Positron Emission Tomography Imaging of Pheochromocytoma and Paraganglioma— ¹⁸F-FDOPA vs Somatostatin Analogues

TY - JOUR

T1 - Positron Emission Tomography Imaging of Pheochromocytoma and Paraganglioma— 18F-FDOPA vs Somatostatin Analogues

AU - Ebbehoj, Andreas

AU - Iversen, Peter

AU - Kramer, Stine

AU - Stochholm, Kirstine

AU - Poulsen, Per Løgstrup

AU - Hjorthaug, Karin

AU - Søndergaard, Esben

N1 - © The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected]. See the journal About page for additional terms.

PY - 2025/2/1

Y1 - 2025/2/1

N2 - Context: Functional imaging with positron emission tomography (PET) scans is an essential part of the diagnostic workup for pheochromocytoma and paraganglioma (PPGL). The purpose of this review is to (1) provide a brief overview of functional imaging for PPGL, (2) summarize selected present and older guideline and review recommendations, and (3) conduct a literature review on the diagnostic performance of the most used PET tracers for PPGL. Evidence Acquisition: We conducted a systematic literature search in PubMed from January 2004 to August 2024 with the search string (“Pheochromocytoma” OR “Paraganglioma”) AND (“Positron Emission Tomography” OR “Radionuclide Imaging” OR (“PET” AND (“FDG” OR “DOTATOC” OR “DOTANOC” OR “DOTATATE” OR “DOPA” OR “FDOPA”))). Studies involving PET scans of at least 20 individuals with PPGL or at least 5 individuals in a rare, well-defined subgroup of PPGL (eg, sympathetic or head-neck paragangliomas and specific pathogenic variants) were included. Evidence Synthesis: Seventy studies were identified of which 21 were head-to-head comparisons of at least 2 different PET tracers [ 18F-fluorodihydroxyphenylalanine, fluorodihydroxyphenylalanine positron emission tomography ( 18F-FDOPA), 68Ga-DOTA-conjugated somatostatin analogues, 68Ga-DOTA-conjugated somatostatin analogue positron emission tomography ( 68Ga-SSA), and 18F-fluorodeoxyglucose]. 18F-FDOPA had higher sensitivity for pheochromocytoma compared to 68Ga-SSA and equal sensitivity for metastatic pheochromocytoma. 18F-FDOPA and 68Ga-SSA had similar sensitivity for primary non-succinate dehydrogenase subunits (SDHx) sympathetic and head-neck paraganglioma. However, 68Ga-SSA had higher sensitivity for metastatic sympathetic and head-neck paraganglioma and for SDHx-related paraganglioma. Conclusion: 18F-FDOPA and 68Ga-SSA PET are both sensitive for localizing PPGL. However, 18F-FDOPA is the most sensitive for detecting pheochromocytoma, while 68Ga-SSA is superior to 18F-FDOPA for metastatic sympathetic and head-neck paraganglioma and SDHx-related paraganglioma.

AB - Context: Functional imaging with positron emission tomography (PET) scans is an essential part of the diagnostic workup for pheochromocytoma and paraganglioma (PPGL). The purpose of this review is to (1) provide a brief overview of functional imaging for PPGL, (2) summarize selected present and older guideline and review recommendations, and (3) conduct a literature review on the diagnostic performance of the most used PET tracers for PPGL. Evidence Acquisition: We conducted a systematic literature search in PubMed from January 2004 to August 2024 with the search string (“Pheochromocytoma” OR “Paraganglioma”) AND (“Positron Emission Tomography” OR “Radionuclide Imaging” OR (“PET” AND (“FDG” OR “DOTATOC” OR “DOTANOC” OR “DOTATATE” OR “DOPA” OR “FDOPA”))). Studies involving PET scans of at least 20 individuals with PPGL or at least 5 individuals in a rare, well-defined subgroup of PPGL (eg, sympathetic or head-neck paragangliomas and specific pathogenic variants) were included. Evidence Synthesis: Seventy studies were identified of which 21 were head-to-head comparisons of at least 2 different PET tracers [ 18F-fluorodihydroxyphenylalanine, fluorodihydroxyphenylalanine positron emission tomography ( 18F-FDOPA), 68Ga-DOTA-conjugated somatostatin analogues, 68Ga-DOTA-conjugated somatostatin analogue positron emission tomography ( 68Ga-SSA), and 18F-fluorodeoxyglucose]. 18F-FDOPA had higher sensitivity for pheochromocytoma compared to 68Ga-SSA and equal sensitivity for metastatic pheochromocytoma. 18F-FDOPA and 68Ga-SSA had similar sensitivity for primary non-succinate dehydrogenase subunits (SDHx) sympathetic and head-neck paraganglioma. However, 68Ga-SSA had higher sensitivity for metastatic sympathetic and head-neck paraganglioma and for SDHx-related paraganglioma. Conclusion: 18F-FDOPA and 68Ga-SSA PET are both sensitive for localizing PPGL. However, 18F-FDOPA is the most sensitive for detecting pheochromocytoma, while 68Ga-SSA is superior to 18F-FDOPA for metastatic sympathetic and head-neck paraganglioma and SDHx-related paraganglioma.

KW - pheochromocytoma

KW - paraganglioma

KW - review

KW - positron emission tomography (PET)

KW - positron-emission tomography

KW - Ga-DOTA-conjugated somatostatin analogues

KW - F-fluorodeoxyglucose

KW - F-fluorodihydroxyphenylalanine

UR - http://www.scopus.com/inward/record.url?scp=85216606485&partnerID=8YFLogxK

U2 - 10.1210/clinem/dgae764

DO - 10.1210/clinem/dgae764

M3 - Journal article

C2 - 39468778

SN - 0021-972X

VL - 110

SP - 303

EP - 316

JO - The Journal of clinical endocrinology and metabolism

JF - The Journal of clinical endocrinology and metabolism

IS - 2

ER -