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Imperiale A, Berti V. SDH-related head and neck paragangliomas: Unraveling PET radiomics beyond 18F-FDG. Best Pract Res Clin Endocrinol Metab 2024:101926. [PMID: 39191631 DOI: 10.1016/j.beem.2024.101926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
Radiomics revolutionizes medical imaging by providing quantitative analysis that complements traditional qualitative assessments through advanced computational techniques. In this narrative review we have investigated the impact of succinate dehydrogenase (SDH) pathogenic variants on the radiomic profile of 18F-FDG, 18F-DOPA, and 68Ga-DOTA-peptides PET in paragangliomas, focusing on head and neck localizations (HNPGLs). This influence manifests in uptake intensity and textural heterogeneity, revealing a complex radiomic landscape that may reflect specific tumor behaviors and mutation statuses. By combining radiomic analysis with genetic data, we will gain new insights into the relationship between PET imaging features and underlying molecular changes. In the future, we envision an approach integrating macroscopic indices, such as lesion location, size, and SUV, with advanced computer-based algorithms. This comprehensive analysis could facilitate in vivo predictions of SDH pathogenic variants, thereby encouraging genetic testing, and ultimately improving patient outcomes.
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Affiliation(s)
- Alessio Imperiale
- Nuclear Medicine and Molecular Imaging, ICANS, University Hospitals of Strasbourg, University of Strasbourg, Strasbourg, France; IPHC, UMR 7178, CNRS/Unistra, Strasbourg, France.
| | - Valentina Berti
- Nuclear Medicine Unit, Careggi University Hospital, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', Florence University, Florence, Italy.
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Ng Hung Shin PB, Lombardo A, Black K. Retroperitoneal venous malformation mimics paraganglioma on triple imaging modalities. BMJ Case Rep 2024; 17:e258708. [PMID: 38538100 PMCID: PMC10982780 DOI: 10.1136/bcr-2023-258708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Here, we report a case of a woman in her 50s who was referred for an incidentally discovered lesion anterior to the origin of inferior vena cava suspicious for a paraganglioma following a CT scan for vaginal bleeding. A follow-up 68Ga-DOTATATE PET-CT and MRI of the abdomen reinforced the radiological impression of an extra-adrenal paraganglioma (EAP). The EAP was deemed non-functional given normal urine biogenic amine, supine plasma fractionated metanephrines and chromogranin A levels. The mass was resected laparoscopically without perioperative blockade. Histological examination revealed a venous malformation. Extrahepatic abdominal venous malformations are rare and can be indistinguishable from an EAP on imaging preoperatively. Although benign, the lesion nevertheless warrants excision as it is associated with a risk of haemorrhage.
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Affiliation(s)
| | | | - Katherine Black
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
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3
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Kim SJ, Park CY, Kwon H, Kim YH. Evaluation of adrenal masses using 18 F-FDOPA PET/CT in patients suspected with pheochromocytoma. Nucl Med Commun 2024; 45:86-92. [PMID: 37901929 DOI: 10.1097/mnm.0000000000001781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
OBJECTIVE Pheochromocytomas (PHEOs) are chromaffin cell-derived adrenal tumors. 6-[ 18 F]-L-fluoro-L-3, 4-dihydroxyphenylalanine ( 18 F-FDOPA) is a radiotracer taken up in neuroendocrine chromaffin cells via the L-type amino-acid transporter. 18 F-FDOPA is useful in patients with PHEO. However, more information about the use of 18 F-FDOPA PET/CT scan is needed. Thus, the current study investigated various PET parameters on preoperative 18 F-FDOPA PET/CT scan. METHODS The 18 F-FDOPA PET/CT scan findings of 29 patients who underwent adrenalectomy after PET/CT scans were evaluated according to their pathologic diagnosis. Thereafter, the patients were classified under different risk groups which were compared based on the Grading System for Adrenal Pheochromocytoma and Paraganglioma (GAPP). RESULTS In terms of histopathologic results after surgery, 24 patients presented with PHEO. The remaining 5 patients were diagnosed with adrenal cortical adenomas or adrenal medullary hyperplasia. The maximum standardized uptake value, mean standardized uptake value, tumor-to-liver ratio, and tumor-to-contralateral adrenal gland ratio of PHEOs on preoperative 18 F-FDOPA PET/CT scan were higher than those of other tumors. The metabolic tumor volume (MTV) and total lesion uptake of PHEOs in the intermediate-risk group (n = 19) were higher than those in the low-risk group (n = 5). The MTV and total lesion uptake were significantly correlated with the GAPP score. CONCLUSION Preoperative 18 F-FDOPA PET/CT is helpful to identifying PHEOs. In addition, imaging interpretation using the standardized uptake value of the suspected tumor or the tumor-to-liver/contralateral adrenal gland ratio can be effective. The metabolic parameters of PHEOs are positively correlated with the GAPP score.
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Affiliation(s)
- Soo Jeong Kim
- Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine and
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyemi Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Hwan Kim
- Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine and
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Goujon A, Pop G, Hissier J, Moreau B, Palard-Novello X. 18 F-FDOPA PET/CT of Paraganglioma in the Spermatic Cord. Clin Nucl Med 2023; 48:e232-e234. [PMID: 36854289 DOI: 10.1097/rlu.0000000000004616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
ABSTRACT A 53-year-old man with chronic kidney failure was referred to perform an 18 F-FDOPA PET/CT to characterize a mass located on the right spermatic cord. Previously, the pathological analysis of CT-guided biopsies suggested paraganglioma or metastatic lesion of pheochromocytoma. Serum normetanephrine and serum metanephrine values were respectively 2- and 1.5-fold greater than the normal upper limit, which could be explained by the chronic kidney failure. PET/CT images revealed intense 18 F-FDOPA uptake of the mass without any other pathological findings, suggesting the diagnosis of paraganglioma. Pathological examination of surgical specimen confirmed the diagnosis of paraganglioma of the spermatic cord, which is exceptional.
