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European Association of Nuclear Medicine Practice Guideline/Society of Nuclear Medicine and Molecular Imaging Procedure Standard 2019 for radionuclide imaging of phaeochromocytoma and paraganglioma

  • David TaïebEmail author
  • Rodney J. Hicks
  • Elif Hindié
  • Benjamin A. Guillet
  • Anca Avram
  • Pietro Ghedini
  • Henri J. Timmers
  • Aaron T. Scott
  • Saeed Elojeimy
  • Domenico Rubello
  • Irène J. Virgolini
  • Stefano Fanti
  • Sona Balogova
  • Neeta Pandit-Taskar
  • Karel Pacak
Original Article
  • 186 Downloads
Part of the following topical collections:
  1. Oncology – General

Abstract

Purpose

Diverse radionuclide imaging techniques are available for the diagnosis, staging, and follow-up of phaeochromocytoma and paraganglioma (PPGL). Beyond their ability to detect and localise the disease, these imaging approaches variably characterise these tumours at the cellular and molecular levels and can guide therapy. Here we present updated guidelines jointly approved by the EANM and SNMMI for assisting nuclear medicine practitioners in not only the selection and performance of currently available single-photon emission computed tomography and positron emission tomography procedures, but also the interpretation and reporting of the results.

Methods

Guidelines from related fields and relevant literature have been considered in consultation with leading experts involved in the management of PPGL. The provided information should be applied according to local laws and regulations as well as the availability of various radiopharmaceuticals.

Conclusion

Since the European Association of Nuclear Medicine 2012 guidelines, the excellent results obtained with gallium-68 (68Ga)-labelled somatostatin analogues (SSAs) in recent years have simplified the imaging approach for PPGL patients that can also be used for selecting patients for peptide receptor radionuclide therapy as a potential alternative or complement to the traditional theranostic approach with iodine-123 (123I)/iodine-131 (131I)-labelled meta-iodobenzylguanidine. Genomic characterisation of subgroups with differing risk of lesion development and subsequent metastatic spread is refining the use of molecular imaging in the personalised approach to hereditary PPGL patients for detection, staging, and follow-up surveillance.

Keywords

Guidelines Radionuclide imaging Phaeochromocytoma Paraganglioma Targeted radionuclide therapy Positron emission tomography Somatostatin analogues 

