Diagnostic Performance of 68 Ga-DOTATATE PET/CT, 18 F-FDG PET/CT and 131 I-MIBG Scintigraphy in Mapping Metastatic Pheochromocytoma and Paraganglioma

Abstract

Purpose: To evaluate the diagnostic performance of 68 Ga-DOTATATE 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography (PET)/computed tomography (CT), 18 F-FDG PET/CT and 131 I-MIBG scintigraphy in the mapping of metastatic pheochromocytoma and paraganglioma. Materials and Methods: Seventeen patients (male = 8, female = 9; age range, 13–68 years) with clinically proven or suspicious metastatic pheochromocytoma or paraganglioma were included in this prospective study. Twelve patients underwent all three modalities, whereas five patients underwent 68 Ga-DOTATATE and 131 I-MIBG without 18 F-FDG. A composite reference standard derived from anatomical and functional imaging findings, along with histopathological information, was used to validate the findings. Results were analysed on a per-patient and on per-lesion basis. Sensitivity and accuracy were assessed using McNemar’s test. Results: On a per-patient basis, 14/17 patients were detected in 68 Ga-DOTATATE, 7/17 patients in 131 I-MIBG, and 10/12 patients in 18 F-FDG. The sensitivity and accuracy of 68 Ga-DOTATATE, 131 I-MIBG and 18 F-FDG were (93.3 %, 94.1 %), (46.7 %, 52.9 %) and (90.9 %, 91.7 %) respectively. On a per-lesion basis, an overall of 472 positive lesions were detected; of which 432/472 were identified by 68 Ga-DOTATATE, 74/472 by 131 I-MIBG, and 154/300 (patient, n = 12) by 18 F-FDG. The sensitivity and accuracy of 68 Ga-DOTATATE, 131 I-MIBG and 18 F-FDG were (91.5 %, 92.6 % p < 0.0001), (15.7 %, 26.0 % p < 0.0001) and (51.3 %, 57.8 % p < 0.0001) respectively. Discordant lesions were demonstrated on 68 Ga-DOTATATE, 131 I-MIBG and 18 F-FDG. Conclusions: Ga-DOTATATE PET/CT shows high diagnostic accuracy than 131 I-MIBG scintigraphy and 18 F-FDG PET/ CT in mapping metastatic pheochromocytoma and paraganglioma.