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Compared to 123I-MIBG SPECT/CT, 18F-DOPA PET/CT provides accurate tumor extent in patients with extra-adrenal paraganglioma

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Abstract

Aim

The aim of this study was to compare the accuracy of 123I-MIBG SPECT/CT with that of 18F-DOPA PET/CT for staging extra-adrenal paragangliomas (PGLs) using both functional and anatomical images (i.e., combined cross-sectional imaging) as the reference standards.

Methods

Three men and seven women (age range 26–73 years) with anatomical and/or histologically proven disease were included in this study. Three patients had either metastatic head-and-neck paragangliomas (HNPGLs) or multifocal PGL, and seven patients had nonmetastatic disease. Comparative evaluation included morphological imaging with CT, functional imaging with 18F-DOPA PET, and 123I-MIBG imaging including SPECT/CT. Imaging results were analyzed on a per-patient and per-lesion basis.

Results

On a per-patient basis, 18F-DOPA PET’s detection rate for both nonmetastatic and metastatic/multifocal disease was 100%, whereas that of planar 123I-MIBG imaging alone was 10.0% and that of 123I-MIBG SPECT/CT was 20.0%. Overall, on a per-lesion basis, 18F-DOPA PET showed a sensitivity of 69.2% (McNemar p < 0.001) compared with anatomical imaging. Sensitivity of planar 123I-MIBG scintigraphy was 5.6%, and that of SPECT/CT was 11.1% (McNemar p < 0.0001). Overall, 18F-DOPA PET identified 18 lesions, and anatomical imaging identified 26 lesions; planar 123IMIBG imaging identified only 1 lesion, and SPECT/CT, 2 lesions.

Conclusion

18F-DOPA PET is more sensitive than is 123I-MIBG imaging, including SPECT/CT, for staging HNPGL. Combined functional and anatomical imaging (PET/CT) is indicated to exclude metastatic disease in extra-adrenal PGL.

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Acknowledgements

We thank Mathias Wochinz and Gerwig Eisenstein (Department of Nuclear Medicine, Medical University Innsbruck) for their work on this project, Dr. Cherise Guess (Department of Scientific Editing, St. Jude Children’s Research Hospital) for editorial assistance and Harald Kühschelm for statistical advice.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35 A-6020, Innsbruck, Austria

    Alexander Stephan Kroiss, Christian Uprimny & Irene Johanna Virgolini

  2. Department of Nuclear Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Barry Lynn Shulkin

  3. Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria

    Andreas Frech & Gustav Fraedrich

  4. Department of Internal Medicine I, Medical University Innsbruck, Innsbruck, Austria

    Herbert Tilg & Rudolf Wolfgang Gasser

  5. Department of Otorhinolaryngology, State Clinic, St. Poelten, Austria

    Georg Mathias Sprinzl

  6. Department of Radiology, Medical University Innsbruck, Innsbruck, Austria

    Leonhard Gruber

  7. Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria

    Claudius Thomé & Clemens Plangger

  8. Department of Otorhinolaryngology, Head and Neck Surgery, Medical University Innsbruck, Innsbruck, Austria

    Christoph Url

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  1. Alexander Stephan Kroiss
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Correspondence to Alexander Stephan Kroiss.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the principles of the 1964 declaration of Helsinki and its subsequent amendments. All patients published in this manuscript signed a written informed consent.

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Kroiss, A.S., Uprimny, C., Shulkin, B.L. et al. Compared to 123I-MIBG SPECT/CT, 18F-DOPA PET/CT provides accurate tumor extent in patients with extra-adrenal paraganglioma. Ann Nucl Med 31, 357–365 (2017). https://doi.org/10.1007/s12149-017-1162-7

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  • DOI: https://doi.org/10.1007/s12149-017-1162-7

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