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Affiliation(s)
| | | | | | | | - Xavier Palard-Novello
- Department of Nuclear Medicine, Univ Rennes, CLCC Eugène Marquis, INSERM, Rennes, France
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Marcus C, Subramaniam RM. Paragangliomas and Pheochromocytomas: Positron Emission Tomography/Computed Tomography Diagnosis and Therapy. PET Clin 2023; 18:233-242. [PMID: 36585340 DOI: 10.1016/j.cpet.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Molecular imaging evaluation of pheochromocytomas and paragangliomas depends on multiple factors, such as localized versus metastatic disease, the genetic, and biochemical profile of tumors. Positron emission tomography/computed tomography (PET/CT) imaging of these tumors outperforms Meta-Iodo-Benzyl-Guanidine (MIBG) scintigraphy in most cases. A few PET radiotracers have been studied in evaluating these patients with somatostatin receptor PET imaging and have shown superior performance compared with other agents in most of these patients. 18F-fluorodeoxyglucose PET/CT imaging is useful in select patients, such as those with succinate dehydrogenase complex subunit B-associated disease. Treatment strategy depends on multiple factors and necessitates a multidisciplinary approach.
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Affiliation(s)
- Charles Marcus
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Radiological Sciences, Emory University School of Medicine, 1364 Clifton Road Northeast, 1st Floor #E163, Atlanta, GA 30322, USA.
| | - Rathan M Subramaniam
- Department of Medicine, Otago Medical School, University of Otago, 1st Floor, Dunedin Hospital, 201 Great King Street, Dunedin 9016, New Zealand; Duke University Medical Center, Department of Radiology, 2301 Erwin Road, Box 3808, Durham, NC 27710, USA
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6
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Yao Y, Guo Y, Fan J, Lin T, Wang L, Zhang S. Influence of duration of preoperative treatment with phenoxybenzamine and secretory phenotypes on perioperative hemodynamics and postoperative outcomes in pheochromocytoma and paraganglioma. Front Endocrinol (Lausanne) 2023; 14:1139015. [PMID: 37152936 PMCID: PMC10154584 DOI: 10.3389/fendo.2023.1139015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/28/2023] [Indexed: 05/09/2023] Open
Abstract
Objectives Resection of pheochromocytoma and paraganglioma (PPGL) carries risks with perioperative hemodynamic instability. Phenoxybenzamine (PXB) is a commonly used α-blockade to prevent it. It is unclear whether lengthening the preoperative duration of PXB is better for hemodynamic stability and postoperative outcomes. Furthermore, different types of catecholamines have varying effects on perioperative hemodynamics. Thus, our study aimed to investigate the impact of the duration of preoperative preparation with PXB and secretory phenotypes of the patients on intraoperative hemodynamic stability and postoperative complications in PPGL. Methods Between Dec 2014 and Jan 2022, 166 patients with PPGL were operated on by the same team at Sun Yat-sen Memorial Hospital. They were divided into group A(1-14d), Group B(15-21d), and Group C(>21d) based on the duration of management with PXB and into the adrenergic and the noradrenergic phenotype group based on secretory profiles. Data on intraoperative hemodynamics and postoperative outcomes were collected and compared among groups. Results A total of 96 patients occurred intraoperative hemodynamic instability, and 24 patients had 29 postoperative complications related to the surgery. Among the 145 patients treated with PXB, no significant differences were found in the cumulative time outside the target blood pressure(6.67%[0-17.16%] vs. 5.97%[0-23.08%] vs. 1.22%[0-17.27%], p=0.736) or in the median total HI-score(42.00[30.00-91.00] vs. 89.00[30.00-113.00] vs. 49.00[30.00-93.00], p=0.150) among group A(n=45), B(n=51) and C(n=49). Multivariate analysis demonstrated that the level of plasma-free metanephrine(MN) was an independent risk factor for intraoperative hemodynamic instability. And the median cumulative time outside of the target blood pressure in the adrenergic phenotype group was significantly greater than that in the noradrenergic phenotype group(8.17%[0-26.22%] vs. 1.86%[0-11.74%], p=0.029). However, the median total HI-score(99.50[85.00-113.25] vs. 90.00[78.00-105.00], p=0.570) and postoperative outcomes showed no differences between the two groups. Conclusions A preoperative duration of nearly 14 days with PXB is sufficient for ensuring intraoperative hemodynamic stability in PPGL. And lengthening the preparation duration may not provide additional benefits in the era of widespread application and advanced techniques of laparoscopic surgery. Additionally, patients with the adrenergic phenotype are more prone to intraoperative hemodynamic instability than the noradrenergic phenotype. Thus, more attention should be given to the adrenergic phenotype during surgery.
