help button home button Endocrine Society JCEM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a related Letter to the Editor
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Copyright Permission
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gourgiotis, L.
Right arrow Articles by Pacak, K.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Gourgiotis, L.
Right arrow Articles by Pacak, K.
The Journal of Clinical Endocrinology & Metabolism Vol. 88, No. 2 637-641
Copyright © 2003 by The Endocrine Society

Localization of Medullary Thyroid Carcinoma Metastasis in a Multiple Endocrine Neoplasia Type 2A Patient by 6-[18F]-Fluorodopamine Positron Emission Tomography

Loukas Gourgiotis, Nicholas J. Sarlis, James C. Reynolds, Carter VanWaes, Maria J. Merino and Karel Pacak

Clinical Endocrinology Branch (L.G., N.J.S.), National Institute of Diabetes, Digestive, and Kidney Diseases; Nuclear Medicine Department (J.C.R.), Warren G. Magnuson Clinical Center; Office of the Clinical Director, National Institute of Communicative Disorders and Deafness (C.V.); Laboratory of Pathology (M.J.M.), National Cancer Institute; and Pediatric and Reproductive Endocrinology Branch (K.P.), National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892

Address all correspondence and requests for reprints to: Karel Pacak, M.D., Ph.D., D.Sc., Pediatric and Reproductive Endocrinology Branch/National Institute of Child Health and Human Development, National Institutes of Health, Building 10, Room 9D42, 10 Center Drive, Bethesda, Maryland 20892-1583. E-mail: karel{at}mail nih.gov.


   Abstract
Top
 Abstract
Introduction
 Case Report
 Discussion
 References
 
6-[18F]fluorodopamine, a substrate for the norepinephrine transporter, has been used as a tumor-seeking tracer in positron emission tomography (PET) to localize pheochromocytomas and other chromaffin tumors. Here, we report the case of a 42-yr-old woman with multiple endocrine neoplasia type 2A, in whom biopsy-proven recurrent medullary thyroid cancer (MTC) was detected by 6-[18F]fluorodopamine PET scanning. The patient had previously undergone bilateral adrenalectomy for pheochromocytoma, total thyroidectomy, and extirpation of a parapharyngeal MTC metastatic deposit. An increase in plasma calcitonin 5 yr after her initial presentation was further investigated, leading to the discovery of a mass in the left parapharyngeal space. Levels of serum and urine catecholamines and metanephrines were normal. To exclude a hormonally silent pheochromocytoma metastasis, 6-[18F]fluorodopamine PET was performed. The study showed a focus of radionuclide accumulation corresponding to the parapharyngeal mass. After resection of the latter, pathology confirmed metastatic MTC. To our knowledge, this is the first case of metastatic, histologically proven MTC, which was unequivocally detected by 6-[18F]fluorodopamine PET scanning. Because norepinephrine transporter systems have been previously found in MTC, it is conceivable that 6-[18F]fluorodopamine PET scanning can be used for the diagnostic localization of this tumor and its metastatic deposits because total and early resection is beneficial to the outcome of the patient.


   Introduction
Top
 Abstract
 Introduction
Case Report
 Discussion
 References
 
6-[18F]-FLUORODOPAMINE IS A positron-emitting analog of dopamine, developed at National Institutes of Health (NIH) as an imaging agent for the sympathetic nervous system (1). In catecholamine-synthesizing cells, 6-[18F]-fluorodopamine is transported actively by both the plasma membrane norepinephrine transporter and the intracellular vesicular monoamine transporter. Accumulation of 6-[18F]-fluorodopamine-derived radioactivity in catecholamine storage vesicles enables visualization of sympathetic cells. Because chromaffin cells also express the above-mentioned transporters, 6-[18F]-fluorodopamine has been successfully used for tumor localization in patients with adrenal and extraadrenal pheochromocytomas (2, 3).

We hereby report the case of a patient with prior history of bilateral pheochromocytomas and medullary thyroid carcinoma (MTC) in the context of multiple endocrine neoplasia (MEN) type 2A syndrome, who presented with a positive 6-[18F]-fluorodopamine positron emission tomography (PET) focus during follow-up restaging. This focus corresponded to a metastasis from an MTC, as proven by pathology following surgical extirpation of the lesion.


