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Journal of Nuclear Medicine Vol. 49 No. 4 524-531
© 2008 by Society of Nuclear Medicine
doi: 10.2967/jnumed.107.047720

Clinical Investigation

18F-Dihydroxyphenylalanine PET in Patients with Biochemical Evidence of Medullary Thyroid Cancer: Relation to Tumor Differentiation

Klaas P. Koopmans1, Jan Willem B. de Groot2, John T.M. Plukker3, Elisabeth G.E. de Vries4, Ido P. Kema5, Wim J. Sluiter2, Pieter L. Jager1 and Thera P. Links2

1 Departments of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands; 2 Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands; 3 Department of Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands; 4 Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands; and 5 Department of Pathology and Laboratory Medicine, University Medical Center Groningen, Groningen, The Netherlands

Correspondence: For correspondence contact: Thera P. Links, MD, PhD, Department of Endocrinology, University Medical Centre Groningen, P. O. Box 30.001, 9700 RB Groningen, The Netherlands E-mail: t.p.links{at}int.umcg.nl.

Curative treatment for recurrent medullary thyroid cancer (MTC), diagnosed by rising serum calcitonin, is surgery, but tumor localization is difficult. Therefore, the value of 18F-dihydroxyphenylanaline PET (18F-DOPA PET), 18F-FDG PET, 99mTc-V-di-mercaptosulfuricacid (DMSA-V) scintigraphy, and MRI or CT was studied. Methods: Twenty-one patients with biochemical recurrent or residual MTC underwent 18F-DOPA PET, 18F-FDG PET, DMSA-V scintigraphy, and MRI or CT. Patient- and lesion-based sensitivities were calculated using a composite reference consisting of all imaging modalities. Results: In 76% of all patients with MTC, one or more imaging modalities was positive for MTC lesions. In 6 of 8 patients with a calcitonin level of <500 ng/L, imaging results were negative. In 15 patients with positive imaging results, 18F-DOPA PET detected 13 (sensitivity, 62%; with 4.6 lesions per patient [lpp]). Morphologic imaging (n = 19) was positive in 7 (sensitivity, 37%; 4.7 lpp), DMSA-V (n = 18) in 5 (sensitivity, 28%; 1.1 lpp), and 18F-FDG PET (n = 17) in 4 (sensitivity, 24%; 1.6 lpp). In a lesion-based analysis, 18F-DOPA PET detected 95 of 134 lesions (sensitivity, 71%), morphologic imaging detected 80 of 126 (sensitivity, 64%), DMSA-V detected 20 of 108 (sensitivity, 19%), and 18F-FDG PET detected 48 of 102 (sensitivity, 30%). In 2 of 3 patients with a calcitonin/carcinoembryonic antigen (CEA) doubling time of ≤12 mo, 18F-FDG PET performed better than 18FDOPA PET; in the third patient, 18F-FDG PET was not performed. Conclusion: MTC lesions are best detectable when serum calcitonin was >500 ng/L. 18F-DOPA PET is superior to 18F-FDG PET, DMSA-V, and morphologic imaging. With short calcitonin doubling times (≤12 mo), 18F-FDG PET may be superior.

Key Words: medullary thyroid cancer • PET • 18F-DOPA • 18F-FDG • tumor markers • tumor differentiation • calcitonin

COPYRIGHT © 2008 by the Society of Nuclear Medicine, Inc.


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