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Research ArticleOncology

First Experience Using 18F-Flubrobenguane PET Imaging in Patients with Suspected Pheochromocytoma or Paraganglioma

Lukas Kessler, Anna M. Schlitter, Markus Krönke, Alexander von Werder, Robert Tauber, Tobias Maurer, Simon Robinson, Cesare Orlandi, Michael Herz, Behrooz H. Yousefi, Stephan G. Nekolla, Markus Schwaiger, Matthias Eiber and Christoph Rischpler
Journal of Nuclear Medicine April 2021, 62 (4) 479-485; DOI: https://doi.org/10.2967/jnumed.120.248021
Lukas Kessler
1Department of Nuclear Medicine, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
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Anna M. Schlitter
2Institute of Pathology, Technical University Munich, Munich, Germany
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Markus Krönke
3Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Alexander von Werder
4Department of Gastroenterology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Robert Tauber
5Department of Urology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Tobias Maurer
5Department of Urology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Simon Robinson
6Discovery Research, Lantheus Medical Imaging, North Billerica, Massachusetts; and
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Cesare Orlandi
6Discovery Research, Lantheus Medical Imaging, North Billerica, Massachusetts; and
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Michael Herz
3Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Behrooz H. Yousefi
3Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
7Department of Nuclear Medicine, Philipps University of Marburg, Marburg, Germany
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Stephan G. Nekolla
3Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Markus Schwaiger
3Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Matthias Eiber
3Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Christoph Rischpler
1Department of Nuclear Medicine, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
3Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Abstract

Pheochromocytomas and paragangliomas are a rare tumor entity originating from adrenomedullary chromaffin cells in the adrenal medulla or in sympathetic, paravertebral ganglia outside the medulla. Small lesions are especially difficult to detect by conventional CT or MRI and even by SPECT with the currently available radiotracers (e.g., metaiodobenzylguanidine [MIBG]). The novel PET radiotracer 18F-flubrobenguane could change the diagnostic paradigm in suspected pheochromocytomas and paragangliomas because of its homology with MIBG and the general advantages of PET imaging. The aim of this retrospective analysis was to evaluate 18F-flubrobenguane in pheochromocytomas and paragangliomas and to investigate the biodistribution in patients. Methods: Twenty-three patients with suspected pheochromocytoma or paraganglioma underwent PET/CT or PET/MRI at 63 ± 24 min after injection of 256 ± 33 MBq of 18F-flubrobenguane. The SUVmean and SUVmax of organs were measured with spheric volumes of interest. Threshold-segmented volumes of interest were used to measure the SUVmean or SUVmax of the tumor lesions. One reader evaluated all cross-sectional imaging datasets (CT or MRI) separately, as well as the PET hybrid datasets, and reported the lesion number and size. The diagnostic certainty for a positive lesion was scored on a 3-point scale. Results: 18F-flubrobenguane showed a reproducible, stable biodistribution, with the highest SUVmax and SUVmean being in the thyroid gland (30.3 ± 2.2 and 22.5 ± 1.6, respectively), pancreas (12.2 ± 0.8 and 9.5 ± 0.7, respectively), and tumor lesions (16.8 ± 1.7 and 10.1 ± 1.1, respectively) and the lowest SUVmax and SUVmean being in muscle (1.1 ± 0.06 and 0.7 ± 0.04, respectively) and the lung (2.5 ± 0.17 and 1.85 ± 0.13, respectively). In a subgroup analysis, a significantly higher average SUVmean was seen for both pheochromocytoma and paraganglioma than for healthy adrenal glands (11.9 ± 2.0 vs. 9.9 ± 1.5 vs. 3.7 ± 0.2, respectively). In total, 47 lesions were detected. The reader reported more and smaller lesions with higher certainty in PET hybrid imaging than in conventional imaging; however, statistical significance was not reached. Of the 23 (23/47, 49%) lesions smaller than 1 cm, 61% (14/23) were found on hybrid imaging only. Conclusion: Our preliminary data suggest 18F-flubrobenguane PET to be a new, effective staging tool for patients with suspected pheochromocytoma or paraganglioma. Major advantages are the fast acquisition and high spatial resolution of PET imaging and the intense uptake in tumor lesions, facilitating detection. Further studies are warranted to define the role of 18F-flubrobenguane PET, particularly in comparison to standard diagnostic procedures such as MRI or 123I-MIBG SPECT/CT.

  • PET/CT
  • PET/MRI
  • F-18 flubrobenguane
  • PET
  • paraganglioma
  • pheochromocytoma

Footnotes

  • Published online Aug. 28, 2020.

  • © 2021 by the Society of Nuclear Medicine and Molecular Imaging.
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Journal of Nuclear Medicine: 62 (4)
Journal of Nuclear Medicine
Vol. 62, Issue 4
April 1, 2021
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First Experience Using 18F-Flubrobenguane PET Imaging in Patients with Suspected Pheochromocytoma or Paraganglioma
Lukas Kessler, Anna M. Schlitter, Markus Krönke, Alexander von Werder, Robert Tauber, Tobias Maurer, Simon Robinson, Cesare Orlandi, Michael Herz, Behrooz H. Yousefi, Stephan G. Nekolla, Markus Schwaiger, Matthias Eiber, Christoph Rischpler
Journal of Nuclear Medicine Apr 2021, 62 (4) 479-485; DOI: 10.2967/jnumed.120.248021

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First Experience Using 18F-Flubrobenguane PET Imaging in Patients with Suspected Pheochromocytoma or Paraganglioma
Lukas Kessler, Anna M. Schlitter, Markus Krönke, Alexander von Werder, Robert Tauber, Tobias Maurer, Simon Robinson, Cesare Orlandi, Michael Herz, Behrooz H. Yousefi, Stephan G. Nekolla, Markus Schwaiger, Matthias Eiber, Christoph Rischpler
Journal of Nuclear Medicine Apr 2021, 62 (4) 479-485; DOI: 10.2967/jnumed.120.248021
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Keywords

  • PET/CT
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  • F-18 flubrobenguane
  • PET
  • paraganglioma
  • pheochromocytoma
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