   Case Report
Top
 Abstract
 Introduction
 Case Report
Discussion
 References
 
A 42-yr-old Caucasian woman presented at the age of 37 yr with a 2-month history of anterior neck pain, fatigue, worsening headaches, and increased snoring during sleep. Physical examination by her primary care physician revealed an asymmetrical multinodular goiter with an approximately 4-fold enlarged left lobe, a 1.0-cm lymph node along the left sternocleidomastoid muscle and shotty bilateral submandibular lymphadenopathy. Her past medical history was significant for the development of hypertension 2 yr earlier, which was well controlled on oral lisinopril (20 mg daily). There was no family history known because the patient was adopted. Biochemical evaluation revealed normal thyroid function tests, and a plasma calcitonin of 30,000 pg/ml [normal range (NR), 0–14 pg/ml]. Fine-needle aspiration biopsy of the left thyroid lobe was consistent with the diagnosis of MTC. At this point, the patient was referred to NIH for further evaluation and management.

During her initial visit to our institution, the patient was afebrile; her blood pressure was 140/80 mm Hg, and her pulse was 80/min and regular. Body mass index was 25.1 kg/m2. The patient was clinically euthyroid, and the rest of the examination was unremarkable, with the exception of the above-mentioned neck abnormalities. Because of the diagnosis of both MTC and hypertension, and given the lack of physical stigmata of MEN-2B syndrome, the patient was also screened for pheochromocytoma to exclude MEN-2A.

With regard to her MTC, laboratory tests showed a normal serum calcium and PTH along with normal repeat thyroid function tests. Neck ultrasonography (U/S) revealed a large solid mass extending in the left lobe and isthmus of the thyroid, with increased calcification and vascularity. Computed tomography (CT) of the neck, using iv iodinated contrast, showed bilateral inhomogeneous lobulated masses in the region of the thyroid with paratracheal adenopathy along with a 4.0-cm left parapharyngeal mass.

Consistent with the diagnosis of pheochromocytoma, laboratory tests revealed markedly elevated 24-h urinary values for norepinephrine [1,312 and 1,365 nmol/d (NR 88–972)], epinephrine [1,173 and 1,567 nmol/d (NR 0–110)], dopamine [84,240 and 83,304 nmol/d (NR 10,000–62,000)], and vanillylmandelic acid [20,8563 and 45,4500 nmol/d (NR 0–39,895)]. Plasma catecholamines were not measured. Positive glucagon stimulation and clonidine suppression tests confirmed the biochemical diagnosis of pheochromocytoma (results not shown). Magnetic resonance imaging (MRI) of the abdomen revealed a 7.0 x 8.1 x 9.2 cm left adrenal mass but no evidence of metastatic disease to the liver or the retroperitoneum. Subsequent RET proto-oncogene analysis was positive for a missense mutation in codon 631 of the 11th exon of the gene, thus genetically confirming the diagnosis of MEN-2A.

During bilateral adrenal exploration, two additional nodules were discovered in the right adrenal gland that had not been previously detected by abdominal imaging. Hence, a bilateral adrenalectomy was performed without complications, and the patient was initiated on life-long hydrocortisone and fludrocortisone replacement. Surgical pathology confirmed the existence of bilateral pheochromocytomas, with no capsular or vascular invasion.

The patient returned normotensive and asymptomatic to NIH within 3 months of the adrenalectomy for management of her MTC. A total thyroidectomy with central and left lateral compartment cervical dissections was performed, resulting in a decrease in plasma calcitonin to a level of 6200 pg/ml. It was decided then that the large left parapharyngeal mass would be resected at a later date because the procedure would be long and extensive. Following thyroidectomy, levothyroxine replacement therapy was initiated. One month later, the patient underwent a CT-guided biopsy of the residual neck mass, which confirmed the presence of metastatic MTC. She subsequently underwent a left modified radical neck dissection, midline lip-split mandibulotomy, and excision of that mass, with resultant further decrease in plasma calcitonin levels to 44.0 pg/ml. The patient’s left vagus nerve was killed during this operation.

