• Saurabh Arora, Rakesh Kumar, Averilicia Passah, Madhavi Tripathi, Sandeep Agarwala, Rajesh Khadgawat, and Chandrasekhar Bal.
• Department of Nuclear Medicine.
• Nucl Med Commun. 2019 Dec 1; 40 (12): 1230-1242.

AimTo evaluate Ga-DOTANOC positron emission tomography/computed tomography (PET/CT) and I-meta-iodobenzylguanidine single-photon emission computed tomography/computed tomography (131I-MIBG SPECT/CT) in patients with paragangliomas, including uncommon primaries.MethodsNinety patients were prospectively enrolled, and both scans were done within 2 weeks of each other. Lesions were grouped as Head/neck, abdominal, uncommon primary paraganglioma, and metastatic lesions. In most histopathology was used as reference standard.ResultsPET/CT had sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 97%, 94%, 99%,88%,97% respectively on patient wise analysis (90) and 98%, 94%, 99%, 85% and 97% respectively on lesion wise analysis (149). Comparison with MIBG SPECT/CT: Significant difference in sensitivities noted (PET/CT-98%, I-131 MIBG -39%) (P < 0.001), however, no significant difference in specificities (94% and 100%, respectively). Group-wise analysis: Head/Neck: Significant difference noted between PET/CT (sensitivity 100%) and I-131 MIBG SPECT/CT (sensitivity 22%) (P = 0.001). Abdominal: No significant difference noted in sensitivities and specificities of PET/CT and I-131 MIBG SPECT/CT. Uncommon paraganglioma: PET/CT detected 10 of 11, while I-131 MIBG detected only 2 of 11 uncommon paraganglioma. Metastatic sites: Significant difference noted between PET/CT (sensitivity 97%) and I-131 MIBG SPECT/CT (sensitivity 33%) (P < 0.0001).ConclusionThe study demonstrates high diagnostic accuracy of Ga-DOTANOC PET/CT and superiority over I MIBG SPECT/CT for evaluation of extra-adrenal paraganglioma. The current diagnostic role of I-131 MIBG seems limited to abdominal paragangliomas and for theranostic purpose.

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