Routine preoperative 123I-MIBG scintigraphy for patients with phaeochromocytoma is not necessary (original) (raw)
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Clinical Endocrinology, 2008
Context Evidence regarding the accuracy of [123I] metaiodobenzylguanidine (MIBG) imaging for phaeochromocytoma localization is currently limited to small series.Objective We present the largest series of primary phaeochromocytomas in which the performance of [123I]MIBG has been evaluated and correlated with cross-sectional imaging.Design We identified 76 patients with both preoperative [123I]MIBG and cross-sectional imaging for confirmed primary phaeochromocytoma between 1995 and 2005 at our institution. This comprised 60 adrenal tumours in 55 patients and 33 extra-adrenal tumours in 23 patients (2 patients had both adrenal and extra-adrenal tumours). Phaeochromocytoma metastases were not evaluated.Main outcome measure(s) [123I]MIBG studies were independently reviewed and correlated with CT and MRI examinations, as well as tumour functional status, to identify features that may predict a false negative [123I]MIBG result.Results The overall sensitivity of [123I]MIBG was 75%. Tumour detection was lower for extra-adrenal (58%) vs. adrenal (85%) phaeochromocytomas (P = 0·005). For extra-adrenal tumours, [123I]MIBG demonstrated 8 of 14 carotid body, 2 of 2 intrathoracic, 8 of 14 retroperitoneal and 2 of 3 pelvic phaeochromocytomas. Overall, MRI and CT demonstrated 68 of 68 and 72 of 74 primary phaeochromocytomas, respectively. Tumour size correlated with [123I]MIBG uptake for adrenal (P = 0·009) but not extra-adrenal tumours. When tumours were adjusted for size, no other imaging feature or functional status correlated with [123I]MIBG negativity, although two large [123I]MIBG negative adrenal tumours contained large areas of necrosis or haemorrhage.Conclusions Extra-adrenal and small adrenal phaeochromocytomas are more likely to result in false negatives on [123I]MIBG. Tumoural necrosis or haemorrhage do not consistently relate to [123I]MIBG uptake, although adrenal phaeochromocytomas containing minimal solid tissue due to extensive necrosis may predict a negative [123I]MIBG result.
Journal of Nuclear Medicine, 2009
Although 123 I-MIBG has been in clinical use for the imaging of pheochromocytoma for many years, a large multicenter evaluation of this agent has never been performed. The present study was designed to provide a prospective confirmation of the performance of 123 I-MIBG scintigraphy for the evaluation of patients with known or suspected primary or metastatic pheochromocytoma or paraganglioma. Methods: A total of 81 patients with a prior history of primary or metastatic pheochromocytoma or paraganglioma and 69 with suspected pheochromocytoma or paraganglioma based on symptoms of catecholamine excess, CT or MRI findings, or elevated catecholamine or metanephrine levels underwent whole-body planar and selected SPECT 24 h after the administration of 123 I-MIBG. Images were independently interpreted by 3 masked readers, with consensus requiring agreement of at least 2 readers. Final diagnoses were based on histopathology, correlative imaging, catecholamine or metanephrine measurements, and clinical follow-up. Results: Among 140 patients with definitive diagnoses (91, disease present; 49, disease absent), 123 I-MIBG planar scintigraphy had a sensitivity and specificity of 82%. For patients evaluated for suspected disease, sensitivity and specificity were 88% and 84%, respectively. For the subpopulations of adrenal (pheochromocytoma) and extraadrenal (paraganglioma) tumors, sensitivities were 88% and 67%, respectively. The addition of SPECT increased reader confidence but minimally affected sensitivity and specificity. Conclusion: This prospective study demonstrated a sensitivity of 82%288% and specificity of 82%284% for 123 I-MIBG imaging used in the diagnostic assessment of primary or metastatic pheochromocytoma or paraganglioma.
