05.12.2015 | Original Article
Prospective comparison of 68Ga-DOTATATE and 18F-FDOPA PET/CT in patients with various pheochromocytomas and paragangliomas with emphasis on sporadic cases
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 7/2016
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Purpose
Pheochromocytomas/paragangliomas (PHEOs/PGLs) overexpress somatostatin receptors and recent studies have already shown excellent results in the localization of these tumors using 68Ga-labeled somatostatin analogs (68Ga-DOTA-SSA), especially in patients with germline succinate dehydrogenase subunit B gene (SDHB) mutations and head and neck PGLs (HNPGLs). The value of 68Ga-DOTA-SSA has to be established in sporadic cases, including PHEOs. Thus, the aim of this study was to compare 68Ga-DOTATATE PET/CT, 18F-FDOPA PET/CT, and conventional imaging in patients with various PHEOs/PGLs with a special emphasis on sporadic cases, including those located in the adrenal gland.
Design
68Ga-DOTATATE, 18F-FDOPA PET/CT, and conventional imaging (contrast-enhanced CT and MRI with MR angiography sequences) were prospectively performed in 30 patients (8 with SDHD mutations, 1 with a MAX mutation and 21 sporadic cases) with PHEO/PGL at initial diagnosis or relapse.
Results
The patient-based sensitivities were 93 % (28/30), 97 % (29/30), and 93 % (28/30) for 68Ga-DOTATATE PET/CT, 18F-FDOPA PET/CT, and conventional imaging, respectively. The lesion-based sensitivities were 93 % (43/46), 89 % (41/46), and 76 % (35/46) for 68Ga-DOTATATE PET/CT, 18F-FDOPA PET/CT, and conventional imaging respectively (p = 0.042). 68Ga-DOTATATE PET/CT detected a higher number of HNPGLs (30/30) than 18F-FDOPA PET/CT (26/30; p = 0.112) and conventional imaging (24/30; p = 0.024). 68Ga-DOTATATE PET/CT missed two PHEOs of a few millimeters in size and a large recurrent PHEO. One lesion was considered false-positive on 68Ga-DOTATATE PET/CT and corresponded to a typical focal lesion of fibrous dysplasia on MRI. Among the 11 lesions missed by conventional imaging, 7 were detected by conventional imaging with knowledge of the PET results (4 HNPGLs, 2 LNs, and 1 recurrent PHEO).
Conclusion
68Ga-DOTATATE PET/CT is the most sensitive tool in the detection of HNPGLs, especially SDHD-related tumors, which may be very small and fail to concentrate sufficient 18F-FDOPA. The present study further expands the use of 68Ga-DOTATATE for all patients with HNPGLs, regardless of their genotype. 68Ga-DOTATATE PET/CT may be inferior to 18F-FDOPA PET/CT in the detection PHEOs.
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