Diagnostic performance of [68Ga]DOTATATE PET/CT, [18F]FDG PET/CT, MRI of the spine, and whole-body diagnostic CT and MRI in the detection of spinal bone metastases associated with pheochromocytoma and paraganglioma

Abhishek Jha; Mayank Patel; Alexander Ling; Ritu Shah; Clara C Chen; Corina Millo; Matthew A Nazari; Ninet Sinaii; Kailah Charles; Mickey J M Kuo; Tamara Prodanov; Babak Saboury; Sara Talvacchio; Alberta Derkyi; Jaydira Del Rivero; Geraldine O'Sullivan Coyne; Alice P Chen; Naris Nilubol; Peter Herscovitch; Frank I Lin; David Taieb; A Cahid Civelek; Jorge A Carrasquillo; Karel Pacak

doi:10.1007/s00330-024-10652-4

Diagnostic performance of [⁶⁸Ga]DOTATATE PET/CT, [¹⁸F]FDG PET/CT, MRI of the spine, and whole-body diagnostic CT and MRI in the detection of spinal bone metastases associated with pheochromocytoma and paraganglioma

Eur Radiol. 2024 Oct;34(10):6488-6498. doi: 10.1007/s00330-024-10652-4. Epub 2024 Apr 16.

Authors

Abhishek Jha¹, Mayank Patel¹, Alexander Ling², Ritu Shah², Clara C Chen³, Corina Millo⁴, Matthew A Nazari¹, Ninet Sinaii⁵, Kailah Charles¹, Mickey J M Kuo^{1

6}, Tamara Prodanov¹, Babak Saboury³, Sara Talvacchio¹, Alberta Derkyi¹, Jaydira Del Rivero⁷, Geraldine O'Sullivan Coyne⁸, Alice P Chen⁸, Naris Nilubol⁹, Peter Herscovitch⁴, Frank I Lin¹⁰, David Taieb¹¹, A Cahid Civelek¹², Jorge A Carrasquillo¹⁰, Karel Pacak¹³

Affiliations

¹ Section On Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Room 1E-3140, CRC, Bldg. 10, 10 Center Dr. MSC-1109, Bethesda, MD, 20892-1109, USA.
² Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bldg. 10, 10 Center Dr., Bethesda, MD, 20892, USA.
³ Nuclear Medicine Division, Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bldg. 10, 10 Center Dr., Bethesda, MD, 20892, USA.
⁴ Positron Emission Tomography Department, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bldg. 10, 10 Center Dr., Bethesda, MD, 20892, USA.
⁵ Biostatistics and Clinical Epidemiology Service, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bldg. 10, 10 Center Dr., Bethesda, MD, 20892, USA.
⁶ Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
⁷ Developmental Therapeutics Branch, National Cancer Institute, National Institutes of Health, Room 13C434, Bldg. 10, 10 Center Dr., Bethesda, MD, 20892, USA.
⁸ Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Room 8D53, Bldg. 10, 10 Center Dr., Bethesda, MD, 20892, USA.
⁹ Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, Room 4-5952, Bldg. 10, 10 Center Dr., Bethesda, MD, 20892, USA.
¹⁰ Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Room 13C442, Bldg. 10, 10 Center Dr., Bethesda, MD, 20892, USA.
¹¹ Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, Marseille, France.
¹² Nuclear Medicine, Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, MD, USA.
¹³ Section On Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Room 1E-3140, CRC, Bldg. 10, 10 Center Dr. MSC-1109, Bethesda, MD, 20892-1109, USA. [email protected].

Abstract

Objective: To compare the diagnostic performance of [⁶⁸Ga]DOTATATE PET/CT, [¹⁸F]FDG PET/CT, MRI of the spine, and whole-body CT and MRI for the detection of pheochromocytoma/paraganglioma (PPGL)-related spinal bone metastases.

