signature=2d8bbc8cb2a035c02b489df3dc3fda8a,Functional Imaging Signature of Patients Presenting with ...

摘要：

Rationale: Pheochromocytoma/paraganglioma (PPGL) syndromes associated with polycythemia have previously been described in association with mutations in the von Hippel-Lindau ( VHL ) gene. Recently, mutations in the prolyl hydroxylase gene ( PHD ) 1 and 2 and in the hypoxia-inducible factor 2 alpha ( HIF2A ) were also found to be associated with multiple and recurrent PPGL. Such patients also presented with PPGL and polycythemia, and later on, some presented with duodenal somatostatinoma. In additional patients presenting with PPGL and polycythemia, no further mutations have been discovered. Since the functional imaging signature of patients with PPGL-polycythemia syndromes is still unknown, and since these tumors (in most patients) are multiple, recurrent and metastatic, the goal of our study was to assess the optimal imaging approach utilizing 4 different positron emission tomography (PET) radiopharmaceuticals and computed tomography (CT)/magnetic resonance imaging (MRI) in these patients. Methods: Fourteen patients (10 females, 4 males) with confirmed PPGL and polycythemia prospectively underwent 68 Ga-DOTA(0)-Tyr(3)-octreotate ( 68 Ga-DOTATATE), (13 patients), 18 F-fluoro-2-deoxy-D-glucose ( 18 F-FDG) (13 patients), 18 F-fluorodihydroxyphenylalanine ( 18 F-FDOPA) (14 patients), 18 F-fluorodopamine ( 18 F-FDA) (11 patients), and CT/MRI (14 patients). Detection rates of PPGL lesions were compared between all imaging studies and stratified between the underlying mutations. Results: 18 F-FDOPA and 18 F-FDA PET/CT showed similar combined lesion-based detection rates of 98.7% (95% confidence interval (CI) 92.7 to 99.8%) and 98.3% (CI 90.9 to 99.7%), respectively. The detection rates for 68 Ga-DOTATATE (35.3%, CI 25.0 to 47.2%), 18 F-FDG (42.3, CI 29.9 to 55.8%), and CT/MRI (60.3%, CI 48.8 to 70.7%) were significantly lower (p<0.01), irrespective of the mutation status. Conclusion: 18 F-FDOPA and 18 F-FDA are superior to 18 F-FDG, 68 Ga-DOTATATE, and CT/MRI and should be the radiopharmaceuticals of choice in this rare group of patients. Copyright 2017 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

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