Published in:
01-08-2012 | Short Communication
A comparison of the performance of 68Ga-DOTATATE PET/CT and 123I-MIBG SPECT in the diagnosis and follow-up of phaeochromocytoma and paraganglioma
Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 8/2012
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Purpose
To compare the sensitivity of 123I-metaiodobenzylguanidine (MIBG) SPECT and 68Ga-DOTATATE PET/CT in detecting phaeochromocytomas (PCC) and paragangliomas (PGL) in the initial diagnosis and follow-up of patients with PCC and PGL disease.
Methods
Retrospective analysis of 15 patients with PCC/PGL who had contemporaneous 123I-MIBG and 68Ga-DOTATATE imaging.
Results
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 68Ga-DOTATATE and negative 123I-MIBG, and 2 (12 and 14) had negative 68Ga-DOTATATE and positive 123I-MIBG. Utilizing 123I-MIBG as the gold standard, 68Ga-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 68Ga-DOTATATE and missed by 123I-MIBG. On a per-lesion analysis, cross-sectional (CT and MRI) and 68Ga-DOTATATE was superior to 123I-MIBG in detecting lesions in all anatomical locations, and particularly bony lesions.
Conclusion
First, 68Ga-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 123I-MIBG does not detect lesions in patients with a high pretest probability of PCC or PGL, 68Ga-DOTATATE should be considered as the next investigation. Third, 68Ga-DOTATATE hould be considered in preference to 123I-MIBG in patients in whom metastatic spread, particularly to the bone, is suspected.