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Superiority of 6-[¹⁸F]-Fluorodopamine Positron Emission Tomography Versus [¹³¹I]-Metaiodobenzylguanidine Scintigraphy in the Localization of Metastatic Pheochromocytoma

Pediatric and Reproductive Endocrinology Branch (I.I., J.Y., K.P.), National Institute of Child Health and Human Development; Nuclear Medicine Department (J.A.C., C.C.C., M.W.) and Nursing Department (B.M.), Warren Grant Magnuson Clinical Center; and Clinical Neurocardiology Section (G.E.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1583

Address all correspondence and requests for reprints to: Karel Pacak, M.D., Ph.D., D.Sc., Chief, Unit on Clinical Neuroendocrinology, PREB, NICHD, NIH, Building 10 Room 9D42, 10 Center Drive, Bethesda, Maryland 20892. E-mail: karel{at}mail.nih.gov.

The purpose of the study was to assess the diagnostic utility of 6-[¹⁸F]-fluorodopamine ([¹⁸F]-DA) positron emission tomography scanning (PET) vs. [¹³¹I]-metaiodobenzylguanidine (MIBG) scintigraphy in patients with metastatic pheochromocytoma (PHEO). We studied 10 men and six women (mean age 38.2 ± 11.5 yr) referred to our institution for metastatic PHEO; two patients were studied twice within a 2-yr interval. Imaging modalities included computed tomography (CT), magnetic resonance imaging (MRI), [¹³¹I]-MIBG scintigraphy, and [¹⁸F]-DA PET. Fifteen of 16 patients had positive findings on CT and/or MRI consistent with the presence of pheochromocytoma. [¹⁸F]-DA PET was positive in all patients, but seven patients had negative [¹³¹I]-MIBG scans. Thirty-eight foci of uptake were shown by both [¹⁸F]-DA PET and [¹³¹I]-MIBG scintigraphy, 90 only by [¹⁸F]-DA PET, and 10 only by [¹³¹I]-MIBG; most lesions were also visible on CT/MRI. In this initial series of patients with metastatic pheochromocytoma, [¹⁸F]-DA PET localized PHEO in all patients and showed a large number of foci that were not imaged with [¹³¹I]-MIBG scintigraphy. Thus, [¹⁸F]-DA PET was found to be a superior imaging method in patients with metastatic PHEO, in which correct detection of disease extension often determines the most appropriate therapeutic plan and future follow-up.

Abbreviations: CT, Computed tomography; [¹⁸F]-DA, 6-[¹⁸F]-fluorodopamine; FDG, fluorodeoxyglucose; [¹⁸F]-DOPA, [¹⁸F]-dihydroxyphenylalanine; MIBG, metaiodobenzylguanidine; MRI, magnetic resonance imaging; PET, positron emission tomography; PHEO, pheochromocytoma; TE, echo time; TR, repetition time.

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