A comparison of the performance of Ga-68-DOTATATE PET/CT and I-123-MIBG SPECT in the diagnosis and follow-up of phaeochromocytoma and paraganglioma

作者：Maurice J B^*; Troke R; Win Z; Ramachandran R; Al Nahhas A; Naji M; Dhillo W; Meeran K; Goldstone A P; Martin N M; Todd J F; Palazzo F; Tan T

来源：European Journal of Nuclear Medicine and Molecular Imaging, 2012, 39(8): 1266-1270.

DOI：10.1007/s00259-012-2119-7

• Phaeochromocytoma
• Paraganglioma
• I-123-Metaiodobenzylguanidine
• Ga-68-DOTATATE
• Single positron emission computed tomography
• Positron emission tomography

To compare the sensitivity of I-123-metaiodobenzylguanidine (MIBG) SPECT and Ga-68-DOTATATE PET/CT in detecting phaeochromocytomas (PCC) and paragangliomas (PGL) in the initial diagnosis and follow-up of patients with PCC and PGL disease.
Retrospective analysis of 15 patients with PCC/PGL who had contemporaneous I-123-MIBG and Ga-68-DOTATATE imaging.
Of the 15 patients in the series, 8 were concordant with both modalities picking up clinically significant lesions. There were no patients in whom both modalities failed to pick up clinically significant lesions. There was discordance in seven patients: 5 had positive Ga-68-DOTATATE and negative I-123-MIBG, and 2 (12 and 14) had negative Ga-68-DOTATATE and positive I-123-MIBG. Utilizing I-123-MIBG as the gold standard, Ga-68-DOTATATE had a sensitivity of 80 % and a positive predictive value of 62 %. The greatest discordance was in head and neck lesions, with the lesions in 4 patients being picked up by Ga-68-DOTATATE and missed by I-123-MIBG. On a per-lesion analysis, cross-sectional (CT and MRI) and Ga-68-DOTATATE was superior to I-123-MIBG in detecting lesions in all anatomical locations, and particularly bony lesions.
First, Ga-68-DOTATATE should be considered as a first-line investigation in patients at high risk of PGL and metastatic disease, such as in the screening of carriers for mutations associated with familial PGL syndromes. Second, if I-123-MIBG does not detect lesions in patients with a high pretest probability of PCC or PGL, Ga-68-DOTATATE should be considered as the next investigation. Third, Ga-68-DOTATATE hould be considered in preference to I-123-MIBG in patients in whom metastatic spread, particularly to the bone, is suspected.

• 出版日期2012-8