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Kathryn S. King, Clara C. Chen, Dimitrios K. Alexopoulos, Millie A. Whatley, James C. Reynolds, Nicholas Patronas, Alexander Ling, Karen T. Adams, Paraskevi Xekouki, Howard Lando, Constantine A. Stratakis, Karel Pacak, Functional Imaging of SDHx-Related Head and Neck Paragangliomas: Comparison of 18F-Fluorodihydroxyphenylalanine, 18F-Fluorodopamine, 18F-Fluoro-2-Deoxy-d-Glucose PET, 123I-Metaiodobenzylguanidine Scintigraphy, and 111In-Pentetreotide Scintigraphy, The Journal of Clinical Endocrinology & Metabolism, Volume 96, Issue 9, 1 September 2011, Pages 2779–2785, https://doi.org/10.1210/jc.2011-0333
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Abstract
Accurate diagnosis of head and neck paragangliomas is often complicated by biochemical silence and lack of catecholamine-associated symptoms, making accurate anatomical and functional imaging techniques essential to the diagnostic process.
Ten patients (seven SDHD, three SDHB), with a total of 26 head and neck paragangliomas, were evaluated with anatomical and functional imaging. This study compares five different functional imaging techniques [18F-fluorodihydroxyphenylalanine (18F-FDOPA) positron emission tomography (PET), 18F-fluorodopamine (18F-FDA) PET/computed tomography (CT), 18F-fluoro-2-deoxy-d-glucose (18F-FDG) PET/CT, 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy, and 111In-pentetreotide scintigraphy] in the localization of head and neck paragangliomas.
Prospectively 18F-FDOPA PET localized 26 of 26 lesions in the 10 patients, CT/magnetic resonance imaging localized 21 of 26 lesions, 18F-FDG PET/CT localized 20 of 26 lesions, 111In-pentetreotide scintigraphy localized 16 of 25 lesions, 18F-FDA PET/CT localized 12 of 26 lesions, and 123I-MIBG scintigraphy localized eight of 26 lesions. Differences in imaging efficacy related to genetic phenotype, even in the present small sample size, included the negativity of 18F-FDA PET/CT and 123I-MIBG scintigraphy in patients with SDHB mutations and the accuracy of 18F-FDG PET/CT in all patients with SDHD mutations, as compared with the accuracy of 18F-FDG PET/CT in only one patient with an SDHB mutation.
Overall, 18F-FDOPA PET proved to be the most efficacious functional imaging modality in the localization of SDHx-related head and neck paragangliomas and may be a potential first-line functional imaging agent for the localization of these tumors.