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Prospective evaluation of 68Ga-DOTANOC positron emission tomography/computed tomography and 131I-meta-iodobenzylguanidine single-photon emission computed tomography/computed tomography in extra-adrenal paragangliomas, including uncommon primary sites and to define their diagnostic roles in current scenario

Arora, Saurabha; Kumar, Rakesha; Passah, Averiliciaa; Tripathi, Madhavia; Agarwala, Sandeepb; Khadgawat, Rajeshc; Bal, Chandrasekhara

doi: 10.1097/MNM.0000000000001096
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Aim To evaluate 68Ga-DOTANOC positron emission tomography/computed tomography (PET/CT) and 131I-meta-iodobenzylguanidine single-photon emission computed tomography/computed tomography (131I-MIBG SPECT/CT) in patients with paragangliomas, including uncommon primaries.

Methods Ninety patients were prospectively enrolled, and both scans were done within 2 weeks of each other. Lesions were grouped as Head/neck, abdominal, uncommon primary paraganglioma, and metastatic lesions. In most histopathology was used as reference standard.

Results PET/CT had sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 97%, 94%, 99%,88%,97% respectively on patient wise analysis (90) and 98%, 94%, 99%, 85% and 97% respectively on lesion wise analysis (149). Comparison with MIBG SPECT/CT: Significant difference in sensitivities noted (PET/CT-98%, I-131 MIBG -39%) (P < 0.001), however, no significant difference in specificities (94% and 100%, respectively). Group-wise analysis: Head/Neck: Significant difference noted between PET/CT (sensitivity 100%) and I-131 MIBG SPECT/CT (sensitivity 22%) (P = 0.001). Abdominal: No significant difference noted in sensitivities and specificities of PET/CT and I-131 MIBG SPECT/CT. Uncommon paraganglioma: PET/CT detected 10 of 11, while I-131 MIBG detected only 2 of 11 uncommon paraganglioma. Metastatic sites: Significant difference noted between PET/CT (sensitivity 97%) and I-131 MIBG SPECT/CT (sensitivity 33%) (P < 0.0001).

Conclusion The study demonstrates high diagnostic accuracy of 68Ga-DOTANOC PET/CT and superiority over 131I MIBG SPECT/CT for evaluation of extra-adrenal paraganglioma. The current diagnostic role of I-131 MIBG seems limited to abdominal paragangliomas and for theranostic purpose.

aDepartment of Nuclear Medicine

bDepartment of Paediatric surgery

cDepartment of Endocrinology and metabolism, All India Institute of Medical Sciences, New Delhi, India

Received 4 July 2019 Accepted 2 September 2019

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Correspondence to Rakesh Kumar, MD, PhD, Division of Diagnostic Nuclear Medicine, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, India, Tel: +91 11 26594472; fax: +91 11 26588500; e-mail: rkphulia@hotmail.com

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