DOI: 10.1007/s00259-017-3896-9Pages: 1-11

Superiority of 68Ga-DOTATATE over 18F-FDG and anatomic imaging in the detection of succinate dehydrogenase mutation (SDHx)-related pheochromocytoma and paraganglioma in the pediatric population

1. National Institutes of Health, Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development

2. National Institutes of Health, Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center

3. National Institutes of Health, Positron Emission Tomography Department, Warren Grant Magnuson Clinical Center

4. National Institutes of Health, Molecular Imaging Program, National Cancer Institute

5. La Timone University Hospital, CERIMED, Aix-Marseille University, Department of Nuclear Medicine

6. National Institutes of Health, Urologic Oncology Branch, National Cancer Institute

7. National Institutes of Health, Cardiovascular & Pulmonary Branch, National Heart Lung and Blood Institute

8. National Institutes of Health, Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development

9. National Cancer Institute, Endocrine Oncology Branch, Center for Cancer Research

10. National Institutes of Health, Nuclear Medicine Division, Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center

Correspondence to:
Karel Pacak
Tel: 1-301-402-4594
Email: karel@mail.nih.gov

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Abstract

Purpose

To evaluate and compare diagnostic performance of 68Ga-DOTA(0)-Tyr(3)-octreotate (68Ga-DOTATATE) with 18F–fluoro-2-deoxy-D-glucose (18F–FDG) positron emission tomography-computed tomography (PET/CT) and anatomic imaging using computed tomography and/or magnetic resonance (CT/MR) imaging in detection of SDHx-related pheochromocytomas and paragangliomas (PPGLs) in pediatric patients.

Methods

Nine pediatric patients (5:4, girls:boys; 14.6 ± 2.0 years) with an SDHx-related mutation (SDHB:SDHA:SDHD, n = 7:1:1) were included in this retrospective study. At the time of initial diagnosis, 7/9 patients had metastatic disease. They underwent CT/MR imaging along with PET/CT using 68Ga-DOTATATE (n = 9), 18F–FDG (n = 8), and positron emission tomography-magnetic resonance imaging (PET/MR) using 18F–FDG (n = 1). In this manuscript, 18F–FDG PET/CT refers to both 18F–FDG PET/CT and 18F–FDG PET/MR. The per-lesion, per-region, and per-patient detection rates were compared and calculated for each of the imaging modalities. A composite of all functional and anatomic imaging studies served as the imaging comparator.

Results

Eight out of nine patients were positive for PPGLs on the imaging studies that demonstrated 107 lesions in 22 anatomic regions on the imaging comparator. The per-lesion detection rates for 68Ga-DOTATATE PET/CT, 18F–FDG PET/CT, and CT/MR imaging were 93.5% (95%CI, 87.0% to 97.3%); 79.4% (95%CI, 70.5% to 86.6%); and 73.8% (95%CI, 64.5% to 81.9%), respectively. The per-lesion detection rate for 68Ga-DOTATATE PET/CT was significantly higher than that of 18F–FDG PET/CT (p = 0.001) or CT/MR imaging (p < 0.001). In all of the anatomic regions except abdomen, the per-lesion detection rates for 68Ga-DOTATATE PET/CT was found to be equal or superior to 18F–FDG PET/CT, and CT/MR imaging. The per-region detection rate was 100% (95%CI, 84.6% to 100%) for 68Ga-DOTATATE PET/CT and 90.9% (95%CI, 70.8% to 98.9%) for both 18F–FDG PET/CT and CT/MR imaging. The per-patient detection rates for 68Ga-DOTATATE PET/CT, 18FDG PET/CT, and CT/MR imaging were all 100% (95%CI, 63.1% to 100%).

Conclusion

Our preliminary study demonstrates the superiority of 68Ga-DOTATATE PET/CT in localization of SDHx-related PPGLs in pediatric population compared to 18F–FDG PET/CT and CT/MR imaging with the exception of abdominal (excluding adrenal and liver) lesions, and suggests that it might be considered as a first-line imaging modality in pediatric patients with SDHx-related PPGLs.

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  • Accepted: Nov 21, 2017
  • Online: Dec 4, 2017

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