The patient was followed up closely with yearly visits over 3 yr without evidence of gross MTC or hormonally active pheochromocytoma recurrence and with plasma calcitonin levels ranging from 260–450 pg/ml. Subsequently she reported the appearance of a small palpable and painful neck mass, underlying a surgical scar at the lateral border of the left sternocleidomastoid muscle. At this point the patient’s plasma calcitonin had increased to a level of 2100 pg/ml, whereas her serum and urine catecholamines continued to be within the normal range. Imaging of her neck with U/S, CT, and MRI failed to reveal any distinct abnormality corresponding to the palpable mass. However, it showed instead the presence of a 1.7 x 0.5 cm soft tissue mass adjacent to the left trachea in the region of the parapharyngeal space, which was anteromedial to the left internal carotid artery and inferior to the styloid process. The mass was adjacent to a vascular clip left from the previous extensive modified radical neck dissection (Fig. 1Go). The differential diagnosis of this mass included: 1) recurrent MTC; 2) metastatic pheochromocytoma; 3) glomus tumor (paraganglioma), or 4) a low-flow vascular leak. A subsequent digital subtraction carotid angiogram confirmed the presence of a tumor in this area, supplied by an enlarged ascending pharyngeal artery (Fig. 2Go), thus excluding a venous or arterial leak. An 111In-labeled pentetreotide (Octreoscan, Mallinkrodt Medical, St. Louis, MO) scan showed two foci of increased nuclide uptake: a small, yet intense one in the rostral aspect of the left lateral neck, and a fainter one at the posterior lateral margin of the left sternocleidomastoid muscle at the level of the cricoid (corresponding to the palpable abnormality) (Fig. 3Go).



View larger version (90K):
[in this window]
[in a new window]
  		Figure 1. Anatomical imaging by MRI and CT showing an abnormal lesion (white arrows and black arrow).

 


View larger version (125K):
[in this window]
[in a new window]
  		Figure 2. Angiographic findings. Tumor "blush" is shown with white arrows. The ascending pharyngeal artery was the feeding vessel for the tumor deposit; its course is shown by arrowheads. DS, Digital subtraction; CCA, common carotid artery.

 


View larger version (51K):
[in this window]
[in a new window]
  		Figure 3. Octreoscan findings showing increased uptake in the superior parapharyngeal area at the level of the skull base (black arrow). Diffusely increased nonspecific uptake is also demonstrable along the extensive surgical scar on the left maxillary/submandibular areas, a residual effect of the previous mandibulotomy. Orthogonal (or axial) projections are pertaining to the three axes of a structure in space (sagittal, coronal, and transverse).

 
The location of the parapharyngeal mass, as well as its vascularity, precluded the performance of fine-needle aspiration biopsy for tissue diagnosis; therefore, we performed additional imaging modalities, which could provide a diagnosis. Despite the presence of normal serum and urine catecholamines (including serum dopamine) and the absence of hypertension, a pheochromocytoma metastasis or a paraganglioma, either hormonally silent or intermittently secretory, could not be excluded. Thus, before further surgical intervention, we opted to perform 6-[18F]-fluorodopamine PET scanning, which possesses an increased sensitivity for the detection of metastatic pheochromocytoma, compared with other conventional imaging modalities (2). This special imaging study was conducted with the patient’s informed consent and following her enrollment in a study protocol, approved by the Institutional Review Board of the Division of Intramural Research, National Institute of Child Health and Human Development, NIH. 6-[18F]-fluorodopamine at a dose of 37 MBq was administered iv, and images were acquired using a GE Advance scanner (General Electric, Milwaukee, WI) with a 15-cm field of view. The patient was studied in the fasting state and was asked to avoid caffeine, tobacco, and alcohol for at least 12 h before the scan. The patient was scanned sequentially, at four levels, from the pelvis to the vertex of the skull. Attenuation-corrected images were combined into a composite image. We reasoned that a negative 6-[18F]-fluorodopamine PET scan would probably exclude a chromaffin tissue tumor, and hence would be indicative of metastatic MTC. The 6-[18F]-fluorodopamine PET scan was positive, showing a focus of nuclide uptake located at the rostral aspect of the lateral left neck, corresponding to the location of the parapharyngeal mass (Fig. 4Go).



