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Whole-Body PET/CT with ¹¹C-Meta-Hydroxyephedrine in Tumors of the Sympathetic Nervous System: Feasibility Study and Comparison with ¹²³I-MIBG SPECT/CT

¹ Department of Nuclear Medicine, University Hospital, Münster, Germany; ² Department of Clinical Radiology, University Hospital, Münster, Germany; and ³ Department of Pediatric Hematology and Oncology, University Hospital, Münster, Germany

View larger version (33K): [in a new window]   FIGURE 1.  A 43-y-old woman with normal whole-body distribution on 11C-HED PET scan (several levels of coronal slices) with high 11C-HED accumulation in renal pelvis, ureter, urinary bladder, myocardium, liver, thyroid, and pancreas and moderate tracer uptake in salivary glands and spleen. Adrenal glands demonstrate only very low 11C-HED uptake and can only be differentiated from surrounding tissue by using PET/CT fusion image.

View larger version (77K): [in a new window]   FIGURE 2.  A 33-y-old woman (patient HA) who had pheochromocytoma of right adrenal gland and resection years ago. 11C-HED PET/CT: (A and B) PET images; (C and D) PET/CT fusion images, 2 levels of coronal slices. There is local relapse (solid arrow) and metastases retrocrural (solid arrow), cervical (dotted arrow), and mediastinal (not shown) with highly increased tracer uptake. 11C-HED uptake of left adrenal gland is very low. 123I-MIBG SPECT/CT: (E and F) SPECT images; (G and H) SPECT/CT fusion images, 2 levels of coronal slices. There is moderately increased tracer uptake in local relapse (solid arrow) and physiologic uptake in left adrenal gland (open arrow). Retrocrural metastases are not visible with increased 123I-MIBG accumulation. Cervical and mediastinal metastases are not within field of view of SPECT.

View larger version (69K): [in a new window]   FIGURE 3.  A 57-y-old man (patient GP) with metastatic paraganglioma. Primary tumor (open arrows) in left paravertebral region with involvement of 10th thoracic vertebral body and osseous metastasis in right iliac bone (solid arrows) demonstrate moderately increased 11C-HED uptake in PET/CT: (A) PET, coronal slice; (B) PET/CT fusion image, coronal slice. 123I-MIBG SPECT/CT: (C) SPECT, coronal slice; (D) SPECT/CT fusion image, coronal slice. Very high tracer uptake is evident in primary tumor and only faintly increased tracer uptake is seen in osseous metastasis.

View larger version (66K): [in a new window]   FIGURE 4.  A 5-y-old girl (patient EN) who had neuroblastoma stage IV 3 y ago. Large local relapse in left upper abdomen does not demonstrate increased 11C-HED uptake above surrounding tissue in PET/CT: (A) PET, coronal slice; (B) PET/CT fusion, coronal slice; (C) PET, transversal slice; (D) CT, transversal slice; (E) gadolinium-enhanced T1-weighted MRI with fat saturation, transversal slice. Osseous metastasis (solid arrows in A and B) in left hemipelvis is visible with faintly increased tracer uptake. 123I-MIBG SPECT/CT: (F) SPECT, coronal slice; (G) SPECT/CT fusion, coronal slice. Local relapse (open arrows) and osseous metastasis (solid arrows) show highly increased 123I-MIBG accumulation. Neuroblastoma was confirmed histologically at first diagnosis 3 y ago. In relapse situation, osseous involvement was confirmed by bone marrow puncture. Additionally, patient showed increased urinary catecholamines at first diagnosis and in relapse situation.