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The incremental benefit of functional imaging in pheochromocytoma/paraganglioma: a systematic review

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Abstract

Computed tomography (CT) and magnetic resonance imaging (MRI) are the major imaging modalities used for the localization of catecholamine-producing tumors (pheochromocytoma and paraganglioma). Functional imaging (FI) offers an alternative approach to localize, evaluate, and stage these tumors. Our objective was to describe the additive benefit of FI studies for patients with pheochromocytoma and paraganglioma (PPG) who have undergone MRI or CT scan evaluation. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus from database inception through June 2012 for studies that included patients with biochemically proven PPGs who underwent CT or MRI and additional FI for the localization of PPGs. We included 32 studies enrolling a total of 1,264 patients with a mean age of 43-years old. The studies were uncontrolled and evaluated six FI modalities. FI tests provided small additive value to CT/MRI, aiding in the localization of only 24/1,445 primary cases (1.4 %) and 28/805 metastatic cases (3.5 %). In metastatic cases, 6-[F-18]fluoro-l-dihydroxyphenylalanine (DOPA) and fluorodopamine-PET (FDA) were the FI tests most successful at identifying disease missed by CT/MRI, providing additional benefit in 6/60 (10 %) and 5/78 (6.4 %) cases, respectively. No clinically significant findings were observed in any of the predefined subgroups. No study evaluated the impact of FI on the completeness of surgical resection or other patient-important outcomes. Observational evidence suggests that FI tests have a limited additional role in patients with PPGs who have undergone CT/MRI evaluation. However, the role of FI tests in specific subgroups of patients with atypical presentations (metastatic, extra-adrenal) as well as the use of hybrid FI tests should be explored. Further research should also evaluate the impact of FI tests on patient-important outcomes

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Acknowledgments

This review was commissioned and funded by a contract for The Endocrine Society.

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All co-authors have seen and agree with the contents of the review and there is no financial interest to report. We certify that the submission is original, that the manuscript does not, in whole or part, infringe any copyright or violate any right of privacy or other personal or property right.

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Authors and Affiliations

  1. Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, 55905, USA

    Juan P. Brito, Catalina Norman & Victor M. Montori

  2. Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Juan P. Brito, Noor Asi, Michael R. Gionfriddo, Aaron L. Leppin, Claudia Zeballos-Palacios, Chaitanya Undavalli, Zhen Wang, Juan P. Domecq, Gabriela Prustsky, Tarig A. Elraiyah, Larry J. Prokop, Victor M. Montori & Mohammad Hassan Murad

  3. Mayo Graduate School, Mayo Clinic, Rochester, MN, 55905, USA

    Michael R. Gionfriddo

  4. Division of Preventive Medicine, Mayo Clinic, Rochester, MN, 55905, USA

    Mohammad Hassan Murad

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Brito, J.P., Asi, N., Gionfriddo, M.R. et al. The incremental benefit of functional imaging in pheochromocytoma/paraganglioma: a systematic review. Endocrine 50, 176–186 (2015). https://doi.org/10.1007/s12020-015-0544-7

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