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Role of 18F-DOPA PET/CT in Diagnosis and Follow-up of Adrenal and Extra-adrenal Paragangliomas

Bacca, Alessandra MD*; Chiacchio, Serena MD; Zampa, Virna MD; Carrara, Davide MD*; Duce, Valerio MD; Congregati, Caterina MD§; Simi, Paolo MS Biology§; Taddei, Stefano MD*; Materazzi, Gabriele MD; Volterrani, Duccio MD; Mariani, Giuliano MD; Bernini, Giampaolo MD*

doi: 10.1097/RLU.0000000000000242
Original Articles

Purpose The objective of this study was to establish the clinical value of 18F-DOPA PET/CT in patients with adrenal and extra-adrenal paragangliomas (PGLs).

Methods Twenty-six consecutive patients with suspected or recurrent PGL underwent MR (and/or CT) and 18F-DOPA PET/CT. Histopathology confirmation was obtained in 20 cases. Genetic analysis on known susceptibility genes for PGL (VHL, RET, SDHx, TMEM127) was available in 13 patients.

Results Fourteen patients were affected by PGL (8 with head/neck location, 6 with abdominal/thoracic location), whereas 12 showed masses of other origin. Three patients proved to be SDHD, 1 SDHB, 2 SDHC, and 1 TMEM127 mutation carriers. 18F-DOPA PET/CT showed pathological uptake in 13 of 26 patients. The procedure identified all PGLs except one with bone metastases (previous malignant adrenal PGL). No uptake was found in patients without proven PGL. Thus, in the whole group, 18F-DOPA PET/CT sensitivity was 92.8%, and specificity was 100% with positive and negative predictive values of 100% and 92.3%, respectively. Total diagnostic accuracy was 96.2%. In the head/neck subgroup, sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were 100%. In the abdominal location, sensitivity was 80% and specificity was 100%, and positive and negative predictive values were 100% and 91.7%, respectively. Abdominal diagnostic accuracy was 93.7%. Radiotracer uptake was superimposable in head/neck PGLs versus abdominal PGLs and in mutated versus wild-type patients.

Conclusions The high diagnostic performance of 18F-DOPA PET/CT showed this technique to be a useful tool in detecting PGLs, above all those located at the head/neck site, regardless of the genetic pattern.

From the *Department of Clinical and Experimental Medicine and †Regional Center of Nuclear Medicine, University of Pisa; ‡Department of Radiodiagnostic, Vascular, and Interventional Radiology and Nuclear Medicine and §Medical Genetics Laboratory, Department of Medical Laboratories, University Hospital of Pisa; and ¶Department of Surgical, Molecular, Clinical Pathology and of Critical Care, University of Pisa, Pisa, Italy

Received for publication March 18, 2013; revision accepted August 26, 2013.

Conflicts of interest and sources of funding: none declared.

Reprints: Giampaolo Bernini, MD, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy. E-mail:

© 2014 by Lippincott Williams & Wilkins