingmentioning

confidence: 99%

“…18 F-DOPA PET has a sensitivity of 90%, and a specificity of 79% for head and neck paragangliomas, being very sensitive-up to 100% for multifocal tumors [37]. The disadvantage of 18 F-DOPA PET is the extremely low sensitivity for SDHB-related metastasesonly 20%-while for non-SDHB ones, it performs extremely well, identifying up to 94% of them [38,39].…”

Section: Imagingmentioning

confidence: 99%

“…123 I-MIBG scintigraphy shows a limited use for metastatic paragangliomas, identifying between 59 and 79% of them, but with a sensitivity of 92-98% for non-metastatic tumors [38]. 18 F-FDG PET/CT has great utility in localizing primary paragangliomas and metastases, especially those SDHB-related, but later results have shown fluctuating numbers for sensitivity, between 58 to 88%, so it should be interpreted with caution [17,38,39]. 18 F-FDA PET/CT has proven to be superior to 18 F-DOPA PET and 123 I-MIBG for identifying metastases and has offered great results, especially for pheochromocytomas and paragangliomas derived from the sympathetic nervous system, with a sensitivity and specificity between 70 and 95%, but unfortunately, it has performed poorly when it comes to paragangliomas of the head and neck, which are from the parasympathetic nervous system, revealing only 46% of them [17,39].…”

Section: Imagingmentioning

confidence: 99%

“…General recommendations encourage the use of 18 F-DOPA PET and 18 F-FDA PET/CT in patients with non-SDHB paragangliomas and restrict the 18 F-FDG PET/CT in correlation with CT or MRI for patients with SDHB mutation [38,39]. 68 Ga-DOTATE PET/CT represents an incredibly valuable imaging resource in the evaluation of paragangliomas and their metastases due to the higher uptake related to the somatostatin receptor (SSTR) overexpression in this type of tumors, especially SSTR2, being able to detect 36% more lesions that CT or MRI [18]. Many studies show the superiority of 68 Ga-DOTATE PET/CT over other functional imaging methods 18 F-FDG PET/CT, 18 F-FDA PET/CT, or 18 F-DOPA PET being suggested that it should become the first choice in evaluating paragangliomas [18,40,41].…”

Section: Imagingmentioning

confidence: 99%

“…68 Ga-DOTATE PET/CT represents an incredibly valuable imaging resource in the evaluation of paragangliomas and their metastases due to the higher uptake related to the somatostatin receptor (SSTR) overexpression in this type of tumors, especially SSTR2, being able to detect 36% more lesions that CT or MRI [18]. Many studies show the superiority of 68 Ga-DOTATE PET/CT over other functional imaging methods 18 F-FDG PET/CT, 18 F-FDA PET/CT, or 18 F-DOPA PET being suggested that it should become the first choice in evaluating paragangliomas [18,40,41]. It can also provide a better option to differentiate between paragangliomas and other tumors, such as esthesioneuroblastoma, schwannoma, osteosarcoma, and plasmacytoma, due to their significantly lower uptake, but with limitations when it comes to meningioma and ectopic thyroid tissue, that both present a similar expression of SSTR [18].…”

Section: Imagingmentioning

confidence: 99%

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Paragangliomas of the Head and Neck: A Review of the Latest Diagnostic and Treatment Methods