Abbreviations

AADC

Aromatic L-amino acid decarboxylase

BAT

Brown adipose tissue

CI

Confidence interval

CTAC

CT-based attenuation correction

CT

Computed tomography

COMT

Catechol-O-methyltransferase

DA

Dopamine

DOPA

Dihydroxyphenylalanine

DTPA

Diethylenetriaminepentaacetic acid

EGLN1

egl-9 family hypoxia inducible factor 1α

EGLN2

egl-9 family hypoxia-inducible factor 2α

EPAS1/HIF2A

Endothelial PAS domain protein 1/hypoxia-inducible factor 2α

EANM

European Association of Nuclear Medicine

EPI

Epinephrine

FH

Fumarate hydratase

GEP

Gastroenteropancreatic

GI

Gastrointestinal

GIST

Gastrointestinal stromal tumour

HNPGL

Head and neck paraganglioma

5HT

5-hydroxytryptamine

MAX

Myc-associated factor X

MEN

Multiple endocrine neoplasia

MIBG

Meta-iodobenzylguanidine

MRI

Magnetic resonance imaging

MTC

Medullary thyroid carcinoma

NE

Norepinephrine

NET

Neuroendocrine tumour

NF1

Neurofibromin 1

NPV

Negative predictive value

PET

Positron emission tomography

PGL

Paraganglioma

PHD 1/2

Prolyl hydroxylase 1/2

PPGL

Phaeochromocytoma and paraganglioma

PHEO

Phaeochromocytoma

PPV

Positive predictive value

PRRT

Peptide receptor radionuclide therapy

RET

Rearranged during transfection proto-oncogene

RCC

Renal cell carcinoma

SDH

Succinate dehydrogenase

SDHA, -B, -C, -D

Succinate dehydrogenase subunits A, B, C, and D

SDHx

Succinate dehydrogenase subunits

SNMMI

Society of Nuclear Medicine and Molecular Imaging

SPECT

Single-photon emission computed tomography

SSAs

Somatostatin analogues

SSTa

Somatostatin agonist

SSTR

Somatostatin receptor

SSTR1, -2, -3, -4, -5

Somatostatin receptor subtypes 1, 2, 3, 4, and 5

SUV

Standardised uptake value

TLC

Thin-layer chromatography

TMEM127

Transmembrane protein 127

VHL

von Hippel–Lindau

VMAT

Vesicular monoamine transporter

WHO

World Health Organization

Notes

Acknowledgements

We thank the EANM Committees, EANM National Societies, and the SNMMI bodies for their review and contribution.

K.P. was supported by the Intramural Research Program of NIH, NICHD.

Compliance with Ethical Standards

Conflict of interest

RH has received research funding from Ipsen, Novartis, and Clarity Pharmaceuticals and holds stock in Telix Pharmaceuticals on behalf of his institution.

NPT has received consultant/advisory board/honoraria (current/past) from Y-mAbs, Progenics, Bayer, and MedImmune/AstraZeneca and sponsored trials/research support from ImaginAb, Genentech, and Actinium Pharma/FluoroPharma.

The other authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • David Taïeb
    • 1
    Email author
  • Rodney J. Hicks
    • 2
  • Elif Hindié
    • 3
  • Benjamin A. Guillet
    • 4
  • Anca Avram
    • 5
  • Pietro Ghedini
    • 6
  • Henri J. Timmers
    • 7
  • Aaron T. Scott
    • 8
  • Saeed Elojeimy
    • 9
  • Domenico Rubello
    • 10
  • Irène J. Virgolini
    • 11
  • Stefano Fanti
    • 6
  • Sona Balogova
    • 12
    • 13
  • Neeta Pandit-Taskar
    • 14
  • Karel Pacak
    • 15
  1. 1.Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille UniversityMarseille Cedex 05France
  2. 2.Centre for Cancer ImagingPeter MacCallum Cancer CentreMelbourneAustralia
  3. 3.Department of Nuclear Medicine, Hôpital Haut-LévêqueBordeaux University HospitalsPessacFrance
  4. 4.Department of Radiopharmacy, La Timone University Hospital, CERIMEDAix-Marseille UniversityMarseilleFrance
  5. 5.Nuclear Medicine/RadiologyUniversity of MichiganAnn ArborUSA
  6. 6.Nuclear Medicine Unit, Medicina Nucleare MetropolitanaUniversity Hospital S.Orsola-MalpighiBolognaItaly
  7. 7.Department of EndocrinologyRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
  8. 8.John Hopkins HospitalBaltimoreUSA
  9. 9.Department of RadiologyUniversity of New MexicoAlbuquerqueUSA
  10. 10.Department of Nuclear Medicine, Radiology, Neuroradiology, Medical Physics, Clinical Laboratory, Microbiology, Pathology, Transfusional MedicineSanta Maria della Misericordia HospitalRovigoItaly
  11. 11.Department of Nuclear MedicineMedical University InnsbruckInnsbruckAustria
  12. 12.Department of Nuclear MedicineComenius University and St. Elisabeth Oncology InstituteBratislavaSlovakia
  13. 13.Department of Nuclear MedicineHôpital Tenon Assistance Publique-Hôpitaux de Paris and Sorbonne UniversityParisFrance
  14. 14.Department of Radiology, Molecular Imaging and Therapy ServiceMemorial Sloan Kettering Cancer CenterNew YorkUSA
  15. 15.Eunice Kennedy Shriver National Institutes of Child Health and Human DevelopmentNational Institutes of HealthBethesdaUSA

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