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Affiliation(s)
- Yao Yao
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Guo
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Fan
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tianxin Lin
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lin Wang
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Shaoling Zhang, ; Lin Wang,
| | - Shaoling Zhang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Shaoling Zhang, ; Lin Wang,
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Prinzi N, Corti F, Torchio M, Niger M, Antista M, Pagani F, Beninato T, Pulice I, Rossi RE, Coppa J, Cascella T, Giacomelli L, Di Bartolomeo M, Milione M, de Braud F, Pusceddu S. Metastatic pheochromocytomas and paragangliomas: where are we? TUMORI JOURNAL 2022; 108:526-540. [PMID: 35593402 DOI: 10.1177/03008916221078621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pheochromocytomas and paragangliomas (PPGLs) can metastasize in approximately 15-20% of cases. This review discusses the available evidence on the biology and treatment of metastatic PPGLs. Chemotherapy is the first-line treatment option for this evolving and symptomatic disease. In patients with high MIBG uptake and positive PETGa-68, radiometabolic treatment may be considered. The efficacy of sunitinib has been shown in observational studies, and pembrolizumab has been evaluated in phase II clinical studies, while other agents investigated in this setting are anti-angiogenic drugs cabozantinib, dovitinib, axitinib and lenvatinib. As these agents' efficacy and safety data, alone or in combination, are scant and based on few treated patients, enrollment in clinical trials is mandatory. Future therapeutic options may be represented by DNA repair system inhibitors (such as olaparib), HIF2 inhibitors and immunotherapy.
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Affiliation(s)
- Natalie Prinzi
- Department of Medical Oncology, Fondazione IRCCS Istituto Tumori Milano, Milan, Italy
| | - Francesca Corti
- Department of Medical Oncology, Fondazione IRCCS Istituto Tumori Milano, Milan, Italy
| | - Martina Torchio
- Department of Medical Oncology, Fondazione IRCCS Istituto Tumori Milano, Milan, Italy
| | - Monica Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Tumori Milano, Milan, Italy
| | - Maria Antista
- Department of Medical Oncology, Fondazione IRCCS Istituto Tumori Milano, Milan, Italy
| | - Filippo Pagani
- Department of Medical Oncology, Fondazione IRCCS Istituto Tumori Milano, Milan, Italy
| | - Teresa Beninato
- Department of Medical Oncology, Fondazione IRCCS Istituto Tumori Milano, Milan, Italy
| | - Iolanda Pulice
- Clinical Trial Center, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Roberta Elisa Rossi
- Gastro-intestinal Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Pathophysiology and Organ Transplant, Università degli Studi di Milano, Milan, Italy
| | - Jorgelina Coppa
- Gastro-intestinal Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tommaso Cascella
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Maria Di Bartolomeo
- Department of Medical Oncology, Fondazione IRCCS Istituto Tumori Milano, Milan, Italy
| | - Massimo Milione
- Diagnostic Pathology and Laboratory Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Tumori Milano, Milan, Italy.,Oncology and Hemato-Oncology Department, Università degli Studi di Milano, Milan, Italy
| | - Sara Pusceddu
- Department of Medical Oncology, Fondazione IRCCS Istituto Tumori Milano, Milan, Italy
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Overexpression of miR-375 and L-type Amino Acid Transporter 1 in Pheochromocytoma and Their Molecular and Functional Implications. Int J Mol Sci 2022; 23:ijms23052413. [PMID: 35269556 PMCID: PMC8910416 DOI: 10.3390/ijms23052413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/06/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023] Open
Abstract
Pheochromocytoma (Pheo) is a tumor derived from chromaffin cells. It can be studied using 18F-dihydroxyphenylalanine (DOPA)—positron emission tomography (PET) due to its overexpression of L-type amino acid transporters (LAT1 and LAT2). The oncogenic pathways involved are still poorly understood. This study examined the relationship between 18F-DOPA-PET uptake and LAT1 expression, and we explored the role of miR-375 and putative target genes. A consecutive series of 58 Pheo patients were retrospectively analyzed, performing 18F-DOPA-PET in 32/58 patients. Real-time quantitative PCR was used to assess the expression of LAT1, LAT2, phenylethanolamine N-methyltransferase (PNMT), miR-375, and the major components of the Hippo and Wingless/Integrated pathways. Principal germline mutations associated with hereditary Pheo were also studied. Pheo tissues had significantly higher LAT1, LAT2, and PNMT mRNA levels than normal adrenal tissues. MiR-375 was strongly overexpressed. Yes-associated protein 1 and tankyrase 1 were upregulated, while beta-catenin, axin2, monocarboxylate transporter 8, and Frizzled 8 were downregulated. A positive relationship was found between 18F-DOPA-PET SUV mean and LAT1 gene expression and for 24 h-urinary norepinephrine and LAT1. This is the first experimental evidence of 18F-DOPA uptake correlating with LAT1 overexpression. We also demonstrated miR-375 overexpression and downregulated (Wnt) signaling and identified the Hippo pathway as a new potentially oncogenic feature of Pheo.
