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

Abhishek Jha; Alexander Ling; Corina Millo; Garima Gupta; Bruna Viana; Frank I Lin; Peter Herscovitch; Karen T Adams; David Taïeb; Adam R Metwalli; W Marston Linehan; Alessandra Brofferio; Constantine A Stratakis; Electron Kebebew; Maya Lodish; Ali Cahid Civelek; Karel Pacak

doi:10.1007/s00259-017-3896-9

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

Eur J Nucl Med Mol Imaging. 2018 May;45(5):787-797. doi: 10.1007/s00259-017-3896-9. Epub 2017 Dec 4.

Authors

Abhishek Jha¹, Alexander Ling², Corina Millo³, Garima Gupta¹, Bruna Viana¹, Frank I Lin⁴, Peter Herscovitch³, Karen T Adams¹, David Taïeb⁵, Adam R Metwalli⁶, W Marston Linehan⁶, Alessandra Brofferio⁷, Constantine A Stratakis⁸, Electron Kebebew⁹, Maya Lodish⁸, Ali Cahid Civelek¹⁰, Karel Pacak¹¹

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.
¹¹ 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. karel@mail.nih.gov.

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, girls:boys; 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 nine 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.

Keywords: 68Ga-DOTATATE; FDG; PET/CT; Paraganglioma; Pediatric; Pheochromocytoma.

MeSH terms

Adolescent
Child
Female
Fluorodeoxyglucose F18
Humans
Male
Mutation*
Organometallic Compounds*
Paraganglioma / diagnostic imaging
Paraganglioma / genetics*
Pheochromocytoma / diagnostic imaging
Pheochromocytoma / genetics*
Positron Emission Tomography Computed Tomography*
Positron-Emission Tomography
Retrospective Studies
Succinate Dehydrogenase / genetics*
Tomography, X-Ray Computed

Substances

Organometallic Compounds
Fluorodeoxyglucose F18
gallium Ga 68 dotatate
Succinate Dehydrogenase

Abstract

MeSH terms

Substances

Grants and funding