Materials and methods: Between 2014 and 2020, PPGL participants with spinal bone metastases prospectively underwent [⁶⁸Ga]DOTATATE PET/CT, [¹⁸F]FDG PET/CT, MRI of the cervical-thoracolumbar spine (MRI_spine), contrast-enhanced MRI of the neck and thoraco-abdominopelvic regions (MRI_WB), and contrast-enhanced CT of the neck and thoraco-abdominopelvic regions (CT_WB). Per-patient and per-lesion detection rates were calculated. Counting of spinal bone metastases was limited to a maximum of one lesion per vertebrae. A composite of all functional and anatomic imaging served as an imaging comparator. The McNemar test compared detection rates between the scans. Two-sided p values were reported.

Results: Forty-three consecutive participants (mean age, 41.7 ± 15.7 years; females, 22) with MRI_spine were included who also underwent [⁶⁸Ga]DOTATATE PET/CT (n = 43), [¹⁸F]FDG PET/CT (n = 43), MRI_WB (n = 24), and CT_WB (n = 33). Forty-one of 43 participants were positive for spinal bone metastases, with 382 lesions on the imaging comparator. [⁶⁸Ga]DOTATATE PET/CT demonstrated a per-lesion detection rate of 377/382 (98.7%) which was superior compared to [¹⁸F]FDG (72.0%, 275/382, p < 0.001), MRI_spine (80.6%, 308/382, p < 0.001), MRI_WB (55.3%, 136/246, p < 0.001), and CT_WB (44.8%, 132/295, p < 0.001). The per-patient detection rate of [⁶⁸Ga]DOTATATE PET/CT was 41/41 (100%) which was higher compared to [¹⁸F]FDG PET/CT (90.2%, 37/41, p = 0.13), MRI_spine (97.6%, 40/41, p = 1.00), MRI_WB (95.7%, 22/23, p = 1.00), and CT_WB (81.8%, 27/33, p = 0.03).

Conclusions: [⁶⁸Ga]DOTATATE PET/CT should be the modality of choice in PPGL-related spinal bone metastases due to its superior detection rate.

Clinical relevance statement: In a prospective study of 43 pheochromocytoma/paraganglioma participants with spinal bone metastases, [⁶⁸Ga]DOTATATE PET/CT had a superior per-lesion detection rate of 98.7% (377/382), compared to [¹⁸F]FDG PET/CT (p < 0.001), MRI of the spine (p < 0.001), whole-body CT (p < 0.001), and whole-body MRI (p < 0.001).

Key points: • Data regarding head-to-head comparison between functional and anatomic imaging modalities to detect spinal bone metastases in pheochromocytoma/paraganglioma are limited. • [⁶⁸Ga]DOTATATE PET/CT had a superior per-lesion detection rate of 98.7% in the detection of spinal bone metastases associated with pheochromocytoma/paraganglioma compared to other imaging modalities: [¹⁸]F-FDG PET/CT, MRI of the spine, whole-body CT, and whole-body MRI. • [⁶⁸Ga]DOTATATE PET/CT should be the modality of choice in the evaluation of spinal bone metastases associated with pheochromocytoma/paraganglioma.

Keywords: Fluorodeoxyglucose F18; Gallium GA 68 DOTATATE; Neuroendocrine tumors; Paraganglioma; Pheochromocytoma.

Publication types

Comparative Study

MeSH terms

Adrenal Gland Neoplasms* / diagnostic imaging
Adrenal Gland Neoplasms* / secondary
Adult
Aged
Female
Fluorodeoxyglucose F18*
Humans
Magnetic Resonance Imaging* / methods
Male
Middle Aged
Organometallic Compounds*
Paraganglioma* / diagnostic imaging
Paraganglioma* / secondary
Pheochromocytoma* / diagnostic imaging
Pheochromocytoma* / secondary
Positron Emission Tomography Computed Tomography* / methods
Prospective Studies
Radiopharmaceuticals*
Spinal Neoplasms* / diagnostic imaging
Spinal Neoplasms* / secondary
Tomography, X-Ray Computed / methods
Whole Body Imaging* / methods

Substances

Fluorodeoxyglucose F18
Organometallic Compounds
gallium Ga 68 dotatate
Radiopharmaceuticals