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Sporadic Primary Pheochromocytoma: A Prospective Intra-Individual Comparison of Six Imaging Tests (CT, MRI, and PET/CT Using 68Ga-DOTATATE, FDG, 18F-FDOPA, and 18F-FDA). AJR Am J Roentgenol 2021; 218:342-350. [PMID: 34431366 PMCID: PMC10389669 DOI: 10.2214/ajr.21.26071] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Recent professional society guidelines for radionuclide imaging of sporadic pheochromocytoma (PHEO) recommend 18F-FDOPA as the radiotracer of choice, deeming 68Ga-DOTATATE and FDG to be secondand third-line agents, respectively. An additional agent, 18F-FDA, remains experimental for PHEO detection. A paucity of research has performed head-to-head comparison among these agents. Purpose: To perform an intra-individual comparison of 68Ga-DOTATATE PET/CT, FDG PET/CT, 18F-FDOPA PET/CT, 18F-FDA PET/CT, CT, and MRI in visualization of sporadic primary PHEO. Methods: This prospective study enrolled patients referred with clinical suspicion for sporadic PHEO. Patients were scheduled for 68Ga-DOTATATE PET/CT, FDG PET/CT, 18F-FDOPA PET/CT, 18F-FDA PET/CT, whole-body staging CT (portal venous phase), and MRI, within a 3-month period. PET/CT examinations were reviewed by two nuclear medicine physicians, and CT and MRI were reviewed by two radiologists; differences were resolved by consensus. Readers scored lesions in terms of confidence in diagnosis of PHEO (1-5 scale; 4-5 considered positive for PHEO). Lesion-to-liver SUVmax was computed using both readers' measurements. Interreader agreement was assessed, using intraclass correlation coefficients (ICCs) for SUVmax. Analysis included only patients with histologically- confirmed PHEO on resection. Results: The analysis included 14 patients (8 women, 6 men; mean age, 52.4±16.8 years) with PHEO. Both 68Ga-DOTATATE PET/CT and FDG PET/CT were completed in 14/14 patients, 18F-FDOPA PET/CT in 11/14, 18F-FDA PET/CT in 7/14, CT in 12/14, and MRI in 12/14. Mean conspicuity score for PHEO was 5.0±0.0 for 18F-FDOPA PET/ CT, 4.7±0.5 for MRI, 4.6±0.8 for 18F-FDA PET/CT, 4.4±1.0 for 68Ga-DOTATATE PET/CT, 4.3±1.0 for CT, and 4.1±1.5 for FDG PET/CT. The positivity rate for PHEO was 100.0% (11/11) for 18F-FDOPA PET/CT, 100.0% (12/12) for MRI, 85.7% (6/7) for 18F-FDA PET/CT, 78.6% (11/14) for FDG PET/CT, 78.6% (11/14) for 68Ga-DOTATATE, and 66.7% (8/12) for CT. Lesion-to-liver SUVmax was 10.5 for 18F-FDOPA versus 3.0-4.2 for the other tracers. Interreader agreement across modalities ranged from 85.7-100.0% for lesion positivity and from ICC=0.55-1.00 for SUVmax measurements. Conclusion: Findings from this small intra-individual comparative study support 18F-FDOPA PET/CT as a preferred firstline imaging modality in evaluation of sporadic PHEO. Clinical Impact: This study provides data supporting current guidelines for imaging evaluation of suspected PHEO.
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Carrasquillo JA, Chen CC, Jha A, Ling A, Lin FI, Pryma DA, Pacak K. Imaging of Pheochromocytoma and Paraganglioma. J Nucl Med 2021; 62:1033-1042. [PMID: 34330739 PMCID: PMC8833868 DOI: 10.2967/jnumed.120.259689] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/16/2021] [Indexed: 02/05/2023] Open
Abstract
Imaging plays a critical role in the management of pheochromocytomas and paragangliomas and often guides treatment. The discovery of susceptibility genes associated with these tumors has led to better understanding of clinical and imaging phenotypes. Functional imaging is of prime importance because of its sensitivity and specificity in subtypes of pheochromocytoma and paraganglioma. Several radiopharmaceuticals have been developed to target specific receptors and metabolic processes seen in pheochromocytomas and paragangliomas, including 131I/123I-metaiodobenzylguanidine, 6-18F-fluoro-l-3,4-dihydroxyphenylalanine, 18F-FDG, and 68Ga-DOTA-somatostatin analogs. Two of these have consequently been adapted for therapy. This educational review focuses on the current imaging approaches used in pheochromocytomas and paragangliomas, which vary among clinical and genotypic presentations.
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Affiliation(s)
- Jorge A Carrasquillo
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York;
| | - Clara C Chen
- Department of Radiology, Clinical Center, NIH, Bethesda, Maryland
| | - Abhishek Jha
- Section on Medical Neuroendocrinology, National Institute of Child Health and Human Development, NIH, Bethesda, Maryland
| | - Alexander Ling
- Department of Radiology, Clinical Center, NIH, Bethesda, Maryland
| | - Frank I Lin
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, Maryland; and
| | - Daniel A Pryma
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karel Pacak
- Section on Medical Neuroendocrinology, National Institute of Child Health and Human Development, NIH, Bethesda, Maryland
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Usefulness of FDG-PET/CT-Based Radiomics for the Characterization and Genetic Orientation of Pheochromocytomas Before Surgery. Cancers (Basel) 2020; 12:cancers12092424. [PMID: 32859070 PMCID: PMC7565830 DOI: 10.3390/cancers12092424] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 01/06/2023] Open
Abstract
Simple Summary Around 40% of patients with pheochromocytomas (PHEO) carry a germline mutation. Early germline mutation identification is important for accurate treatment and follow-up in affected patients. The aim of our retrospective study was to assess the potential added value of FDG-PET/CT radiomics for the characterization of PHEO and their genetic orientation prior to surgery and genetic testing. We confirmed in an homogeneous population of 52 PHEO (49 patients) the usual avidity of these tumors for FDG (92%) and the impact of germline mutation on their phenotypic presentations with higher SUVmax observed in Cluster-1-related genes. Radiomics biomarkers provided valuable additional and independent information for discriminating genetically determined PHEO (Cluster-1 or Cluster-2-related genes) as well as sporadic forms. FDG-PET/CT is then useful for preoperative detection of PHEO, and when combined with texture features, provides evidences for a genetic predisposition. Abstract Purpose: To assess the potential added value of FDG-PET/CT radiomics for the characterization of pheochromocytomas (PHEO) and their genetic orientation prior to surgery and genetic testing. Methods: This retrospective monocentric study, included 49 patients (52 tumors) that underwent both FDG-PET/CT and MIBG scan before surgery. A germline mutation was secondarily identified in 13 patients in one of the genes related to Cluster 1 (n = 4) or Cluster 2 (n = 9). No mutation was identified in 32 patients and 4 did not have genetic testing. Correlation between several PET-based biomarkers, including SUVmax, metabolic tumor volume (MTV), total lesion glycolysis (TLG) and textural features, and biochemical and genetic features were analyzed. Results: Sensitivity of FDG-PET/CT alone was 92%, and 98% when combined to MIBG. The SUVmax was significantly higher for mutated tumors classified in Cluster 1 than in Cluster 2 (p = 0.002) or for tumors with no identified mutations (p = 0.04). MTV and TLG of the tumors with the most intense uptake discriminated mutated Cluster 2 from sporadic tumors, but not from Cluster 1 tumors. Textural features combined with MTV led to better differentiation between sporadic and mutated tumors (p < 0.05). Conclusion: FDG-PET/CT is useful for preoperative characterization of PHEO, and when combined with radiomics biomarkers, provides evidences for a genetic predisposition.
