Use of 6-[¹⁸F]-fluorodopamine positron emission tomography (PET) as first-line investigation for the diagnosis and localization of non-metastatic and metastatic phaeochromocytoma (PHEO)

Authors: Timmers, Henri J. L. M.; Eisenhofer, Graeme; Carrasquillo, Jorge A.¹; Chen, Clara C.¹; Whatley, Millie¹; Ling, Alexander²; Adams, Karen T.³; Pacak, Karel³

Source: Clinical Endocrinology, Volume 71, Number 1, July 2009 , pp. 11-17(7)

Publisher: Wiley-Blackwell

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Abstract:

Summary Objective

Imaging modalities available for the localization of phaeochromocytoma (PHEO) include computed tomography (CT), magnetic resonance imaging (MRI), [¹²³I]- or [¹³¹I]-labelled metaiodobenzylguanidine (^123/131I-MIBG) scintigraphy and 6-[¹⁸F]-fluorodopamine (¹⁸F-FDA) positron emission tomography (PET). Our aim was to investigate the yield of ¹⁸F-FDA PET vs. biochemical testing and other imaging techniques to establish the diagnosis and location of PHEO. Patients and measurements

The study included 99 consecutive patients (35 Males, 64 Females, mean ± SD age 46·4 ± 13·4 years), who underwent ¹⁸F-FDA PET, biochemical testing (plasma catecholamines and free metanephrines) and CT and/or MRI. The majority (78%) also underwent ^123/131I-MIBG. Results

In total 26 patients had non-metastatic PHEO, 34 patients had metastatic PHEO, and PHEO was ruled out in 39 patients. Investigations to rule out or confirm PHEO yielded the following sensitivity/specificity: plasma metanephrines 97/95%, ¹⁸F-FDA 92/90%, ¹²³I-MIBG 83/100%, ^123/131I-MIBG 70/100%, CT 100/41%, MRI 98/60%. Sensitivities for localizing non-metastatic PHEO on a per-lesion base were: CT 97%, MRI 92%, ¹⁸F-FDA 78%, ¹²³I-MIBG 78% and ^123/131I-MIBG 76%. Sensitivities for detecting metastases on a per-patient base were: CT and MRI 100%, ¹⁸F-FDA 97%, ¹²³I-MIBG 85% and ^123/131I-MIBG 65%. Conclusion

For tumour localization, ¹⁸F-FDA PET and ^123/131I-MIBG scintigraphy perform equally well in patients with non-metastatic PHEO, but metastases are better detected by ¹⁸F-FDA PET than by ^123/131I-MIBG.

Document Type: Research article

DOI: 10.1111/j.1365-2265.2008.03496.x

Affiliations: 1: Nuclear Medicine Department 2: Department of Diagnostic Radiology, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, MD, USA 3: Reproductive and Adult Endocrinology Program, National Institutes of Health, Bethesda, MD, USA