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Prospective comparison of 68Ga-DOTATATE and 18F-FDOPA PET/CT in patients with various pheochromocytomas and paragangliomas with emphasis on sporadic cases

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Abstract

Purpose

Pheochromocytomas/paragangliomas (PHEOs/PGLs) overexpress somatostatin receptors and recent studies have already shown excellent results in the localization of these tumors using 68Ga-labeled somatostatin analogs (68Ga-DOTA-SSA), especially in patients with germline succinate dehydrogenase subunit B gene (SDHB) mutations and head and neck PGLs (HNPGLs). The value of 68Ga-DOTA-SSA has to be established in sporadic cases, including PHEOs. Thus, the aim of this study was to compare 68Ga-DOTATATE PET/CT, 18F-FDOPA PET/CT, and conventional imaging in patients with various PHEOs/PGLs with a special emphasis on sporadic cases, including those located in the adrenal gland.

Design

68Ga-DOTATATE, 18F-FDOPA PET/CT, and conventional imaging (contrast-enhanced CT and MRI with MR angiography sequences) were prospectively performed in 30 patients (8 with SDHD mutations, 1 with a MAX mutation and 21 sporadic cases) with PHEO/PGL at initial diagnosis or relapse.

Results

The patient-based sensitivities were 93 % (28/30), 97 % (29/30), and 93 % (28/30) for 68Ga-DOTATATE PET/CT, 18F-FDOPA PET/CT, and conventional imaging, respectively. The lesion-based sensitivities were 93 % (43/46), 89 % (41/46), and 76 % (35/46) for 68Ga-DOTATATE PET/CT, 18F-FDOPA PET/CT, and conventional imaging respectively (p = 0.042). 68Ga-DOTATATE PET/CT detected a higher number of HNPGLs (30/30) than 18F-FDOPA PET/CT (26/30; p = 0.112) and conventional imaging (24/30; p = 0.024). 68Ga-DOTATATE PET/CT missed two PHEOs of a few millimeters in size and a large recurrent PHEO. One lesion was considered false-positive on 68Ga-DOTATATE PET/CT and corresponded to a typical focal lesion of fibrous dysplasia on MRI. Among the 11 lesions missed by conventional imaging, 7 were detected by conventional imaging with knowledge of the PET results (4 HNPGLs, 2 LNs, and 1 recurrent PHEO).

Conclusion

68Ga-DOTATATE PET/CT is the most sensitive tool in the detection of HNPGLs, especially SDHD-related tumors, which may be very small and fail to concentrate sufficient 18F-FDOPA. The present study further expands the use of 68Ga-DOTATATE for all patients with HNPGLs, regardless of their genotype. 68Ga-DOTATATE PET/CT may be inferior to 18F-FDOPA PET/CT in the detection PHEOs.

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Acknowledgments

This research was supported by the Intramural Research Program of the Assistance Publique-Hôpitaux de Marseille (AP-HM, France).

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Authors and Affiliations

  1. Department of Nuclear Medicine, La Timone & North University Hospital, Aix-Marseille University, Marseille, France

    Aurélien Archier, Philippe Garrigue, Sophie Gabriel, Benjamin Guillet & David Taïeb

  2. European Center for Research in Medical Imaging, Aix-Marseille University, Marseille, France

    Aurélien Archier, Sophie Gabriel & David Taïeb

  3. Institut Paoli-Calmettes, Inserm UMR1068 Marseille Cancerology Research Center, Marseille, France

    Aurélien Archier & David Taïeb

  4. Department of Medical Imaging, Conception Hospital, Aix-Marseille University, Marseille, France

    Arthur Varoquaux & Eva Beschmout

  5. Department of Radiopharmacy, La Timone & North University Hospital, Aix-Marseille University, Marseille, France

    Philippe Garrigue & Benjamin Guillet

  6. Department of Otorhinolaryngology-Head and Neck Surgery, Conception Hospital, Aix-Marseille University, Marseille, France

    Marion Montava & Nicolas Fakhry

  7. Department of Endocrine Surgery, Conception Hospital, Aix-Marseille University, Marseille, France

    Carole Guerin & Frédéric Sebag

  8. Department of Endocrinology, Conception Hospital, Aix-Marseille University, Marseille, France

    Isabelle Morange & Frédéric Castinetti

  9. Laboratory of Biochemistry and Molecular Biology, Conception Hospital, Aix-Marseille, University, Marseille, France

    Anne Barlier

  10. Department of Public Health, Aix-Marseille University, Marseille, France

    Anderson Loundou

  11. Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health, Bethesda, MD, 20892, USA

    Karel Pacak

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  1. Aurélien Archier
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Correspondence to David Taïeb.

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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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Supplemental Table 1

Patient and tumor characteristics (location and uptake patterns). Negative on whole body acquisition, but positive on the craniocervical acquisition image (see Fig. 4). Quantitative results were obtained from WB images. VA visual analysis, JP jugular PGL, VP vagal PGL, LP laryngeal PGL, CBP carotid body PGL, PHEO pheochromocytoma, as apparently sporadic. (DOC 116 kb)

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Archier, A., Varoquaux, A., Garrigue, P. et al. Prospective comparison of 68Ga-DOTATATE and 18F-FDOPA PET/CT in patients with various pheochromocytomas and paragangliomas with emphasis on sporadic cases. Eur J Nucl Med Mol Imaging 43, 1248–1257 (2016). https://doi.org/10.1007/s00259-015-3268-2

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