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Taïeb D, Visvikis D, Hicks RJ, Pacak K. Molecular Imaging in the Era of Precision Medicine: Paraganglioma as a Template for Understanding Multiple Levels of Analysis. J Nucl Med 2020; 61:646-648. [DOI: 10.2967/jnumed.119.239095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/10/2020] [Indexed: 11/16/2022] Open
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Castinetti F, Barlier A, Sebag F, Taieb D. Diagnostic des phéochromocytomes et paragangliomes. ONCOLOGIE 2020. [DOI: 10.3166/onco-2019-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les phéochromocytomes et les paragangliomes sont des tumeurs rares responsables d’une surmorbidité et d’une surmortalité. Au cours de ces 20 dernières années, de nombreuses avancées ont permis de mieux les caractériser sur le plan phénotypique (via l’imagerie métabolique) et génotypique (avec la mise en évidence de nombreux gènes de prédisposition). La prise en charge d’un phéochromocytome ou d’un paragangliome nécessite désormais le recours à un centre expert dès la phase diagnostique. L’objectif de cette revue est de souligner les principales caractéristiques de ces tumeurs, et ce, afin de sensibiliser le clinicien aux différentes étapes permettant d’aboutir à une prise en charge optimale.
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Reichert T, Fakhry N, Lavieille JP, Amodru V, Sebag F, Romanet P, Loundou A, Castinetti F, Pacak K, Montava M, Taïeb D. Exploring the link between tumour metabolism and succinate dehydrogenase deficiency: A 18 F-FDOPA PET/CT study in head and neck paragangliomas. Clin Endocrinol (Oxf) 2019; 91:879-884. [PMID: 31479526 PMCID: PMC7446860 DOI: 10.1111/cen.14086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/20/2019] [Accepted: 08/26/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Nuclear imaging findings by virtue of phenotyping disease heavily depend on genetic background, metabolites, cell membrane specific targets and signalling pathways. PPGL related to succinate dehydrogenase subunits mutations (SDHx mutations) are less differentiated than other subgroups and therefore may lack to concentrate 18 F-FDOPA, a precursor of catecholamines biosynthesis. However, this 18 F-FDOPA negative phenotype has been reported mostly in SDHx-PPGL of sympathetic origin, suggesting that both genotype status and location (from sympathetic vs parasympathetic paraganglia; adrenal vs extra-adrenal) could influence 18 F-FDOPA uptake. The aim of this study was to test if SDHx drives 18 F-FDOPA uptake in presence of normal epinephrine/norepinephrine concentrations. DESIGN Retrospective study PATIENTS: A cohort of 86 head and neck PPGL patients (including three metastatic) with normal metanephrines underwent 18 F-FDOPA PET/CT. The relationships between 18 F-FDOPA uptake and tumour genotype were evaluated. RESULTS In nonmetastatic HNPGL (50 non-SDHx/33 SDHx), no significant difference was observed between these two groups for SUVmax (P = .256), SUVmean (P = .188), MTV 42% (P = .596) and total lesion uptake (P = .144). Metastatic HNPGL also had high elevated uptake values. CONCLUSIONS Our results suggest that SDH deficiency or metastatic behaviour have no influence on 18 F-FDOPA uptake in HNPGL probably due to their very-well differentiation status, even at metastatic stage. The potential prognosticator value of 18 F-FDOPA uptake would need to be further explored in the setting of metastatic PPGL of sympathetic origin.
