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68Ga-DOTATOC PET/CT in the localization of head and neck paraganglioma compared with 18F-DOPA PET/CT and 123I-MIBG SPECT/CT

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  • Alexander Stephan Kroiss
  • Christian Uprimny
  • Barry Lynn Shulkin
  • Leonhard Gruber
  • Andreas Frech
  • Christoph Url
  • Herbert Riechelmann
  • Georg Mathias Sprinzl
  • Claudius Thomé
  • Giorgio Treglia
  • Andreas Kjaer
  • Gustav Fraedrich
  • Irene Johanna Virgolini
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PURPOSE: 18F-Fluoro-L-dihydroxyphenylalanine (18F-DOPA) PET offers high sensitivity and specificity in the imaging of non-malignant head and neck paraganglioma (HNPGL) but lower sensitivity in metastatic disease of these neuroendocrine tumours (NET). In contrast to the radiotracer 18F-DOPA, both 123I-meta-iodo-benzylguanidine (123I-MIBG) and 68Ga-DOTA-Tyr3-octreotide (68Ga-DOTA-TOC) offer valuable clinical information on norepinephrine and somatostatin (SST) receptor status for planning 131I-MIBG and radionuclide peptide therapy (PRRT), respectively. Therefore, we compared 68Ga-DOTA-TOC and 18F-DOPA PET/CT with 123I-MIBG planar and SPECT/CT imaging, for the detection of HNPGL. Combined cross-sectional imaging was the reference standard.

METHODS: A total of 3 men and 7 women (age range 22 to 73 years) with anatomical and/or histologically proven HNPGL were included in this study. Of these patients, 3 patients had metastatic HNPGL. Comparative evaluation included morphological imaging with CT and functional imaging with 68Ga-DOTA-TOC and 18F-DOPA PET, including 123I-MIBG imaging. The imaging results were analysed on a per-patient and per-lesion basis.

RESULTS: On a per-patient analysis, the detection rate of both 68Ga-DOTA-TOC PET/CT and 18F-DOPA PET/CT was 100%, that of planar 123I-MIBG imaging 10.0% and that of SPECT/CT 20.0%. On a per-lesion basis and in reference to diagnostic CT, the sensitivity of 68Ga-DOTA-TOC PET/CT was 100% (McNemar, P < 0.5), that of 18F-DOPA PET/CT was 66.7% (McNemar, P < 0.01), that of planar 123I-MIBG imaging was 3.7% (McNemar, P < 0.0001), and that of SPECT/CT was 7.4% (McNemar, P < 0.0001) in HNPGL. Overall, 68Ga-DOTA-TOC PET identified 29 lesions and anatomical imaging identified 27 lesions. 18F-DOPA PET identified 18 lesions, whereas planar 123I-MIBG imaging identified 1 lesion and SPECT/CT 2 lesions.

CONCLUSION: 68Ga-DOTA-TOC PET/CT is superior for imaging, non-malignant and metastatic HNPGL compared to 18F-DOPA PET/CT and planar 123I-MIBG imaging, including SPECT/CT, particularly in bone lesions. Combined functional/anatomical imaging (68Ga-DOTA-TOC PET/CT) enables excellent delineation of tumour extent in these rare tumour entities. Compared to 123I-MIBG scintigraphy, 68Ga-DOTA-TOC PET appears far more useful for planning radionuclide therapy in patients with surgically inoperable tumours or metastatic disease.

TidsskriftNuclear Medicine and Biology
Sider (fra-til)47-53
Antal sider7
StatusUdgivet - apr. 2019

Bibliografisk note

Copyright © 2019 Elsevier Inc. All rights reserved.

ID: 59321392