Staging and functional characterization of pheochromocytoma and paraganglioma by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography - PubMed (original) (raw)

Comparative Study

. 2012 May 2;104(9):700-8.

doi: 10.1093/jnci/djs188. Epub 2012 Apr 18.

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Comparative Study

Staging and functional characterization of pheochromocytoma and paraganglioma by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography

Henri J L M Timmers et al. J Natl Cancer Inst. 2012.

Abstract

Background: Pheochromocytomas and paragangliomas (PPGLs) are rare tumors of the adrenal medulla and extra-adrenal sympathetic chromaffin tissues; their anatomical and functional imaging are critical to guiding treatment decisions. This study aimed to compare the sensitivity and specificity of (18)F-fluorodeoxyglucose positron emission tomography with computed tomography ((18)F-FDG PET/CT) for tumor localization and staging of PPGLs with that of conventional imaging by [(123)I]-metaiodobenzylguanidine single photon emission CT ((123)I-MIBG SPECT), CT, and magnetic resonance imaging (MRI).

Methods: A total of 216 patients (106 men, 110 women, aged 45.2 ± 14.9 years) with suspected PPGL underwent CT or MRI, (18)F-FDG PET/CT, and (123)I-MIBG SPECT/CT. Sensitivity and specificity were measured as endpoints and compared by the McNemar test, using two-sided P values only.

Results: Sixty (28%) of patients had nonmetastatic PPGL, 95 (44%) had metastatic PPGL, and 61 (28%) were PPGL negative. For nonmetastatic tumors, the sensitivity of (18)F-FDG was similar to that of (123)I-MIBG but less than that of CT/MRI (sensitivity of (18)F-FDG = 76.8%; of (123)I-MIBG = 75.0%; of CT/MRI = 95.7%; (18)F-FDG vs (123)I-MIBG: difference = 1.8%, 95% confidence interval [CI] = -14.8% to 14.8%, P = .210; (18)F-FDG vs CT/MRI: difference = 18.9%, 95% CI = 9.4% to 28.3%, P < .001). The specificity was 90.2% for (18)F-FDG, 91.8% for (123)I-MIBG, and 90.2% for CT/MRI. (18)F-FDG uptake was higher in succinate dehydrogenase complex- and von Hippel-Lindau syndrome-related tumors than in multiple endocrine neoplasia type 2 (MEN2) related tumors. For metastases, sensitivity was greater for (18)F-FDG and CT/MRI than for (123)I-MIBG (sensitivity of (18)F-FDG = 82.5%; of (123)I-MIBG = 50.0%; of CT/MRI = 74.4%; (18)F-FDG vs (123)I-MIBG: difference = 32.5%, 95% CI = 22.3% to 42.5%, P < .001; CT/MRI vs (123)I-MIBG: difference = 24.4%, 95% CI = 11.3% to 31.6%, P < .001). For bone metastases, (18)F-FDG was more sensitive than CT/MRI (sensitivity of (18)F-FDG = 93.7%; of CT/MRI = 76.7%; difference = 17.0%, 95% CI = 4.9% to 28.5%, P = .013).

Conclusions: Compared with (123)I-MIBG SPECT and CT/MRI, both considered gold standards for PPGL imaging, metastases were better detected by (18)F-FDG PET. (18)F-FDG PET provides a high specificity in patients with a biochemically established diagnosis of PPGL.

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Figures

Figure 1

Figure 1

18F-fluorodeoxyglucose positron emission tomography (18F-FDG) and [123I]-metaiodobenzylguanidine (123I-MIBG) images of patients with succinate dehydrogenase subunit B (SDHB) mutations and multiple endocrine neoplasia-2 (MEN2). A and B) Maximum intensity projected 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) (A) and [123I]-metaiodobenzylguanidine (123I-MIBG) scintigraphy (SPECT) (B) of an SDHB patient with a paraganglioma of the mediastinum (Table 1: SDHB, F36): lesion marked by arrow. C and D) Maximum intensity projected 18F-FDG PET (C) and 123I-MIBG scintigraphy (D) of an MEN2 patient with a right adrenal pheochromocytoma (Table 1: MEN2, F40): lesion marked by arrow.

Figure 2

Figure 2

18F-fluorodeoxyglucose positron emission tomography standardized uptake value (SUV) in pheochromocytoma and paraganglioma (PPGL) vs normal adrenal glands. Box and whiskers diagrams of maximum SUVs are statistically significantly higher for adrenal and extra-adrenal PPGLs than for normal adrenal glands in patients without PPGL and contralateral adrenal or extra-adrenal PPGL (boxes indicate 25th and 75th percentile, solid lines indicate median, and whiskers indicate range) (Tukey–Kramer test, two-sided).

Figure 3

Figure 3

Receiver operating curve for 18F-fluorodeoxyglucose positron emission tomography standardized uptake value (SUV). This curve was constructed from the SUVs of pheochromocytomas and normal adrenals in patients with nonmetastatic pheochromocytomas and paragangliomas.

Figure 4

Figure 4

18F-fluorodeoxyglucose positron emission tomography standardized uptake value (SUV) in nonmetastatic pheochromocytoma and paraganglioma across genotypes. MEN2 = multiple endocrine neoplasia type 2, MN = plasma metaneprine, NF1 = neurofibromatosis type 1, NMN = plasma normetanephrine, ns = nonsignificant, SDHB/C/D/x= succinate dehydrogenase subunit B/C/D/x, SPOR = sporadic, SUVmax = maximum SUV, VHL = von Hippel–Lindau syndrome.

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