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Affiliation(s)
- Thibaut Reichert
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, Marseille, France
| | - Nicolas Fakhry
- Department of Head and Neck Surgery, Conception Hospital, Aix-Marseille Univ, Marseille, France
| | - Jean-Pierre Lavieille
- Department of Head and Neck Surgery, Conception Hospital, Aix-Marseille Univ, Marseille, France
| | - Vincent Amodru
- Department of Endocrinology, Conception University Hospital, Aix-Marseille University, Marseille, France
| | - Frédéric Sebag
- Department of Endocrine Surgery, Conception University Hospital, Aix-Marseille University, Marseille, France
| | - Pauline Romanet
- Laboratory of Molecular Biology, Conception Hospital & CNRS, CRN2M UMR 7286, Aix-Marseille University, Marseille, France
| | - Anderson Loundou
- Department of Public Health, EA3279 Self-perceived Health Assessment Research Unit, Aix-Marseille University, Marseille, France
| | - Frédéric Castinetti
- Department of Endocrinology, Conception University Hospital, Aix-Marseille University, Marseille, France
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Marion Montava
- Department of Head and Neck Surgery, Conception Hospital, Aix-Marseille Univ, Marseille, France
| | - David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, Marseille, France
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15
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Giammarile F, Castellucci P, Dierckx R, Estrada Lobato E, Farsad M, Hustinx R, Jalilian A, Pellet O, Rossi S, Paez D. Non-FDG PET/CT in Diagnostic Oncology: a pictorial review. Eur J Hybrid Imaging 2019; 3:20. [PMID: 34191163 PMCID: PMC8218094 DOI: 10.1186/s41824-019-0066-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/22/2019] [Indexed: 11/25/2022] Open
Abstract
Positron emission tomography/computed tomography (PET/CT) is currently one of the main imaging modalities for cancer patients worldwide. Fluorodeoxyglucose (FDG) PET/CT has earned its global recognition in the modern management of cancer patients and is rapidly becoming an important imaging modality for patients with cardiac, neurological, and infectious/inflammatory conditions. Despite its proven benefits, FDG has limitations in the assessment of several relevant tumours such as prostate cancer. Therefore, there has been a pressing need for the development and clinical application of different PET radiopharmaceuticals that could image these tumours more precisely. Accordingly, several non-FDG PET radiopharmaceuticals have been introduced into the clinical arena for management of cancer. This trend will undoubtedly continue to spread internationally. The use of PET/CT with different PET radiopharmaceuticals specific to tumour type and biological process being assessed is part of the personalised precision medicine approach. The objective of this publication is to provide a case-based method of understanding normal biodistribution, variants, and pitfalls, including several examples of different imaging appearances for the main oncological indications for each of the new non-FDG PET radiopharmaceuticals. This should facilitate the interpretation and recognition of common variants and pitfalls to ensure that, in clinical practice, the official report is accurate and helpful. Some of these radiopharmaceuticals are already commercially available in many countries (e.g. 68Ga-DOTATATE and DOTATOC), others are in the process of becoming available (e.g. 68Ga-PSMA), and some are still being researched. However, this list is subject to change as some radiopharmaceuticals are increasingly utilised, while others gradually decrease in use.
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Affiliation(s)
- Francesco Giammarile
- Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria.
| | - Paolo Castellucci
- Department of Nuclear Medicine, Sant'Orsola-Malpighi Hospital, 40138, Bologna, Italy
| | - Rudi Dierckx
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Enrique Estrada Lobato
- Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Mohsen Farsad
- Department of Nuclear Medicine, Bolzano Hospital, Bolzano, Italy
| | - Roland Hustinx
- Department of Nuclear Medicine, CHU Liège, University of Liège, Liège, Belgium
| | - Amirreza Jalilian
- Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Olivier Pellet
- Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - Susana Rossi
- Centro Uruguayo de Imagenología Molecular (CUDIM), Montevideo, Uruguay
| | - Diana Paez
- Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
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16
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Affiliation(s)
- Hartmut P H Neumann
- From the Section for Preventive Medicine, Medical Center-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Germany (H.P.H.N.); the Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN (W.F.Y.); and the Genomic Medicine Institute, Lerner Research Institute, and Taussig Cancer Institute, Cleveland Clinic, Cleveland (C.E.)
| | - William F Young
- From the Section for Preventive Medicine, Medical Center-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Germany (H.P.H.N.); the Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN (W.F.Y.); and the Genomic Medicine Institute, Lerner Research Institute, and Taussig Cancer Institute, Cleveland Clinic, Cleveland (C.E.)
| | - Charis Eng
- From the Section for Preventive Medicine, Medical Center-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Germany (H.P.H.N.); the Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN (W.F.Y.); and the Genomic Medicine Institute, Lerner Research Institute, and Taussig Cancer Institute, Cleveland Clinic, Cleveland (C.E.)
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17
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18F-FDOPA PET Compared With 123I-Metaiodobenzylguanidine Scintigraphy and 18F-FDG PET in Secreting Sporadic Pheochromocytoma. Clin Nucl Med 2019; 44:738-740. [DOI: 10.1097/rlu.0000000000002736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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11C-hydroxy-ephedrine-PET/CT in the Diagnosis of Pheochromocytoma and Paraganglioma. Cancers (Basel) 2019; 11:cancers11060847. [PMID: 31248124 PMCID: PMC6627429 DOI: 10.3390/cancers11060847] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/12/2019] [Accepted: 06/16/2019] [Indexed: 01/04/2023] Open
Abstract
Pheochromocytomas (PCC) and paragangliomas (PGL) may be difficult to diagnose because of vague and uncharacteristic symptoms and equivocal biochemical and radiological findings. This was a retrospective cohort study in 102 patients undergoing 11C-hydroxy-ephedrine (11C-HED)-PET/CT because of symptoms and/or biochemistry suspicious for PCC/PGL and/or with radiologically equivocal adrenal incidentalomas. Correlations utilized CT/MRI, clinical, biochemical, surgical, histopathological and follow-up data. 11C-HED-PET/CT correctly identified 19 patients with PCC and six with PGL, missed one PCC, attained one false positive result (nodular hyperplasia) and correctly excluded PCC/PGL in 75 patients. Sensitivity, specificity, positive and negative predictive values of 11C-HED-PET/CT for PCC/PGL diagnosis was 96%, 99%, 96% and 99%, respectively. In 41 patients who underwent surgical resection and for whom correlation to histopathology was available, the corresponding figures were 96%, 93%, 96% and 93%, respectively. Tumor 11C-HED-uptake measurements (standardized uptake value, tumor-to-normal-adrenal ratio) were unrelated to symptoms of catecholamine excess (p > 0.05) and to systolic blood pressure (p > 0.05). In PCC/PGL patients, norepinephrine and systolic blood pressure increased in parallel (R2 = 0.22, p = 0.016). 11C-HED-PET/CT was found to be an accurate tool to diagnose and rule out PCC/PGL in complex clinical scenarios and for the characterization of equivocal adrenal incidentalomas. PET measurements of tumor 11C-HED uptake were not helpful for tumor characterization.
