6-[F-18]Fluoro-L-dihydroxyphenylalanine positron emission tomography is superior to conventional imaging with (123)I-metaiodobenzylguanidine scintigraphy, computer tomography, and magnetic resonance imaging in localizing tumors causing catecholamine excess.

Abstract

CONTEXT:

Catecholamine excess is rare, but symptoms may be life threatening.

OBJECTIVE:

The objective of the study was to investigate the sensitivity of 6-[F-18]fluoro-l-dihydroxyphenylalanine positron emission tomography ((18)F-DOPA PET), compared with (123)I-metaiodobenzylguanidine ((123)I-MIBG) scintigraphy and computer tomography (CT)/magnetic resonance imaging (MRI) for tumor localization in patients with catecholamine excess.

DESIGN AND SETTING:

All consecutive patients with catecholamine excess visiting the University Medical Center Groningen, Groningen, The Netherlands, between March 2003 and January 2008 were eligible.

PATIENTS:

Forty-eight patients were included. The final diagnosis was pheochromocytoma in 40, adrenal hyperplasia in two, paraganglioma in two, ganglioneuroma in one, and unknown in three.

MAIN OUTCOME MEASURES:

Sensitivities and discordancy between (18)F-DOPA PET, (123)I-MIBG, and CT or MRI were analyzed for individual patients and lesions. Metanephrines and 3-methoxytyramine in plasma and urine and uptake of (18)F-DOPA with PET were measured to determine the whole-body metabolic burden and correlated with biochemical tumor activity. The gold standard was a composite reference standard.

RESULTS:

(18)F-DOPA PET showed lesions in 43 patients, (123)I-MIBG in 31, and CT/MRI in 32. Patient-based sensitivity for (18)F-DOPA PET, (123)I-MIBG, and CT/MRI was 90, 65, and 67% (P < 0.01 for (18)F-DOPA PET vs. both (123)I-MIBG and CT/MRI, P = 1.0 (123)I-MIBG vs. CT/MRI). Lesion-based sensitivities were 73, 48, and 44% (P < 0.001 for (18)F-DOPA PET vs. both (123)I-MIBG and CT/MRI, P = 0.51 (123)I-MIBG vs. CT/MRI). The combination of (18)F-DOPA PET with CT/MRI was superior to (123)I-MIBG with CT/MRI (93 vs. 76%, P < 0.001). Whole-body metabolic burden measured with (18)F-DOPA PET correlated with plasma normetanephrine (r = 0.82), urinary normetanephrine (r = 0.84), and metanephrine (r = 0.57).

CONCLUSION:

To localize tumors causing catecholamine excess, (18)F-DOPA PET is superior to (123)I-MIBG scintigraphy and CT/MRI.

• Authors: Helle-Brit Fiebrich, Adrienne H Brouwers, Michiel N Kerstens, Milan E J Pijl, Ido P Kema, Johan R de Jong, Pieter L Jager, Philip H Elsinga, Rudi A J O Dierckx, Jacqueline E van der Wal, Wim J Sluiter, Elisabeth G E de Vries, Thera P Links
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 94 Issue 10 Pg. 3922-30 (Oct 2009) ISSN: 1945-7197 [Electronic] United States
• PMID: 19622618 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Biomarkers
• Catecholamines
• Radiopharmaceuticals
• fluorodopa F 18
• 3-Iodobenzylguanidine
• Dihydroxyphenylalanine

Topics

• 3-Iodobenzylguanidine
• Adolescent
• Adrenal Gland Neoplasms (diagnosis, diagnostic imaging, metabolism)
• Adrenal Glands (metabolism, pathology)
• Adult
• Aged
• Biomarkers (metabolism)
• Catecholamines (blood, metabolism, urine)
• Child
• Child, Preschool
• Dihydroxyphenylalanine (analogs & derivatives)
• Female
• Humans
• Hyperplasia (diagnosis)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Paraganglioma (diagnosis, diagnostic imaging, metabolism)
• Pheochromocytoma (diagnosis, diagnostic imaging, metabolism)
• Positron-Emission Tomography (methods)
• Prospective Studies
• Radiopharmaceuticals
• Sensitivity and Specificity
• Tomography, X-Ray Computed
• Young Adult