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A retrospective comparison between 68Ga-DOTA-TOC PET/CT and 18F-DOPA PET/CT in patients with extra-adrenal paraganglioma
Authors:Alexander Kroiss  Daniel Putzer  Andreas Frech  Clemens Decristoforo  Christian Uprimny  Rudolf Wolfgang Gasser  Barry Lynn Shulkin  Christoph Url  Gerlig Widmann  Rupert Prommegger  Georg Mathias Sprinzl  Gustav Fraedrich  Irene Johanna Virgolini
Affiliation:1. Department of Nuclear Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
2. Department of Vascular Surgery, Innsbruck Medical University, Innsbruck, Austria
3. Department of Internal Medicine I, Innsbruck Medical University, Innsbruck, Austria
4. Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
5. Department of Otorhinolaryngology, Innsbruck Medical University, Innsbruck, Austria
6. Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
7. Department of Surgery, Sanatorium Kettenbrücke, Innsbruck, Austria
8. Department of Otorhinolaryngology, State Clinic St. Poelten, St. Poelten, Austria
Abstract:

Purpose

18F-Fluoro-l-dihydroxyphenylalanine (18F-DOPA) PET offers high sensitivity and specificity in the imaging of nonmetastatic extra-adrenal paragangliomas (PGL) but lower sensitivity in metastatic or multifocal disease. These tumours are of neuroendocrine origin and can be detected by 68Ga-DOTA-Tyr3-octreotide (68Ga-DOTA-TOC) PET. Therefore, we compared 68Ga-DOTA-TOC and 18F-DOPA as radiolabels for PET/CT imaging for the diagnosis and staging of extra-adrenal PGL. Combined cross-sectional imaging was the reference standard.

Methods

A total of 5 men and 15 women (age range 22 to 73 years) with anatomical and/or histologically proven extra-adrenal PGL were included in this study. Of these patients, 5 had metastatic or multifocal lesions and 15 had single sites of disease. Comparative evaluation included morphological imaging with CT and functional imaging with 68Ga-DOTA-TOC PET and 18F-DOPA PET. The imaging results were analysed on a per-patient and a per-lesion basis. The maximum standardized uptake value (SUVmax) of each functional imaging modality in concordant tumour lesions was measured.

Results

Compared with anatomical imaging, 68Ga-DOTA-TOC PET and 18F-DOPA PET each had a per-patient and per-lesion detection rate of 100 % in nonmetastatic extra-adrenal PGL. However, in metastatic or multifocal disease, the per-lesion detection rate of 68Ga-DOTA-TOC was 100 % and that of 18F-DOPA PET was 56.0 %. Overall, 68Ga-DOTA-TOC PET identified 45 lesions; anatomical imaging identified 43 lesions, and 18F-DOPA PET identified 32 lesions. The overall per-lesion detection rate of 68Ga-DOTA-TOC PET was 100 % (McNemar, P?18F-DOPA PET was 71.1 % (McNemar, P?max (mean ± SD) of all 32 concordant lesions was 67.9?±?61.5 for 68Ga-DOTA-TOC PET and 11.8?±?7.9 for 18F-DOPA PET (Mann-Whitney U test, P?Conclusion 68Ga-DOTA-TOC PET may be superior to 18F-DOPA PET and diagnostic CT in providing valuable information for pretherapeutic staging of extra-adrenal PGL, particularly in surgically inoperable tumours and metastatic or multifocal disease.
Keywords:
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