6-18F-fluoro-L-dihydroxyphenylalanine positron emission tomography is superior to 123I-metaiodobenzyl-guanidine scintigraphy in the detection of extraadrenal and hereditary pheochromocytomas and paragangliomas: correlation with vesicular monoamine transporter expression.

Abstract

CONTEXT:

Pheochromocytomas (PHEOs) and paragangliomas (PGLs) may be better detected by (18)F-fluorodihydroxyphenylalanine-positron emission tomography (FDOPA-PET) than (123)I-metaiodobenzyl-guanidine (123-I-MIBG) scintigraphy.

OBJECTIVE:

The objective of the study was to correlate functional imaging results with immunohistochemical, molecular-genetic, and biochemical findings.

DESIGN AND SETTING:

Thirty consecutive patients with suspected PHEO/PGL presenting at a tertiary referral centre were investigated in a prospective study.

PATIENTS:

Twenty-five patients had confirmed PHEO/PGL. Thirteen of 25 patients had a hereditary PHEO/PGL syndrome (two multiple endocrine neoplasia II, six succinate dehydrogenase complex, subunit D, two succinate dehydrogenase complex, subunit B, one von Hippel Lindau tumor suppressor protein, two Neurofibromatosis-1), and 12 of 25 were classified as sporadic. Five patients had hormonally inactive adrenal incidentalomas.

MAIN OUTCOME MEASURES:

In all patients computed tomography scan and/or magnetic resonance imaging as well as both 123-I-MIBG scintigraphy and FDOPA-PET were performed. Resected tumors were examined by immunohistochemistry for expression of the vesicular monoamine transporter (VMAT)-1 and -2 and other markers.

RESULTS:

A total of 64 lesions were found with both functional imaging modalities. FDOPA-PET detected 62 lesions, whereas only 34 lesions were detected by 123-I-MIBG scintigraphy. This resulted in an overall sensitivity and specificity for FDOPA-PET of 98 and 100% and for MIBG of 53 and 91%, respectively. Comparable sensitivities were found for adrenal and extraadrenal abdominal lesions (94 vs. 97%), whereas in thoracic/cervical lesions, the sensitivity for 123-I-MIBG scintigraphy (15%) was inferior to that of FDOPA-PET imaging (100%). Immunohistochemistry demonstrated a lack of VMAT-1 expression in all MIBG-negative tumors. Clinical predictors for MIBG negativity were a predominant norepinephrine/normetanephrine secretion, an age less than 45 yr, and a hereditary cause.

CONCLUSION:

FDOPA-PET is superior to 123-I-MIBG scintigraphy in patients with extraadrenal, predominantly noradrenaline-secreting, and hereditary types of PHEO/PGL. The lack of VMAT-1 expression predicts negativity for MIBG-scintigraphy.

• Authors: C Fottner, A Helisch, M Anlauf, H Rossmann, T J Musholt, A Kreft, S Schadmand-Fischer, P Bartenstein, K J Lackner, G Klöppel, M Schreckenberger, M M Weber
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 95 Issue 6 Pg. 2800-10 (Jun 2010) ISSN: 1945-7197 [Electronic] United States
• PMID: 20371665 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Biomarkers
• Genetic Markers
• Radiopharmaceuticals
• Vesicular Monoamine Transport Proteins
• fluorodopa F 18
• 3-Iodobenzylguanidine
• Dihydroxyphenylalanine

Topics

• 3-Iodobenzylguanidine
• Adolescent
• Adrenal Gland Neoplasms (diagnostic imaging, genetics, metabolism)
• Adult
• Aged
• Biomarkers
• Data Interpretation, Statistical
• Dihydroxyphenylalanine (analogs & derivatives)
• Female
• Genetic Markers
• Humans
• Immunohistochemistry
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Paraganglioma (diagnostic imaging, genetics, metabolism)
• Pheochromocytoma (diagnostic imaging, genetics, metabolism)
• Positron-Emission Tomography
• Radiopharmaceuticals
• Tomography, X-Ray Computed
• Vesicular Monoamine Transport Proteins (biosynthesis, genetics)
• Young Adult