View larger version (92K):
[in this window]
[in a new window]
  		Figure 4. 6-[18F]-fluorodopamine PET scan showing uptake in the upper parapharyngeal area. Physiological uptake is also seen in the myocardium, liver, kidneys, and bladder.

 
Subsequently, after the usual preoperative and intraoperative pharmacologic prophylaxis for pheochromocytoma surgery, the patient underwent surgical extirpation of the above lesion via a base-of-the-skull approach. The operative field extended from the styloid process to the left prevertebral musculature. The left parapharyngeal mass was resected almost completely, with the exception of a small amount of tissue, which remained at the tip of the styloid process. Surgical pathology revealed metastatic MTC. Immunohistochemistry staining showed the tumor to be positive for calcitonin (Fig. 5AGo), synaptophysin (Fig. 5BGo), calcitonin-gene related peptide, carcinoembryonic antigen (CEA), chromogranin-A, and neuron-specific enolase but negative for thyroglobulin, S-100 protein, and Leu 7 as well as the proliferative markers p53 and MIB-1 (data not shown). Hence, its histogenetic origin as MTC was not in doubt.



View larger version (82K):
[in this window]
[in a new window]
  		Figure 5. Immunohistochemistry findings from the resected metastasis, confirming the diagnosis of MTC. A, Staining for calcitonin; original magnification, x200. B, Staining for synaptophysin; original magnification, x200.

 
After the resection of the parapharyngeal MTC metastasis, plasma calcitonin levels decreased markedly to a value of 718 pg/ml. The palpable abnormality was also resected and identified as a 3.0-cm anatomical level V neuroma, unrelated to the patient’s diagnosis of MEN-2A.


   Discussion
Top
 Abstract
 Introduction
 Case Report
 Discussion
References
 
We report the case of a patient with prior history of bilateral pheochromocytomas and MTC, in the context of MEN-2A syndrome, who presented with a positive 6-[18F]-fluorodopamine PET focus during follow-up reexamination. This focus corresponded to a metastasis from an MTC, as proven by pathology following surgical extirpation of the lesion.

MTC is a relatively rare thyroid malignancy, accounting for 2–10% of all thyroid cancers (4). MTC arises from the parafollicular (C cells) of the thyroid, which embryologically originate from the neural crest. Plasma calcitonin and serum CEA levels are reliable markers for the initial diagnosis of MTC as well as subsequent follow-up of patients with this malignancy (5). Because surgery is the only curative treatment option for this tumor, it is crucial to correctly localize residual/recurrent disease.

Conventional radiographic modalities, such as CT, MRI, and U/S, are customarily used for detecting recurrences following initial treatment of MTC, i.e. total thyroidectomy (6). However, frequently metastatic disease escapes detection by the above modalities, even when its presence is suggested by persistently elevated serum tumor marker (calcitonin or CEA) levels.

Nuclear imaging methods have a unique ability to localize endocrine tumors because they take advantage of the specific expression of receptors or hormone transporters by the tumor. Examples include 111In-diethylenetriamine-pentacetic acid (DTPA)-pentetreotide scanning (Octreoscan), in which DTPA binds to somatostatin receptors types -2, -3, and -5 (to a lesser degree) expressed by a variety of endocrine tumors, and 131I- and 123I-meta-iodobenzylguanidine (MIBG), which localizes chromaffin cell tumors that express norepinephrine transporter systems (7, 8, 9, 10).

For the localization of disease recurrence in MTC, various scintigraphic techniques have been used with assorted radiolabeled small molecules, such as 99mTc-(V)-dimercaptosuccinic acid, 131I- and 123I-MIBG, 99mTc-Sestamibi, 111In-DTPA-pentetreotide (Octreoscan), and 18F-fluorodeoxyglucose (11, 12, 13, 14, 15, 16, 17, 18) as well as radiolabeled anti-CEA (19) and anticalcitonin monoclonal antibodies (20). However, none of the above methods is adequately sensitive or specific for definitive diagnosis.

