Perirenal 18F-FDG Uptake in a Patient with a Pheochromocytoma

Park, Jihyun; Byun, Byung Hyun; Jung, Chang Won; Moon, Hyeong Cheol; Chang, Kihun; Lim, Ilhan; Choi, Chang Woon; Lim, Sang Moo

doi:10.1007/s13139-014-0276-2

Cited by 4 publications

(2 citation statements)

References 15 publications

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“…Several cases demonstrated extensive activation of BAT on FDG due to very high circulating catecholamines, with follow-up imaging demonstrating resolution of BAT activity in two cases after successful treatment with surgery, PRRT and alpha blockade. BAT activation is commonly stimulated by cold exposure and inversely correlated with body mass index, although it is also a less appreciated but important characteristic of catecholamine secreting PGL/PCCs [ 37 , 38 ]. Given that beta-blockers are often administered to suppress BAT uptake for repeat imaging [ 39 ], it is critical to consider the possibility of PGL/PCC in the appropriate clinical context (e.g., assessment of adrenal/paravertebral lesion) because isolated beta-blockade may precipitate hypertensive crisis due to unopposed alpha-adrenergic activation.…”

Section: Discussionmentioning

confidence: 99%

68Ga-DOTATATE and 18F-FDG PET/CT in Paraganglioma and Pheochromocytoma: utility, patterns and heterogeneity

et al. 2016

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BackgroundPheochromocytomas (PCC) and paragangliomas (PGL) are neuroendocrine tumours arising from pluripotent neural crest stem cells and are associated with neurons of the autonomic nervous system. PCCs/PGLs are often hereditary and multifocal, and their biologic behaviour and metabolic activity vary making imaging of these tumours challenging. The imaging gold standard has been I-123 MIBG complemented by CT or MRI. PGLs being neuroendocrine tumours express somatostatin receptors enabling imaging with Ga-68 DOTA-coupled peptides such as DOTATATE. Imaging with F-18 FDG also provides additional information regarding metabolic activity and biologic aggressiveness of these tumours, or, in some situations, reflecting metabolic reprogramming of these tumours. We report our experience using both Ga-68 DOTATATE and F-18 FDG PET/CT imaging in patients with PGLs and PCCs.MethodsThis was a retrospective review of 23 patients with proven PGL/PCC who underwent both DOTATATE and FDG PET/CT. Seven patients also had I-123 MIBG SPECT/CT and 1 patient had I-124 MIBG PET/CT. Lesional intensity and patterns of uptake were analysed.ResultsDOTATATE and FDG were positive at most sites of disease (96.2 % vs 91.4 %), although uptake intensity was significantly higher on DOTATATE with a median SUV of 21 compared to 12.5 for FDG (p < 0.001). SUVmax on F-18 FDG was significantly higher (p < 0.001) in clinically aggressive cases. I-123/I-124 MIBG detected fewer lesions (30.4 %).ConclusionOverall, Ga-68 DOTATATE PET/CT detected similar number but has significantly greater lesion-to-background contrast compared to F-18 FDG PET/CT. Combined with high specificity, patient convenience and relatively low cost, DOTATATE PET/CT should be considered the ideal first line investigation for imaging PGL/PCC. Depending on DOTATATE findings and the clinical question, FDG and MIBG remain useful and, in selected cases, may provide more accurate staging, disease characterisation and guide treatment choices.

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Section: Discussionmentioning

confidence: 99%

68Ga-DOTATATE and 18F-FDG PET/CT in Paraganglioma and Pheochromocytoma: utility, patterns and heterogeneity

et al. 2016

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“…In patients with PGLs, activated BAT tissue is often visualized (6,7), and it was present in up to 27% of patients when various functional imaging studies, including 18 F-FDG PET/CT, were combined (8). The recruitment of BAT appears to be dynamic, with case reports of patients with PGLs demonstrating BAT activation in association with increased systemic catecholamine levels, whereas normalization of catecholamines after surgery subsequently led to a significant reduction of BAT activation (9,10).…”

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confidence: 99%