• Ann Nucl Med · Jun 2017

    Comparative Study

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

    • Alexander Stephan Kroiss, Christian Uprimny, Barry Lynn Shulkin, Andreas Frech, Herbert Tilg, Rudolf Wolfgang Gasser, Georg Mathias Sprinzl, Leonhard Gruber, Claudius Thomé, Clemens Plangger, Christoph Url, Gustav Fraedrich, and Irene Johanna Virgolini.
    • Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35 A-6020, Innsbruck, Austria. alexander.kroiss@i-med.ac.at.
    • Ann Nucl Med. 2017 Jun 1; 31 (5): 357-365.

    AimThe 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.MethodsThree 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.ResultsOn 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.Conclusion18F-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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