We report the detection of a biopsy-proven MTC recurrence in a patient with MEN-2A syndrome by using 6-[18F]-fluorodopamine PET scan, a novel imaging technique, currently used exclusively at NIH, which is useful for tumor localization in patients with pheochromocytomas and other chromaffin tumors (2, 3). In the recent pilot study in our institution, 6-[18F]-fluorodopamine PET scan was able to detect and localize solitary and metastatic pheochromocytomas with high sensitivity in all patients with known disease; additionally, 6-[18F]-fluorodopamine PET scans were consistently negative in patients in whom pheochromocytoma was suspected but had negative plasma metanephrine levels (2). Furthermore, our preliminary studies suggest that 6-[18F]-fluorodopamine PET scanning is superior to [131I]-metaiodobenzylguanidine scintigraphy in diagnostic localization of pheochromocytoma, including patients with metastatic disease. To our knowledge, this is the first case in which 6-[18F]-fluorodopamine PET scanning was capable of identifying an MTC recurrent lesion. Because the norepinephrine transporter is responsible for the cellular uptake of both MIBG (21) and 6-[18F]-fluorodopamine, and up to 35% of MTCs concentrate MIBG (22), 6-[18F]-fluorodopamine PET scanning could theoretically represent yet another imaging modality for the detection of MTCs. Furthermore, although MTCs do not secrete catecholamines, these have been previously detected in intracellular vesicles within the tumor cells but not in normal thyroid C cells or follicular thyrocytes (23).

In conclusion, it is conceivable that at least some MTCs may possess catecholamine synthesis and uptake mechanisms, in analogy with pheochromocytomas and neuroblastomas, that could explain the uptake of 6-[18F]-fluorodopamine by the metastatic MTC deposit in our case. The present report offers potential novel perspectives in the diagnosis and follow-up of MTC; further studies are needed to define the exact role of this imaging modality in the above context.


   Acknowledgments
 
We thank Dr. William Eckelman, Chief (PET Department, Clinical Center, NIH), for his continuing support of our clinical research studies in thyroid carcinoma and pheochromocytoma patients.


   Footnotes
 
This work was presented in part at the 84th Annual Meeting of The Endocrine Society, San Francisco, California, June 2002.

L.G. and N.J.S. contributed equally to this work.

Abbreviations: CEA, Carcinoembryonic antigen; CT, computed tomography; DTPA, 111In-diethylenetriamine-pentacetic acid; MEN, multiple endocrine neoplasia; MIBG, 123I-meta-iodobenzylguanidine; MRI, magnetic resonance imaging; MTC, medullary thyroid cancer; NR, normal range; PET, positron emission tomography; U/S, ultrasonography.

Received August 26, 2002.

Accepted November 7, 2002.


