MIBG-SPECT/CT-angiography with 3-D reconstruction of an extra-adrenal phaeochromocytoma with dissection of an aortic aneurysm

Abstract

Phaeochromocytomas can cause severe complications like stroke, lung oedema, myocardial infarction or aortic dissection. Ten percent of phaeochromocytomas originate in extra-adrenal localisations and can be detected with 123 I-MIBG scintigraphy [1]. We report on a 50-year-old patient with weight loss, night sweating and increased urinary noradrenaline levels. SPECT with 358 MBq 123 I-MIBG and additionally a dual-phase diagnostic CT were performed, showing increased MIBG uptake para-aortally on the left side (a,b, arrow) corresponding to a hypervascularised lesion visible on CT (b, arrow) [2]. Additionally, in CT a thoracic aneurysm with type B aortic dissection (a,b, arrowheads) was detected. For surgical planning, CT-angiography and SPECT were combined in a fused 3D rendering using the PMOD 2.75 software (see figure). The paraganglioma was resected and 1 month later the aneurysm was successfully treated with a stent graft. There are some case reports in the literature about phaeochromocytomas associated with aortic or carotid dissections [3][4][5]. SPECT/CT-angiography with fused 3D reconstruction requires appropriate software and some postprocessing time but provides the surgeon with important functional and morphological information for adequate therapy planning.

Endocrine Scintigraphy with Hybrid SPECT/CT

“…However some authors have suggested a role for MIBG in the presence of genetic mutations with increased malignant potential (192). (193)(194)(195)(196)(197)(198)(199)(200)(201). One study found SPECT/CT had incremental diagnostic value over planar scintigraphy in up to 53% of cases (202).…”