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

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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, females:males; 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 9 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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Author and article information

Journal

Journal ID (nlm-journal-id): 101140988

Journal ID (pubmed-jr-id): 27055

Journal ID (nlm-ta): Eur J Nucl Med Mol Imaging

Journal ID (iso-abbrev): Eur. J. Nucl. Med. Mol. Imaging

Title: European journal of nuclear medicine and molecular imaging

ISSN (Print): 1619-7070

ISSN (Electronic): 1619-7089

Publication date Nihms-submitted: 5 August 2019

Publication date (Electronic): 04 December 2017

Publication date (Print): May 2018

Publication date PMC-release: 23 August 2019

Volume: 45

Issue: 5

Pages: 787-797

Affiliations

[1 ]Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Dr., Bldg. 10, Room 1E-3140, Bethesda, MD, 20892, USA

[2 ]Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, 10 Center Dr., Bldg. 10, Bethesda, MD, 20892, USA

[3 ]Positron Emission Tomography Department, Warren Grant Magnuson Clinical Center, National Institutes of Health, 10 Center Dr., Bldg. 10, Room 1C-401 and 490, Bethesda, MD, 20892, USA

[4 ]Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr., Bldg. 10, Room B3B69F, Bethesda, MD, 20892, USA

[5 ]Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, Marseille, France

[6 ]Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bldg. 10, Room 2 W-5940 and Room 1-5940, 10 Center Drive, Bethesda, MD, 20892, USA

[7 ]Cardiovascular & Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr., Bldg. 10, Room 5-3130, Bethesda, MD, 20892, USA

[8 ]Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Dr., Bldg. 31, Room 2A46 and Bldg. 10, Room 2-5142, Bethesda, MD, 20892, USA

[9 ]Endocrine Oncology Branch, Center for Cancer Research, National Cancer Institute, 10 Center Dr., Bldg. 10, Room 4-5952, Bethesda, MD, 20892, USA

[10 ]Nuclear Medicine Division, Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, 10 Center Dr., Bldg. 10, Room 1C-455, Bethesda, MD, 20892, USA

Author notes

[*]

Ali Cahid Civelek and Karel Pacak equally share the senior authorship.

Corresponding author and request for reprints: Karel Pacak, M.D., Ph.D., D.Sc., FACE, Chief, Section on Medical Neuroendocrinology, Professor of Medicine, Eunice Kennedy Shriver NICHD, NIH, Building 10, CRC, 1E-3140, 10 Center Drive, MSC-1109, Bethesda, Maryland 20892-1109, karel@ 123456mail.nih.gov , Fax: 1-301-402-0884, Phone: 1-301-402-4594

Article

Accession ID: PMC6707509 Pmcid ID: PMC6707509 Pmc-uid ID: 6707509 Manuscript ID: nihpa1044792

DOI: 10.1007/s00259-017-3896-9

PMC ID: 6707509

PubMed ID: 29204718

SO-VID: bedc33c4-b8fb-4435-a6dd-82c218b4e107

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