New imaging approaches to phaeochromocytomas and paragangliomas - PubMed (original) (raw)

Review

New imaging approaches to phaeochromocytomas and paragangliomas

Bas Havekes et al. Clin Endocrinol (Oxf). 2010 Feb.

Abstract

Formerly used concepts for phaeochromocytomas and paragangliomas have been challenged by recent discoveries that at least 24% of tumours are familial and thereby often multiple in various locations throughout the body. Furthermore, tumours are often malignant and perhaps more aggressive if associated with SDHB gene mutations. Some paragangliomas are clinically silent and may present only with dopamine hypersecretion. In the current era where CT and MRI are more commonly used, tumours are more often found as incidentalomas and MRI may be less specific for phaeochromocytoma and paraganglioma than previously thought. Because of unique tumour characteristics (e.g. the presence of cell membrane and intracellular vesicular norepinephrine transporters) these tumours were 'born' to be imaged by means of specific functional imaging approaches. Moreover, additional recent discoveries related to apoptosis, hypoxia, acidosis, anaerobic glycolysis and angiogenesis, often disturbed in tumour cells, open new options and challenges to specifically image phaeochromocytomas and paragangliomas and possibly link those results to their pathophysiology, genotypic alterations and metastatic potential. Functional imaging, especially represented by positron emission tomography (PET), offers an excellent approach by which tumour-specific processes can be detected, evaluated and seen in the context of tumour-specific behaviour and its genetic signature. In this review, we address the recent developments in new functional imaging modalities for phaeochromocytoma and paraganglioma and provide the reader with suggested imaging approaches in various phaeochromocytomas and paragangliomas of sympathetic origin. Current imaging algorithms of head and neck parasympathetic paragangliomas are not discussed. Finally, this review outlines some future perspectives of functional imaging of these tumours.

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Figures

Figure 1

Figure 1. Non-specific and specific imaging for pheochromocytoma/paraganglioma

DBH = Dopamine-beta-hydroxylase; EPI = Epinephrine; 18F-FDA = 18F-fluorodopamine; 18F-FDG = 18F-fluoro-2-deoxy-D-glucose; 18F-FDOPA = 18F-dihydroxyphenylalanine; 18F-FNE = 18F – Free Norepinephrine; NE = Norepinephrine; DOTANOC = DOTA-Nal3-octreotide; DOTATOC = DOTA-Tyr3-octreotide; 123/131I-MIBG = 123/131I-metaiodobenzylguanidine; L-AADC = L-aromatic-aminoacid decarboxylase; NET = Norepinephrine transporter; PNMT = Phenylethanolamine-N-methyltransferase; SDHB/C/D = Succinate dehydrogenase subunit B/C/D; ST Receptor = Somatostatin receptor;?* = Potential radiopharmaceutical directed at mutations in the mitochondria; FNE? = The question mark indicates that FNE is a possible target for 18F-FDA in secretory granules

Figure 2

Figure 2. Pathways of metabolism of catecholamines to free and sulfate-conjugated metanephrines

Courtesy of: Dr. G. Eisenhofer. PNMT, phenylethanolamine _N_-methyltransferase; COMT, catechol-_O_-methyltransferase; SULT1A3, monoamine-preferring sulfotransferase.

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References

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