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19
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Adrenal tracer uptake by 18F-FDOPA PET/CT in patients with pheochromocytoma and controls. Eur J Nucl Med Mol Imaging 2019; 46:1560-1566. [PMID: 31011769 PMCID: PMC6533226 DOI: 10.1007/s00259-019-04332-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/08/2019] [Indexed: 01/08/2023]
Abstract
Context 18F-FDOPA PET/CT accurately localizes pheochromocytoma in patients with an established biochemical diagnosis. However, cut-off 18F-FDOPA levels of standardized uptake values (SUVmax) for both normal adrenal glands and pheochromocytoma are lacking. Objective Objectives of this study were to determine (1) reference maximum standardized uptake values (SUVmax) for normal adrenal 18F-DOPA tracer uptake and (2) the optimal diagnostic approach for pheochromocytoma localization by using 18F-DOPA SUVmax across a series of cut-off points: the affected adrenal gland (inter-individual analysis), the difference in SUVmax between the affected adrenal gland and the contralateral normal adrenal gland (intra-individual analysis), or a combination of these two. Patients and methods All patients with histologically confirmed pheochromocytoma diagnosed at our center between November 2009 and December 2017 were retrospectively analysed. Only those patients who underwent an 18F-FDOPA PET/CT-scan for localization purposes before adrenalectomy were included for further analysis. The control group consisted of patients who underwent 18F-FDOPA PET/CT for other indications and who had no genetic susceptibility for developing a pheochromocytoma. SUVmax of the volume of interest surrounding the adrenal glands was determined on EARL reconstructed images. Receiver operating characteristic (ROC) analysis was performed for adrenal gland SUVmax and intra-individual difference in SUVmax between affected and normal adrenal gland. In addition, binary logistic regression was performed for ROC analysis of the combined parameters. Results In total, 47 histologically confirmed pheochromocytomas were diagnosed in 45 patients, and 245 disease control patients were identified. In the control group, no statistical differences between the SUVmax of left and right adrenal glands were observed, and uptake values in both adrenal glands correlated significantly with each other (r = 0.865, p < 0.001). Median (range) adrenal gland SUVmax in pheochromocytomas and in the control group was 12 (2.6–50) and 2.9 (1.1–6.6), respectively (p < 0.001). ROC analysis revealed 93% sensitivity and 85% specificity at an SUVmax cut-off value of 4.1 (area under the curve (AUC) = 0.951), and 93% sensitivity and 96% specificity at an intra-individual SUVmax difference between the affected and normal adrenal gland of 1.0 (AUC = 0.992). The combination of both variables increased the AUC to 0.995. Conclusions 18F-FDOPA PET/CT distinguishes pheochromocytoma from normal adrenal glands with the highest diagnostic accuracy when combining the SUVmax of the affected adrenal gland with the difference in SUVmax between affected and normal adrenal gland.
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20
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Kratochwil C, Flechsig P, Lindner T, Abderrahim L, Altmann A, Mier W, Adeberg S, Rathke H, Röhrich M, Winter H, Plinkert PK, Marme F, Lang M, Kauczor HU, Jäger D, Debus J, Haberkorn U, Giesel FL. 68Ga-FAPI PET/CT: Tracer Uptake in 28 Different Kinds of Cancer. J Nucl Med 2019; 60:801-805. [PMID: 30954939 DOI: 10.2967/jnumed.119.227967] [Citation(s) in RCA: 826] [Impact Index Per Article: 165.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/19/2019] [Indexed: 12/31/2022] Open
Abstract
The recent development of quinoline-based PET tracers that act as fibroblast-activation-protein inhibitors (FAPIs) demonstrated promising preclinical and clinical results. FAP is overexpressed by cancer-associated fibroblasts of several tumor entities. Here, we quantify the tumor uptake on 68Ga-FAPI PET/CT of various primary and metastatic tumors to identify the most promising indications for future application. Methods: 68Ga-FAPI PET/CT scans were requested by various referring physicians according to individual clinical indications that were considered insufficiently covered by 18F-FDG PET/CT or other imaging modalities. All PET/CT was performed 1 h after injection of 122-312 MBq of 68Ga-FAPI-04. We retrospectively identified 80 patients with histopathologically proven primary tumors or metastases or radiologically unequivocal metastatic lesions of histologically proven primary tumors. Tumor uptake was quantified by SUVmax and SUVmean (60% isocontour). Results: Eighty patients with 28 different tumor entities (54 primary tumors and 229 metastases) were evaluated. The highest average SUVmax (>12) was found in sarcoma, esophageal, breast, cholangiocarcinoma, and lung cancer. The lowest 68Ga-FAPI uptake (average SUVmax < 6) was observed in pheochromocytoma, renal cell, differentiated thyroid, adenoid cystic, and gastric cancer. The average SUVmax of hepatocellular, colorectal, head-neck, ovarian, pancreatic, and prostate cancer was intermediate (SUV 6-12). SUV varied across and within all tumor entities. Because of low background in muscle and blood pool (SUVmax < 2), the tumor-to-background contrast ratios were more than 3-fold in the intermediate and more than 6-fold in the high-intensity uptake group. Conclusion: Several highly prevalent cancers presented with remarkably high uptake and image contrast on 68Ga-FAPI PET/CT. The high and rather selective tumor uptake may open up new applications for noninvasive tumor characterization, staging examinations, or radioligand therapy.
