Performances of Functional and Anatomic Imaging Modalities in Succinate Dehydrogenase A- Related Metastatic Pheochromocytoma and Paraganglioma

Mayank Patel; Abhishek Jha; Alexander Ling; Clara C Chen; Corina Millo; Mickey J M Kuo; Matthew A Nazari; Sara Talvacchio; Kailah Charles; Markku Miettinen; Jaydira Del Rivero; Alice P Chen; Naris Nilubol; Frank I Lin; Ali Cahid Civelek; David Taïeb; Jorge A Carrasquillo; Karel Pacak

doi:10.3390/cancers14163886

Performances of Functional and Anatomic Imaging Modalities in Succinate Dehydrogenase A- Related Metastatic Pheochromocytoma and Paraganglioma

Cancers (Basel). 2022 Aug 11;14(16):3886. doi: 10.3390/cancers14163886.

Authors

Mayank Patel¹, Abhishek Jha¹, Alexander Ling², Clara C Chen³, Corina Millo⁴, Mickey J M Kuo^{1

5}, Matthew A Nazari¹, Sara Talvacchio¹, Kailah Charles¹, Markku Miettinen⁶, Jaydira Del Rivero⁷, Alice P Chen⁸, Naris Nilubol⁹, Frank I Lin¹⁰, Ali Cahid Civelek¹¹, David Taïeb¹², Jorge A Carrasquillo^{10

13}, Karel Pacak¹

Affiliations

¹ Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20814, USA.
² Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20814, USA.
³ Nuclear Medicine Department, Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20814, USA.
⁴ Positron Emission Tomography Department, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20814, USA.
⁵ Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
⁶ Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD 20814, USA.
⁷ Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
⁸ Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
⁹ Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
¹⁰ Targeted Radionuclide Therapy Section, Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
¹¹ Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, MD 21287, USA.
¹² Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, 13273 Marseille, France.
¹³ Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.

Abstract

The study identifies the importance of positron emission tomographic (PET) and anatomic imaging modalities and their individual performances in detecting succinate dehydrogenase A (SDHA)-related metastatic pheochromocytoma and paraganglioma (PPGL). The detection rates of PET modalities-⁶⁸Ga-DOTATATE, ¹⁸F-FDG, and ¹⁸F-FDOPA-along with the combination of computed tomography (CT) and magnetic resonance imaging (MRI) are compared in a cohort of 11 patients with metastatic PPGL in the setting of a germline SDHA mutation. The imaging detection performances were evaluated at three levels: overall lesions, anatomic regions, and a patient-by-patient basis. ⁶⁸Ga-DOTATATE PET demonstrated a lesion-based detection rate of 88.6% [95% confidence interval (CI), 84.3-92.5%], while ¹⁸F-FDG, ¹⁸F-FDOPA, and CT/MRI showed detection rates of 82.9% (CI, 78.0-87.1%), 39.8% (CI, 30.2-50.2%), and 58.2% (CI, 52.0-64.1%), respectively. The study found that ⁶⁸Ga-DOTATATE best detects lesions in a subset of patients with SDHA-related metastatic PPGL. However, ¹⁸F-FDG did detect more lesions in the liver, mediastinum, and abdomen/pelvis anatomic regions, showing the importance of a combined approach using both PET modalities in evaluating SDHA-related PPGL.

Keywords: 18F-FDG; 68Ga-DOTATATE; CT; MRI; PET; SDHA; metastatic; paraganglioma; pheochromocytoma.

Abstract

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