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Comparison of 6-¹⁸F-Fluorodopamine PET with ¹²³I-Metaiodobenzylguanidine and ¹¹¹In-Pentetreotide Scintigraphy in Localization of Nonmetastatic and Metastatic Pheochromocytoma

¹ Reproductive Biology and Adult Endocrinology Program, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; ² Nuclear Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; ³ Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland; and ⁴ Department of Medicine, Faculty of Medicine, P.J. afárik University, Koice, Slovak Republic

Correspondence: For correspondence or reprints contact: Karel Pacak, Section on Medical Neuroendocrinology, Reproductive Biology and Adult Endocrinology Program, National Institute of Child Health and Human Development, National Institutes of Health, Building 10, CRC, 1 East, Room 1-3140, 10 Center Dr., MSC-1109, Bethesda, MD 20892-1109. E-mail: karel{at}mail.nih.gov

We compared functional imaging modalities including PET with 6-¹⁸F-fluorodopamine (¹⁸F-DA) with ¹²³I-metaiodobenzylguanidine (¹²³I-MIBG) and somatostatin receptor scintigraphy (SRS) with ¹¹¹In-pentetreotide in nonmetastatic and metastatic pheochromocytoma (PHEO). Methods: We studied 25 men and 28 women (mean age ± SD, 44.2 ± 14.2 y) with biochemically proven nonmetastatic (n = 17) or metastatic (n = 36) PHEO. Evaluation included anatomic imaging with CT or MRI and functional imaging that included at least 2 nuclear medicine modalities: ¹⁸F-DA PET, ¹²³I-MIBG scintigraphy, or SRS. Sensitivity of functional imaging versus anatomic imaging was assessed on a per-patient and a per-region basis. Results: For this available cohort, on a per-patient basis overall sensitivity (combined for nonmetastatic and metastatic PHEO) was 90.2% for ¹⁸F-DA PET, 76.0% for ¹²³I-MIBG scintigraphy, and 22.0% for SRS. On a per-region basis, overall sensitivity was 75.4% for ¹⁸F-DA PET, 63.4% for ¹²³I-MIBG scintigraphy, and 64.0% for SRS. Conclusion: If available, ¹⁸F-DA PET should be used in the evaluation of PHEO, because it is more sensitive than ¹²³I-MIBG scintigraphy or SRS. If ¹⁸F-DA PET is not available, ¹²³I-MIBG scintigraphy (for nonmetastatic or adrenal PHEO) and SRS (for metastatic PHEO) should be the first alternative imaging methods to be used.

Key Words: radionuclide imaging • ¹⁸F-fluorodopamine • ¹²³I-metaiodobenzylguanidine • ¹¹¹In-pentetreotide • pheochromocytoma

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