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

Abstract

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.