Journal of Nuclear Medicine, 2009
In this investigation, the efficacy of scintigraphy using 99m Tclabeled hydrazinonicotinyl-Tyr3-octreotide (HYNIC-TOC) in the evaluation of extraadrenal pheochromocytoma was assessed and compared with 131 I-labeled metaiodobenzylguanidine (MIBG) imaging. Methods: Ninety-seven patients who were suspected of having pheochromocytoma but showed no definite adrenal abnormalities on CT were evaluated by both 99m Tc-HYNIC-TOC scintigraphy and 131 I-MIBG imaging. The results were compared with pathology findings or clinical follow-up. Results: Of 58 patients proven to be without pheochromocytoma, 99m Tc-HYNIC-TOC and 131 I-MIBG imaging excluded 56 and 58 patients, respectively, rendering a specificity of 96.6% for 99m Tc-HYNIC-TOC imaging and 100% for 131 I-MIBG imaging. In the evaluation of adrenal pheochromocytoma (14 patients), the sensitivity of 99m Tc-HYNIC-TOC scintigraphy and 131 I-MIBG imaging was 50% and 85.7%, respectively. However, in the evaluation of extraadrenal pheochromocytomas (25 patients), the sensitivity of 99m Tc-HYNIC-TOC scintigraphy and 131 I-MIBG imaging was 96.0% and 72.0%, respectively. Conclusion: 99m Tc-HYNIC-TOC scintigraphy is more sensitive than 131 I-MIBG imaging in the detection of extraadrenal pheochromocytomas.
Nuclear Medicine and Molecular Imaging, 2011
Purpose Pheochromocytoma (PH) is a rare catecholaminesecreting tumor that arises from chromaffin tissue within the adrenal medulla and extra-adrenal sites; commonly it is sporadic, and malignant PH accounts for about 10% of all cases. Several imaging modalities have been used for the diagnosis and staging of this tumor: functional imaging using radio-labelled metaiodobenzylguanidine and, more recently, 18 F-fluorodeoxyglucose positron emission tomography (18 F-FDG PET/CT), which offers substantial sensitivity and specificity to correctly detect metastatic PH and helps to identify patients suitable for treatment with radiopharmaceuticals. The aim of our study was to compare CT, 18 F-FDG PET/CT, and 123 I-metaiodobenzylguanidine single photon emission tomography (123 I-MIBG SPECT) as feasible methods to restage patients diagnosed histologically with PH. Methods We retrospectively evaluated 38 patients (27 females and 11 males; mean age: 44±15 years) with malignant PH documented histologically after surgical intervention. These patients underwent CT, 18 F-FDG PET/ CT, and 123 I-MIBG SPECT. Results 18 F-FDG PET/CT showed positive results for neoplastic tissue in 33/38 patients (86.8%) and negative in 5/38 (13.2%), in concordance with CT alone. 123 I-MIBG SPECT was positive in 30/38 patients (78,9%) and negative in 8/38 (21.1%). No differences in lesion numbers were found between 18 F-FDG PET/CT and CT, whereas a difference could be demonstrated between 18 F-FDG PET/ CT and 123 I-MIBG SPECT. Conclusion 18 F-FDG PET/CT could more accurately restage patients with PH than CT and 123 I-MIBG SPECT, also in the absence of a staging study.
The evolution in the use of MIBG scintigraphy in pheochromocytomas and paragangliomas
Hormones (Athens, Greece)
Radioiodinated metaiodobenzylguanidine (MIBG) was developed in the late 1970's, at the Michigan University Medical Center, for imaging of the adrenal medulla and its diseases. Soon after, MIBG was shown to depict a wide range of tumors of neural crest origin other than pheochromocytomas/paragangliomas (Pheo/PGL) with the result that its use rapidly spread to many countries. After more than 30 years of clinical application, MIBG continues to be the most widespread radiopharmaceutical for the functional imaging of Pheo/PGL in spite of the emergent role of PET agents for detection of these tumors. In this paper we review the evolution in the use of MIBG over more than 30 years of experimental and clinical applications, with particular focus on the uptake mechanisms, pharmacokinetics, biodistribution and drug interaction as well as on clinical studies in Pheo/PGL also in comparison to other gamma-emitters tracers and PET radiopharmaceuticals.