Palade,

Hainarosie,

Zamfir

et al. 2024

Medicina

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Background and objectives: Paragangliomas of the head and neck are rare, slow-growing neuroendocrine tumors, benign in their vast majority, but with a possibility of developing distant metastases. They show great inheritable character, and their behavior has proven to be unpredictable; therefore, they are considered malignant. Material and methods: This article aims to offer a more comprehensive presentation of the pathogenesis, epidemiology, diagnostic methods, imaging development, and treatment guidelines. We tried to bring together all the necessary data that, in our opinion, a head and neck practitioner should know when managing this type of tumor. Our main focus is on the most recent studies, with the purpose of a homogenous presentation of all current guidelines and approaches to this pathology. Results: Paragangliomas of the head and neck are still a disputed topic. One of the main reasons for that is their low incidence of 0.3 to 1 per 100.000 every year. The most frequent locations are the carotid body, the temporal bone, the jugular and mastoid foramen, and the vagal nerve. Their clinical presentation usually involves a painless lateral mass associated with symptoms such as hoarseness, hearing loss, tinnitus, and cranial nerve deficits. Up to 40% of them are inherited, mostly linked with mutations of succinate dehydrogenase complex. Imaging evaluation consists of CT and MRI, and new functional explorations such as 18F-FDA and 18F-FDG PET/CT, 18F-DOPA PET, 123I-MIBG, and 68Ga-DOTATE PET/CT. Measuring the catecholamine levels in the plasma and urine is mandatory, even though paragangliomas of the head and neck rarely display secretory behavior. Treatment mainly consists of surgery, with different approaches and techniques, but conservative management methods such as wait and scan, radiotherapy, proton therapy, and chemotherapy have proven their efficiency. The therapeutical decision lacks consensus, and current studies tend to recommend an individualized approach. Guidelines regarding long-term follow-up are still a matter of debate.

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Section: Imagingmentioning

confidence: 99%

Section: Imagingmentioning

confidence: 99%

Section: Imagingmentioning

confidence: 99%

Section: Imagingmentioning

confidence: 99%

Section: Imagingmentioning

confidence: 99%

See 3 more Smart Citations

Paragangliomas of the Head and Neck: A Review of the Latest Diagnostic and Treatment Methods

Palade,

Hainarosie,

Zamfir

et al. 2024

Medicina

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Laryngeal Paraganglioma—A Case Report

Palade,

Severin,

Vrinceanu

et al. 2024

Medicina

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Background and Objectives: Paragangliomas of the head and neck are rare neuroendocrine tumors originating from the paraganglia, which might be sympathetic or parasympathetic. Laryngeal paragangliomas are the rarest subtype of these tumors, with only 1.41% of all paragangliomas, arising from the supraglottic or subglottic paraganglia of the larynx. The vast majority of them are benign, but there are some cases in which they turn out to be malignant, and the only way to know with certainty the difference between them is when we identify distant metastases. The aim of this article is to share our experience with a rare case of laryngeal paraganglioma and review the clinical characteristics, methods of diagnostic, necessary investigation prior to the operation, and surgical management of this type of tumor. Materials and Methods: We present the case of a 68-year-old female patient, a non-smoker, who accused dysphagia, dysphonia, foreign body sensation, chronic cough, and hoarseness for six months. We performed a tracheostomy prior to biopsy to secure the airways in case of bleeding and then took a few biopsy samples. The histopathological exam revealed the presence of a laryngeal paraganglioma. An enhanced CT scan was performed in order to describe the localization, size, and invasion of the tumor. We also measured the vanillylmandelic acid from the urine to determine if the tumor produced catecholamines alongside a full cardiology and endocrinology examinations. In order to prevent massive bleeding during the operation, chemoembolization was attempted before surgery, but it was unsuccessful due to an anatomical variation of the left superior thyroid artery. She underwent surgery, first through transoral endoscopic microsurgery; however, we decided to undertake an external approach because of poor bleeding control, even though we had ligated both the superior thyroid artery and the external carotid artery, with a thyrotomy and laryngofissure achieving the complete resection of the tumor. Results: The patient was discharged 10 postoperative days later, with the recommendation of introducing food step-by-step from liquids to solids. She was decannulated after 30 days, with no complications regarding breathing, phonation, or deglutition. Twelve months after the surgery, we did not identify any local relapses of distant metastases. Conclusions: Laryngeal paragangliomas are rare neuroendocrine tumors that arise from the laryngeal paraganglia. Surgery is the best treatment option available, and it can be done by either an external approach or by transoral endoscopy. Enhanced CT or MRI, as well as full cardiological and endocrinological evaluation are mandatory prior to the operation. Measuring the catecholamines levels show the if the tumor is secretory. Controlling the bleeding poses the biggest challenge in performing the resection of the tumor, especially when a transoral endoscopic approach is chosen. Further standardized follow-up guidelines are required in the future.

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