[(123)I]metaiodobenzylguanidine and [(111)In]octreotide uptake in begnign and malignant pheochromocytomas.

Abstract

Selecting the appropriate approach for resection and follow-up of pheochromocytomas (PCCs) is highly dependent upon reliable localization and exclusion of multifocal, bilateral, or metastatic disease. Metaiodobenzylguanidine (MIBG) scintigraphy was developed for functional localization of catecholamine-secreting tissues. Somatostatin receptor imaging (SRI) has a high sensitivity for localizing head and neck paragangliomas, but studies of intraabdominal PCCs are rare. In this study we review our experience of [(123)I]MIBG and SRI, performed since 1983 and 1989, respectively, in the work-up of primary and recurrent PCCs. Scintigraphic results were correlated with catecholamine secretion, size and site, malignancy, associated tumor syndromes, and morphological features. [(123)I]MIBG scans were performed in a total of 75 patients, in 70 cases before resection of primary PCCs and in 5 cases because of recurrent disease. Ninety-one PCCs were resected. The overall detection rates were 83.3% and 89.8% for PCCs larger than 1.0 cm. Multifocal disease was detected in 4 patients with [(123)I]MIBG. [(123)I]MIBG uptake correlated with greater size of PCC (r = 0.33; P = 0.008) and greater concentration of plasma epinephrine (r = 0.32; P = 0.006). [(123)I]MIBG-negative PCCs (n = 14) had significantly (P = 0.01) smaller diameters than [(123I)]MIBG-positive tumors. Furthermore, [(123)I]MIBG uptake was significantly higher in unilateral (P = 0.02), benign (P = 0.02), sporadic (P = 0.02), intraadrenal (P = 0.02), and capsular invasive (P = 0.03) PCCs than in bilateral, malignant, MEN2A/2B-related, extraadrenal, and noninvasive PCCs, respectively. The detection rate of SRI was only 25% (8 of 32) for primary benign PCCs. In 14 patients metastases occurred, which were effectively visualized with [(123)I]MIBG in 8 of 14 cases. SRI was able to detect metastases in 7 of 8 cases, including 3 [(123)I]MIBG-negative metastatic cases. In addition, [(123)I]MIBG and SRI detected 2 recurrences. In conclusion, [(123)I]MIBG uptake is correlated with the size, epinephrine production, and site of PCCs. Its role in bilateral and MEN2A/2B-related PCCs seems limited. In cases of recurrent elevation of catecholamines, localization of metastases and/or recurrence should be attempted with [(123)I]MIBG scintigraphy. In suspicious metastatic PCCs, SRI might be considered to supplement [(123)I]MIBG scintigraphy.

• Authors: E van der Harst, W W de Herder, H A Bruining, H J Bonjer, R R de Krijger, S W Lamberts, A H van de Meiracker, F Boomsma, T Stijnen, E P Krenning, F T Bosman, D J Kwekkeboom
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 86 Issue 2 Pg. 685-93 (Feb 2001) ISSN: 0021-972X [Print] United States
• PMID: 11158032 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Indium Radioisotopes
• Iodine Radioisotopes
• Radiopharmaceuticals
• Receptors, Somatostatin
• 3-Iodobenzylguanidine
• Octreotide

Topics

• 3-Iodobenzylguanidine (pharmacokinetics)
• Adolescent
• Adrenal Gland Neoplasms (diagnostic imaging, metabolism, mortality, pathology, surgery)
• Adult
• Aged
• Disease-Free Survival
• Humans
• Indium Radioisotopes (pharmacokinetics)
• Iodine Radioisotopes (pharmacokinetics)
• Middle Aged
• Multiple Endocrine Neoplasia Type 2a (diagnostic imaging)
• Multiple Endocrine Neoplasia Type 2b (diagnostic imaging)
• Neoplasm Metastasis
• Octreotide (pharmacokinetics)
• Pheochromocytoma (diagnostic imaging, metabolism, mortality, pathology, surgery)
• Radionuclide Imaging
• Radiopharmaceuticals (pharmacokinetics)
• Receptors, Somatostatin (analysis)
• Recurrence
• Retrospective Studies
• Survival Rate
• Tissue Distribution