Artigo Revisado por pares

Comparison of [ 111 In]pentetreotide‐SPECT and [ 18 F]FDOPA‐PET in the localization of extra‐adrenal paragangliomas: the case for a patient‐tailored use of nuclear imaging modalities

2010; Wiley; Volume: 74; Issue: 1 Linguagem: Inglês

10.1111/j.1365-2265.2010.03893.x

ISSN

1365-2265

Autores

Nathalie Charrier, Arnaud Devèze, N. Fakhry, F. Sébag, Isabelle Morange, Bénédicte Gaborit, Anne Barlier, Edgardo Torres Carmona, C. De Micco, S. Gallego García, Julien Mancini, Fausto Palazzo, Jean‐Pierre Lavieille, M Zanaret, J. F. Henry, O. Mundler, David Taïeb,

Tópico(s)

Neuroendocrine Tumor Research Advances

Resumo

The aim of this prospective study was to compare the diagnostic value of [¹⁸F]FDOPA-PET and [¹¹¹In]pentetreotide-SPECT somatostatin receptor scintigraphy (SRS) in patients with nonmetastatic extra-adrenal paragangliomas (PGLs). Twenty-five consecutive unrelated patients who were known or suspected of having nonmetastatic extra-adrenal PGLs were prospectively evaluated with SRS and [¹⁸F]FDOPA-PET. ¹³¹I-MIBG and [¹⁸F]FDG-PET were added to the work-up in patients with a personal or familial history of PGL, predisposing mutations, abdominal PGLs, metanephrine hypersecretion and abdominal foci on SRS and/or [¹⁸F]FDOPA-PET.SRS correctly detected 23/45 lesions of which 20 were head or neck lesions (H&N) and 3 were abdominal lesions. [¹⁸F]FDOPA-PET detected significantly more lesions than SRS (39/45, P < 0·001). Both SRS and ¹⁸F-DOPA-PET detected significantly more H&N than abdominal lesions (66·7% vs 20%, P = 0·003 and 96·7% vs 67%, P = 0·012, respectively). In two patients with the succinate dehydrogenase D (SDHD) mutation, [¹⁸F]FDOPA-PET missed five abdominal PGLs which were detected by the combination of SRS, [¹³¹I]MIBG and [¹⁸F]FDG-PET. A lesion-based analysis using a forward stepwise logistic regression model demonstrates that size ≤ 10 mm (P = 0·002) and abdominal lesions (P = 0·031) were independently associated with "[¹⁸F]FDOPA-PET diagnosis only". In turn, a previous history of surgery and/or the presence of germline mutation was associated with lower lesion size (P = 0·001).The sensitivity of SRS for localizing parasympathetic PGLs is lower than originally reported, and [¹⁸F]FDOPA-PET is better than SRS for localizing small lesions. SRS should be replaced by [¹⁸F]FDOPA-PET as the first-line imaging procedure in H&N PGL, especially in patients at risk of multifocal disease (predisposing mutations and or previous history of surgery).

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