The Effects of Carbidopa on Uptake of 6-18F-Fluoro-l-DOPA in PET of Pheochromocytoma and Extraadrenal Abdominal Paraganglioma

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FIGURE 1.
CT scan (A) and ¹⁸F-DOPA PET scans without carbidopa (B) and after carbidopa (C) in patient 9. In PET scans, anterior reprojected images are at left, details of anterior reprojected images are at top right, and transverse sections at tumor level are at bottom right. CT scan shows (recurrent) tumor in left adrenal bed, near tail of pancreas, consistent with abnormal left adrenal focus on ¹⁸F-DOPA PET after carbidopa. On baseline ¹⁸F-DOPA PET, left adrenal bed is masked by physiologic uptake by pancreas.
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FIGURE 2.
Dynamics of ¹⁸F-DOPA tumor uptake. Time–activity curves of ¹⁸F-DOPA uptake by index lesions at baseline (no carbidopa) vs. after carbidopa. Patient numbers and locations of index lesions are indicated in graph titles.

TABLE 1

Patient Characteristics

Patient no.	Sex	Mutation	Age at diagnosis (y)	Location of primary tumor	Biochemical phenotype	Time to metastases^* (y)	Locations of metastases	Previous treatment
1	M	SDHB	27	L extraadrenal abdominal	None	0	Abdominal LN, mediastinum, bone	Primary tumor resection; CVD
2	F	SDHB	51	R paraaortic abdominal	NE	—	—	MIBG
3	F	SDHB	23	Paraaortic abdominal	NE	0.3	Abdominal LN, bone	Primary tumor resection; CVD
4	M	SDHD	22	R adrenal	NE	10.3	Abdominal LN, liver, mediastinum, bone	Primary tumor resection; MIBG
5	F	Pending	53	R adrenal	NE	—	—	—
6	M	SDHB	10	R paraadrenal	NE + DA	8.4	Abdominal LN, lung, liver, bone, neck	MIBG
7	M	Pending	39	R adrenal	NE + DA	14.7	Abdominal LN, mediastinum, bone	Primary tumor resection
8	F	RET	33	R + L adrenal	NE + E	6.2	Abdominal LN, liver, bone	Primary tumor resection; MIBG
9	F	RET	33	R + L adrenal	E	—	—	Primary tumor resection
10	M	SDHB	40	L paraaortic	NE	3.9	Liver	Primary tumor resection
11	M	Pending	40	R adrenal	NE + DA	5.4	Lung, bone	Primary tumor resection; CVD; MIBG

↵* Time between diagnosis of primary tumor and metastatic disease.
SDHB/D = succinate dehydrogenase subunit B/D; LN = lymph nodes; CVD = cyclophosphamide/vincristine/dacarbazine; NE = norepinephrine; MIBG = ¹³¹I-methyliodobenzylguanidine; DA = dopamine; RET = rearranged during transfection; E = epinephrine.

TABLE 2

Tumor Detection

TABLE 3

Dynamics of ¹⁸F-DOPA Tumor Uptake

TABLE 4

Physiologic Distribution of ¹⁸F-DOPA