   References
Top
 Abstract
 Introduction
 Case Report
 Discussion
 References
 

  1. Goldstein DS, Chang PC, Eisenhofer G, Miletich R, Finn R, Bacher J, Kirk KL, Bacharach S, Kopin IJ 1990 Positron emission tomographic imaging of cardiac sympathetic innervation and function. Circulation 81:1606–1621[Abstract/Free Full Text]
  2. Pacak K, Eisenhofer G, Carrasquillo JA, Chen CC, Li ST, Goldstein DS 2001 6-[18F]fluorodopamine positron emission tomographic (PET) scanning for diagnostic localization of pheochromocytoma. Hypertension 38:6–8[Abstract/Free Full Text]
  3. Pacak K, Goldstein DS, Doppman JL, Shulkin BL, Udelsman R, Eisenhofer G 2001 A "pheo" lurks: novel approaches for locating occult pheochromocytoma. J Clin Endocrinol Metab 86:3641–3646[Abstract/Free Full Text]
  4. Moley JF 1995 Medullary thyroid cancer. Surg Clin North Am 75:405–420[Medline]
  5. Chi DD, Moley JF 1998 Medullary thyroid carcinoma: genetic advances, treatment recommendations, and the approach to the patient with persistent hypercalcitoninemia. Surg Oncol Clin North Am 7:681–706[Medline]
  6. Ball DW, Baylin SB, de Bustros AC 1996 Medullary thyroid carcinoma. In: Braverman LE, Utiger RD, eds. Werner and Ingbar’s the thyroid, ed 7. Philadelphia: Lippincott Raven; 946–960
  7. Lewington VJ, Clarke SE 2001 Isotopic evaluation and therapy in patients with malignant endocrine disease. Best Pract Res Clin Endocrinol Metab 15:225–239[CrossRef][Medline]
  8. Bombardieri E, Maccauro M, De Deckere E, Savelli G, Chiti A 2001 Nuclear medicine imaging of neuroendocrine tumours. Ann Oncol 12:S51–S61
  9. Sisson JC, Shulkin BL 1999 Nuclear medicine imaging of pheochromocytoma and neuroblastoma. Q J Nucl Med 43:217–223[Medline]
  10. Rubello D, Bui C, Casara D, Gross MD, Fig LM, Shapiro B 2002 Functional scintigraphy of the adrenal gland. Eur J Endocrinol 147:13–28[Abstract]
  11. Behr TM, Gotthardt M, Barth A, Behe M 2001 Imaging tumors with peptide-based radioligands. Q J Nucl Med 45:189–200[Medline]
  12. Arslan N, Ilgan S, Yuksel D, Serdengecti M, Bulakbasi N, Ugur O, Ozguven MA 2001 Comparison of In-111 octreotide and Tc-99m (V) DMSA scintigraphy in the detection of medullary thyroid tumor foci in patients with elevated levels of tumor markers after surgery. Clin Nucl Med 26:683–688[CrossRef][Medline]
  13. Berna L, Cabezas R, Mora J, Torres G, Estorch M, Carrio I 1995 111In-octreotide and 99mTc(V)-dimercaptosuccinic acid studies in the imaging of recurrent medullary thyroid carcinoma. J Endocrinol 144:339–345[Abstract/Free Full Text]
  14. Krausz Y, Rosler A, Guttmann H, Ish-Shalom S, Shibley N, Chisin R, Glaser B 1999 Somatostatin receptor scintigraphy for early detection of regional and distant metastases of medullary carcinoma of the thyroid. Clin Nucl Med 24:256–260[CrossRef][Medline]
  15. Limouris GS, Giannakopoulos V, Stavraka A, Toubanakis N, Vlahos L 1997 Comparison of In-111 pentetreotide, Tc-99m (V)-DMSA and I-123 MlBG scintimaging in neural crest tumors. Anticancer Res 17:1589–1592[Medline]
  16. Ugur O, Kostakglu L, Güler N, Caner B, Uysal U, Elahi N, Halilioglu M, Yuksel D, Aras T, Bayhan H, Bekdik C 1996 Comparison of 99mTc(V)-DMSA, 201Tl and 99mTc-MIBI imaging in the follow-up of patients with medullary carcinoma of the thyroid. Eur J Nucl Med 23:1367–1371[CrossRef][Medline]
  17. Diehl M, Risse JH, Brandt-Mainz K, Dietlein M, Bohuslavizki KH, Matheja P, Lange H, Bredow J, Korber C, Grunwald F 2001 Fluorine-18 fluorodeoxyglucose positron emission tomography in medullary thyroid cancer: results of a multicentre study. Eur J Nucl Med 28:1671–1676[CrossRef][Medline]
  18. Thomas CC, Cowan RJ, Albertson DA, Cooper MR 1994 Detection of medullary carcinoma of the thyroid with I-131 MIBG. Clin Nucl Med 19:1066–1068[Medline]
  19. Reiners C, Eilles C, Spiegel W, Becker W, Borner W 1986 Immunoscintigraphy in medullary thyroid cancer using an 123I- or 111In-labelled monoclonal anti-CEA antibody fragment. Nuklearmedizin 25:227–231[Medline]
  20. Manil L, Boudet F, Motte P, Gardet P, Saccavini JC, Lumbroso JD, Schlumberger M, Caillou B, Bazin JP, Ricard M, Bellet D, Bohuon C, Tubiana M, Di Paola R, Parmentier C 1989 Positive anticalcitonin immunoscintigraphy in patients with medullary thyroid carcinoma. Cancer Res 49:5480–5485[Abstract/Free Full Text]
  21. Glowniak JV, Kilty JE, Amara SG, Hoffman BJ, Turner FE 1993 Evaluation of metaiodobenzylguanidine uptake by the norepinephrine, dopamine and serotonin transporters. J Nucl Med 34:1140–1146[Abstract/Free Full Text]
  22. Chatal JF, Le Bodic MF, Kraeber-Bodere F, Rousseau C, Resche I 2000 Nuclear medicine applications for neuroendocrine tumors. World J Surg 24:1285–1289[CrossRef]
  23. Oishi S, Sasaki M, Sato T, Hirota Y, Takahashi M 1986 Imaging and uptake mechanism of 131I-meta-iodobenzylguanidine in medullary thyroid carcinoma. Endocrinol Jpn 33:309–315[Medline]



