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A retrospective comparison between 68Ga-DOTA-TOC PET/CT and 18F-DOPA PET/CT in patients with extra-adrenal paraganglioma

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Abstract

Purpose

18F-Fluoro-l-dihydroxyphenylalanine (18F-DOPA) PET offers high sensitivity and specificity in the imaging of nonmetastatic extra-adrenal paragangliomas (PGL) but lower sensitivity in metastatic or multifocal disease. These tumours are of neuroendocrine origin and can be detected by 68Ga-DOTA-Tyr3-octreotide (68Ga-DOTA-TOC) PET. Therefore, we compared 68Ga-DOTA-TOC and 18F-DOPA as radiolabels for PET/CT imaging for the diagnosis and staging of extra-adrenal PGL. Combined cross-sectional imaging was the reference standard.

Methods

A total of 5 men and 15 women (age range 22 to 73 years) with anatomical and/or histologically proven extra-adrenal PGL were included in this study. Of these patients, 5 had metastatic or multifocal lesions and 15 had single sites of disease. Comparative evaluation included morphological imaging with CT and functional imaging with 68Ga-DOTA-TOC PET and 18F-DOPA PET. The imaging results were analysed on a per-patient and a per-lesion basis. The maximum standardized uptake value (SUVmax) of each functional imaging modality in concordant tumour lesions was measured.

Results

Compared with anatomical imaging, 68Ga-DOTA-TOC PET and 18F-DOPA PET each had a per-patient and per-lesion detection rate of 100 % in nonmetastatic extra-adrenal PGL. However, in metastatic or multifocal disease, the per-lesion detection rate of 68Ga-DOTA-TOC was 100 % and that of 18F-DOPA PET was 56.0 %. Overall, 68Ga-DOTA-TOC PET identified 45 lesions; anatomical imaging identified 43 lesions, and 18F-DOPA PET identified 32 lesions. The overall per-lesion detection rate of 68Ga-DOTA-TOC PET was 100 % (McNemar, P < 0.5), and that of 18F-DOPA PET was 71.1 % (McNemar, P < 0.001). The SUVmax (mean ± SD) of all 32 concordant lesions was 67.9 ± 61.5 for 68Ga-DOTA-TOC PET and 11.8 ± 7.9 for 18F-DOPA PET (Mann-Whitney U test, P < 0.0001).

Conclusion

68Ga-DOTA-TOC PET may be superior to 18F-DOPA PET and diagnostic CT in providing valuable information for pretherapeutic staging of extra-adrenal PGL, particularly in surgically inoperable tumours and metastatic or multifocal disease.

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Acknowledgments

We are grateful to Mathias Wochinz and Boris Warwitz (Department of Nuclear Medicine, Innsbruck Medical University) for their work on the project. We thank Dr. Claudia Goetsch (Department of Internal Medicine I, Innsbruck Medical University) and Dr. Lydia Posch (Department of Vascular Surgery, Innsbruck Medical University) for their support on this project. We also thank Harald Kühschelm for statistical advice, and Philipp Heinricher and Dr. Cherise Guess (Department of Scientific Editing, St. Jude Children’s Research Hospital) for editorial assistance.

Conflicts of interest

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Authors and Affiliations

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

    Alexander Kroiss, Daniel Putzer, Clemens Decristoforo, Christian Uprimny & Irene Johanna Virgolini

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

    Andreas Frech & Gustav Fraedrich

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

    Rudolf Wolfgang Gasser

  4. Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Barry Lynn Shulkin

  5. Department of Otorhinolaryngology, Innsbruck Medical University, Innsbruck, Austria

    Christoph Url

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

    Gerlig Widmann

  7. Department of Surgery, Sanatorium Kettenbrücke, Innsbruck, Austria

    Rupert Prommegger

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

    Georg Mathias Sprinzl

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  1. Alexander Kroiss
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Correspondence to Alexander Kroiss.

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Kroiss, A., Putzer, D., Frech, A. et al. A retrospective comparison between 68Ga-DOTA-TOC PET/CT and 18F-DOPA PET/CT in patients with extra-adrenal paraganglioma. Eur J Nucl Med Mol Imaging 40, 1800–1808 (2013). https://doi.org/10.1007/s00259-013-2548-y

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  • DOI: https://doi.org/10.1007/s00259-013-2548-y

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