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PET/CT comparing 68Ga-DOTATATE and other radiopharmaceuticals and in comparison with CT/MRI for the localization of sporadic metastatic pheochromocytoma and paraganglioma

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Pheochromocytomas/paragangliomas (PPGLs) and their metastases are tumors that predominantly express somatostatin receptor 2 (SSR2). 68Ga-DOTA(0)-Tyr(3)-octreotate (68Ga-DOTATATE) is a PET radiopharmaceutical with both high and selective affinity for SSRs. The purpose of this study was to evaluate the utility of 68Ga-DOTATATE in comparison with other specific and nonspecific radiopharmaceuticals recommended in the current guidelines for the localization of metastatic sporadic PPGL by PET/CT.

Methods

This prospective study included 22 patients (15 men, 7 women; aged 50.0 ± 13.9 years) with confirmed metastatic PPGL, a negative family history for PPGL, and negative genetic testing, who underwent 68Ga-DOTATATE, 18F-fluoro-2-deoxy-D-glucose (18F-FDG) PET/CT, and CT/MRI. Only 12 patients underwent an additional 18F-fluorodihydroxyphenylalanine (18F-FDOPA) PET/CT scan and only 11 patients underwent an additional 18F-fluorodopamine (18F-FDA) PET/CT scan. The rates of detection of metastatic lesions were compared among all the imaging studies. A composite of all functional and anatomical imaging studies served as the imaging comparator.

Results

68Ga-DOTATATE PET/CT showed a lesion-based detection rate of 97.6 % (95 % confidence interval, CI, 95.8 – 98.7 %). 18F-FDG PET/CT, 18F-FDOPA PET/CT, 18F-FDA PET/CT, and CT/MRI showed detection rates of 49.2 % (CI 44.5 – 53.6 %; p < 0.01), 74.8 % (CI 69.0 – 79.9 %); p < 0.01), 77.7 % (CI 71.5 – 82.8 %; p < 0.01), and 81.6 % (CI 77.8 – 84.8 %; p < 0.01), respectively.

Conclusion

The results of this study demonstrate the superiority of 68Ga-DOTATATE PET/CT in the localization of sporadic metastatic PPGLs compared to all other functional and anatomical imaging modalities, and suggest modification of future guidelines towards this new imaging modality.

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Acknowledgments

We acknowledge the assistance of all those who participated in this project, especially the technologists in the NIH Clinical Center PET Department.

Author information

Authors and Affiliations

  1. Program in Adult and Reproductive Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Building 10, CRC, Room 1E-3140, 10 Center Drive MSC-1109, Bethesda, MD, 20892, USA

    Ingo Janssen, Karen T. Adams, Katherine I. Wolf & Karel Pacak

  2. Department of Radiology and Nuclear Medicine, Section of Nuclear Medicine, University Hospital Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Ingo Janssen & Inga Buchmann

  3. Nuclear Medicine Division, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, 20892, USA

    Clara C. Chen

  4. Positron Emission Tomography Department, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA

    Corina M. Millo & Peter Herscovitch

  5. Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, 20892, USA

    Alexander Ling

  6. Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, Marseille, France

    David Taieb

  7. Cancer Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA

    Frank I. Lin

  8. Endocrine Oncology Branch, National Cancer Institute, Bethesda, MD, 20892, USA

    Antonio T. Fojo

  9. Center for Cancer Research, National Cancer Institute, Bethesda, MD, 20892, USA

    Electron Kebebew

Authors
  1. Ingo Janssen
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Corresponding author

Correspondence to Karel Pacak.

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Funding

This work was supported, in part, by the Intramural Research Program of the National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Janssen, I., Chen, C.C., Millo, C.M. et al. PET/CT comparing 68Ga-DOTATATE and other radiopharmaceuticals and in comparison with CT/MRI for the localization of sporadic metastatic pheochromocytoma and paraganglioma. Eur J Nucl Med Mol Imaging 43, 1784–1791 (2016). https://doi.org/10.1007/s00259-016-3357-x

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  • DOI: https://doi.org/10.1007/s00259-016-3357-x

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