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This version published online on October 28, 2009
Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2009-1248
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Submitted on June 12, 2009
Accepted on September 21, 2009

Comparison of 18F-Fluoro-L-DOPA, 18F-Fluoro-Deoxyglucose, and 18F-Fluorodopamine PET and 123I-MIBG Scintigraphy in the Localization of Pheochromocytoma and Paraganglioma

Henri J. L. M. Timmers*, Clara C. Chen, Jorge A. Carrasquillo, Millie Whatley, Alexander Ling, Bastiaan Havekes, Graeme Eisenhofer, Lucia Martiniova, Karen T. Adams, and Karel Pacak

Reproductive and Adult Endocrinology Program (H.J.L.M.T., B.H., L.M., K.T.A., K.P.), Eunice Kennedy Shriver National Institutes of Child Health and Human Development, and Departments of Nuclear Medicine (C.C.C., J.A.C., M.W.) and Diagnostic Radiology (A.L.), Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland 20892; Department of Endocrinology (H.J.L.M.T.), Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands; Nuclear Medicine Section (J.A.C.), Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York 10021; Department of Internal Medicine (B.H.), Division of Endocrinology, University Hospital Maastricht, 6202 AZ Maastricht, The Netherlands; and Institute of Clinical Chemistry and Laboratory Medicine and the Department of Medicine (G.E.), University of Dresden, 01307 Dresden, Germany

* To whom correspondence should be addressed. E-mail: h.timmers{at}endo.umcn.nl.

Context: Besides 123I-metaiodobenzylguanidine (MIBG), positron emission tomography (PET) agents are available for the localization of paraganglioma (PGL), including 18F-3,4-dihydroxyphenylalanine (DOPA), 18F-fluoro-2-deoxy-D-glucose (18F-FDG), and 18F-fluorodopamine (18F-FDA).

Objective: The objective of the study was to establish the optimal approach to the functional imaging of PGL and examine the link between genotype-specific tumor biology and imaging.

Design: This was a prospective observational study.

Intervention: There were no interventions.

Patients: Fifty-two patients (28 males, 24 females, aged 46.8 ± 14.2 yr): 20 with nonmetastatic PGL (11 adrenal), 28 with metastatic PGL (13 adrenal), and four in whom PGL was ruled out; 22 PGLs were of the succinate dehydrogenase subunit B (SDHB) genotype.

Main Outcome Measures: Sensitivity of 18F-DOPA, 18F-FDG, and 18F-FDA PET, 123I-MIBG scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI) for the localization of PGL were measured.

Results: Sensitivities for localizing nonmetastatic PGL were 100% for CT and/or MRI, 81% for 18F-DOPA PET, 88% for 18F-FDG PET/CT, 78% for 18F-FDA PET/CT, and 78% for 123I-MIBG scintigraphy. For metastatic PGL, sensitivity in reference to CT/MRI was 45% for 18F-DOPA PET, 74% for 18F-FDG PET/CT, 76% for 18F-FDA PET/CT, and 57% for 123I-MIBG scintigraphy. In patients with SDHB metastatic PGL, 18F-FDA and 18F-FDG have a higher sensitivity (82 and 83%) than 123I-MIBG (57%) and 18F-DOPA (20%).

Conclusions: 18F-FDA PET/CT is the preferred technique for the localization of the primary PGL and to rule out metastases. Second best, equal alternatives are 18F-DOPA PET and 123I-MIBG scintigraphy. For patients with known metastatic PGL, we recommend 18F-FDA PET in patients with an unknown genotype, 18F-FDG or 18F-FDA PET in SDHB mutation carriers, and 18F-DOPA or 18F-FDA PET in non-SDHB patients.






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