Manuel Weber1,2, Jochen Schmitz3,2, Ines Maric3,2, Kim Pabst3,2, Lale Umutlu2,4, Martin Walz5, Ken Herrmann3,2, Christoph Rischpler3,2, Frank Weber6,7, Walter Jentzen3,2, Sarah Theurer2,8, Thorsten D Poeppel9, Nicole Unger2,10, Wolfgang P Fendler3,2. 1. Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; manuel.weber@uk-essen.de. 2. German Cancer Consortium, Essen, Germany. 3. Department of Nuclear Medicine, University Hospital Essen, Essen, Germany. 4. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany. 5. Department of Surgery and Center of Minimally Invasive Surgery, Evangelische Kliniken Essen-Mitte, Academic Teaching Hospital of University Duisburg-Essen, Essen, Germany. 6. German Cancer Consortium, Essen, Germany; manuel.weber@uk-essen.de. 7. Department of General, Visceral, and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany. 8. Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Essen, Germany. 9. Nuklearmedizin, MVZ CDT Strahleninstitut, Cologne, Germany; and. 10. Division of Laboratory Research, Department of Endocrinology and Metabolism, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Abstract
123/131I-metaiodobenzylguanidine (MIBG) scintigraphy has shown a high specificity for imaging pheochromocytoma and paraganglioma, but with low sensitivity because of low spatial resolution. 124I-MIBG PET may be able to overcome this limitation and improve the staging of patients with (suspected) pheochromocytoma. Methods: We analyzed the sensitivity, specificity, and positive and negative predictive values of 124I-MIBG PET in 43 consecutive patients with suspected (recurrence of) pheochromocytoma using histopathologic (n = 25) and clinical validation (n = 18) as the standard of truth. Furthermore, we compared the detection rate of 124I-MIBG PET versus contrast-enhanced (CE) CT on a per-patient and per-lesion basis in 13 additional patients with known metastatic malignant pheochromocytoma. Results: 124I-MIBG PET/CT was positive in 19 (44%) of 43 patients with suspected pheochromocytoma. The presence of pheochromocytoma was confirmed in 22 (51%) of 43. 124I-MIBG PET/CT sensitivity, specificity, and positive and negative predictive values were 86%, 100%, 100%, and 88%, respectively. 124I-MIBG PET was positive in 11 (85%) of 13 patients with malignant pheochromocytoma. Combined 124I-MIBG PET and CE CT detected 173 lesions, of which 166 (96%) and 118 (68%) were visible on 124I-MIBG PET and CE CT, respectively. Conclusion: 124I-MIBG PET detects pheochromocytoma with high accuracy at initial staging and a high detection rate at restaging. Future assessment of 124I-MIBG PET for treatment guidance, including personalized 131I-MIBG therapy, is warranted.
123/131I-metaiodobenzylguanidine (MIBG) scintigraphy has shown a high specificity for imaging pheochromocytoma and paraganglioma, but with low sensitivity because of low spatial resolution. 124I-MIBG PET may be able to overcome this limitation and improve the staging of patients with (suspected) pheochromocytoma. Methods: We analyzed the sensitivity, specificity, and positive and negative predictive values of 124I-MIBG PET in 43 consecutive patients with suspected (recurrence of) pheochromocytoma using histopathologic (n = 25) and clinical validation (n = 18) as the standard of truth. Furthermore, we compared the detection rate of 124I-MIBG PET versus contrast-enhanced (CE) CT on a per-patient and per-lesion basis in 13 additional patients with known metastatic malignant pheochromocytoma. Results: 124I-MIBG PET/CT was positive in 19 (44%) of 43 patients with suspected pheochromocytoma. The presence of pheochromocytoma was confirmed in 22 (51%) of 43. 124I-MIBG PET/CT sensitivity, specificity, and positive and negative predictive values were 86%, 100%, 100%, and 88%, respectively. 124I-MIBG PET was positive in 11 (85%) of 13 patients with malignant pheochromocytoma. Combined 124I-MIBG PET and CE CT detected 173 lesions, of which 166 (96%) and 118 (68%) were visible on 124I-MIBG PET and CE CT, respectively. Conclusion: 124I-MIBG PET detects pheochromocytoma with high accuracy at initial staging and a high detection rate at restaging. Future assessment of 124I-MIBG PET for treatment guidance, including personalized 131I-MIBG therapy, is warranted.
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