This article has been cited by other articles:


Home page
 Am. J. Neuroradiol.Home page
S.L. Kaplan, S.J. Mandel, R. Muller, Z.W. Baloch, E.R. Thaler, and L.A. Loevner
The Role of MR Imaging in Detecting Nodal Disease in Thyroidectomy Patients with Rising Thyroglobulin Levels
AJNR Am. J. Neuroradiol., March 1, 2009; 30(3): 608 - 612.
[Abstract] [Full Text] [PDF]

Home page
 JNMHome page
K. P. Koopmans, J. W. B. de Groot, J. T.M. Plukker, E. G.E. de Vries, I. P. Kema, W. J. Sluiter, P. L. Jager, and T. P. Links
18F-Dihydroxyphenylalanine PET in Patients with Biochemical Evidence of Medullary Thyroid Cancer: Relation to Tumor Differentiation
J. Nucl. Med., April 1, 2008; 49(4): 524 - 531.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
A. L. Giraudet, D. Vanel, S. Leboulleux, A. Auperin, C. Dromain, L. Chami, N. Ny Tovo, J. Lumbroso, N. Lassau, G. Bonniaud, et al.
Imaging Medullary Thyroid Carcinoma with Persistent Elevated Calcitonin Levels
J. Clin. Endocrinol. Metab., November 1, 2007; 92(11): 4185 - 4190.
[Abstract] [Full Text] [PDF]

Home page
 JNMHome page
C. Nanni, S. Fanti, and D. Rubello
18F-DOPA PET and PET/CT
J. Nucl. Med., October 1, 2007; 48(10): 1577 - 1579.
[Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
K. Pacak, I. Ilias, C. C. Chen, J. A. Carrasquillo, M. Whatley, and L. K. Nieman
The Role of [18F]Fluorodeoxyglucose Positron Emission Tomography and [111In]-Diethylenetriaminepentaacetate-D-Phe-Pentetreotide Scintigraphy in the Localization of Ectopic Adrenocorticotropin-Secreting Tumors Causing Cushing's Syndrome
J. Clin. Endocrinol. Metab., May 1, 2004; 89(5): 2214 - 2221.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
I. Ilias and K. Pacak
Current Approaches and Recommended Algorithm for the Diagnostic Localization of Pheochromocytoma
J. Clin. Endocrinol. Metab., February 1, 2004; 89(2): 479 - 491.
[Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
W. M. Manger
In Search of Pheochromocytomas
J. Clin. Endocrinol. Metab., September 1, 2003; 88(9): 4080 - 4082.
[Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a related Letter to the Editor
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Copyright Permission
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gourgiotis, L.
Right arrow Articles by Pacak, K.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Gourgiotis, L.
Right arrow Articles by Pacak, K.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Endocrinology Endocrine Reviews J. Clin. End. & Metab.
Molecular Endocrinology Recent Prog. Horm. Res. All Endocrine Journals