PET scanning with hydroxyephedrine: an approach to the localization of pheochromocytoma
Journal of Nuclear Medicine, 1992
agement and directs the approach to surgical removal. Although most pheochromocytomas are located within the adrenal glands, they may be found in regions from the neck to the pelvis. Precise localization will spare patients whose disease is either extra-adrenal or metastatic unnec essary exploratory surgery. Currently, the principal methods of localization are scintigraphy using MIBG (meta-iodobenzylguanidine) and computed tomography (CT). CT provides excellent images of the adrenal gland. Its sensitivity for the detection of pheochromocytoma is high, since approximately 90% lie within the adrenal glands (4). However, CT does not differentiate pheochromocytoma from other causes of ad renal enlargement, such as cortical adenomas, carcinomas and metastatic disease, and it is considerably less sensitive for the detection of extra-adrenal involvement (5). Magnetic resonance imaging (MRI) also provides im ages with excellent anatomic detail but suffers many of the same limitations as CT (5,6). Neither CT nor MR defines the functional nature of adrenal disorders. Searches for pheochromocytomas by arteriography and venous sam
Clinical Imaging, 2013
To compare 123I-metaiodobenzylguanidine (MIBG) and [Fluorine-18]-2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in 22 patients with phaeochromocytomas and paragangliomas (PGL) retrospectively and to evaluate the correlation between FDG uptake and Ki-67 proliferative index. Fourteen of 17 (82%) patients at initial diagnosis had positive FDG uptake, more intensely in PGL. Eleven of 12 (92%) patients had positive MIBG uptake. PET and MIBG scintigraphy were concordant in 10 patients, discordant in 6. Combined results yielded no false negative findings and are complementary. Neither maximum standardised uptake value nor visual scores on MIBG correlated with Ki-67.
Applied Sciences
Pheochromocytomas may show atypical imaging findings leading to diagnostic pitfalls. We correlated the results of magnetic resonance imaging (MRI) with those of radionuclide studies in patients with pheochromocytomas. T2-weighted (-w), T1-w chemical-shift and T1-w dynamic contrast enhanced (DCE) MRI sequences were evaluated to assess tumor structure. 131Iodine metaiodobenzylguanidine (MIBG) scintigraphy, 18fluoro (F) deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) or FDG PET/MRI were evaluated for direct comparison. Of a total of 80 adrenal lesions in 73 patients, 20 in 18 patients were pheochromocytomas. More than half (55%) of the pheochromocytomas (n = 11) had the typical increased signal intensity on T2-w and T1-w DCE, while the remaining (n = 9) lesions showed atypical findings; of these nine latter atypical lesions, seven (35%) were cystic (two totally, three predominantly and two partially) and two (10%) were hemorrhagic on MRI. In these atypical ...
Annals of Surgical Oncology, 2010
Background. The enhancement of metaiodobenzylguanidine single photon emission computed tomography (MIBG SPECT) imaging through the addition of CT images fused with SPECT data (coregistered MIBG SPECT/CT imaging) is new technology that allows direct correlation of anatomical and functional information. We hypothesized that MIBG SPECT/CT imaging would provide additional information and improve diagnostic confidence for the radiological localization of a pheochromocytoma, in particular for patients at high risk of multifocal or recurrent disease. Methods. A retrospective study of all patients investigated by MIBG SPECT/CT at our institution from 2006 to 2008 for a suspected pheochromocytoma was performed. Each case was compared with conventional radiological investigations to determine whether MIBG SPECT/CT was able to improve diagnostic confidence and provide additional diagnostic information compared with conventional imaging alone. Results. Twenty-two patients had MIBG SPECT/CT imaging for a suspected pheochromocytoma. Fourteen patients had positive MIBG SPECT/CT imaging results correlating with imaging by CT or magnetic resonance imaging in all cases. In six cases, MIBG SPECT/CT provided additional information that altered the original radiological diagnosis. Five patients with a pheochromocytoma-associated germline mutation had multifocal disease excluded by MIBG SPECT/CT. Patients without a germline mutation that had positive biochemistry and a solitary lesion with conventional imaging had no diagnostic improvement with MIBG SPECT/CT imaging. Conclusions. MIBG SPECT/CT fusion imaging is a sensitive and specific radiological imaging tool for patients suspected to have pheochromocytoma. The particular strengths of MIBG SPECT/CT are detection of local recurrence, small extra-adrenal pheochromocytomas, multifocal tumors, or the presence of metastatic disease.