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Affiliation(s)
- Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul Flechsig
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Thomas Lindner
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Labidi Abderrahim
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Annette Altmann
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany
| | - Walter Mier
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Hendrik Rathke
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel Röhrich
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Hauke Winter
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany.,Department of Surgery, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Peter K Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Frederik Marme
- Department Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany.,Department Obstetrics and Gynecology, University Hospital Mannheim, Mannheim, Germany
| | - Matthias Lang
- Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dirk Jäger
- Department of Medical Oncology and Internal Medicine VI, National Center for Tumor Diseases, University Hospital Heidelberg, Germany.,Clinical Cooperation Unit Applied Tumor Immunity, German Cancer Research Center, Heidelberg, Germany; and
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany.,Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany
| | - Frederik L Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
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21
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Giovannini E, Giovacchini G, Borsò E, Lazzeri P, Riondato M, Leoncini R, Duce V, Ciarmiello A. [68Ga]-Dota Peptide PET/CT in Neuroendocrine Tumors: Main Clinical Applications. Curr Radiopharm 2019; 12:11-22. [DOI: 10.2174/1874471012666181212101244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 12/14/2022]
Abstract
Objective:
Neuroendocrine Neoplasms (NENs) are generally defined as rare and heterogeneous
tumors. The gastrointestinal system is the most frequent site of NENs localization, however they
can be found in other anatomical regions, such as pancreas, lungs, ovaries, thyroid, pituitary, and adrenal
glands. Neuroendocrine neoplasms have significant clinical manifestations depending on the
production of active peptide.
Methods:
Imaging modalities play a fundamental role in initial diagnosis as well as in staging and
treatment monitoring of NENs, in particular they vastly enhance the understanding of the physiopathology
and diagnosis of NENs through the use of somatostatin analogue tracers labeled with appropriate
radioisotopes. Additionally, the use of somatostatin analogues provides the ability to in-vivo measure
the expression of somatostatin receptors on NEN cells, a process that might have important therapeutic
implications.
Results:
A large body of evidences showed improved accuracy of molecular imaging based on PET/CT
radiotracer with SST analogues (e.g. [68Ga]-DOTA peptide) for the detection of NEN lesions in comparison
to morphological imaging modalities. So far, the role of imaging technologies in assessing
treatment response is still under debate.
Conclusion:
This review offers the systems of classification and grading of NENs and summarizes the
more useful recommendations based on data recently published for the management of patients with
NENs, with special focus on the role of imaging modalities based on SST targeting with PET / CT
radiotracers.
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Affiliation(s)
| | | | - Elisa Borsò
- Department of Nuclear Medicine, S. Andrea Hospital, La Spezia, Italy
| | - Patrizia Lazzeri
- Department of Nuclear Medicine, S. Andrea Hospital, La Spezia, Italy
| | - Mattia Riondato
- Department of Nuclear Medicine, S. Andrea Hospital, La Spezia, Italy
| | - Rossella Leoncini
- Department of Nuclear Medicine, S. Andrea Hospital, La Spezia, Italy
| | - Valerio Duce
- Department of Nuclear Medicine, S. Andrea Hospital, La Spezia, Italy
| | - Andrea Ciarmiello
- Department of Nuclear Medicine, S. Andrea Hospital, La Spezia, Italy
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22
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Albano D, Agnello F, Midiri F, Pecoraro G, Bruno A, Alongi P, Toia P, Di Buono G, Agrusa A, Sconfienza LM, Pardo S, La Grutta L, Midiri M, Galia M. Imaging features of adrenal masses. Insights Imaging 2019; 10:1. [PMID: 30684056 PMCID: PMC6349247 DOI: 10.1186/s13244-019-0688-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/03/2019] [Indexed: 12/14/2022] Open
Abstract
The widespread use of imaging examinations has increased the detection of incidental adrenal lesions, which are mostly benign and non-functioning adenomas. The differentiation of a benign from a malignant adrenal mass can be crucial especially in oncology patients since it would greatly affect treatment and prognosis. In this setting, imaging plays a key role in the detection and characterization of adrenal lesions, with several imaging tools which can be employed by radiologists. A thorough knowledge of the imaging features of adrenal masses is essential to better characterize these lesions, avoiding a misinterpretation of imaging findings, which frequently overlap between benign and malignant conditions, thus helping clinicians and surgeons in the management of patients. The purpose of this paper is to provide an overview of the main imaging features of adrenal masses and tumor-like conditions recalling the strengths and weaknesses of imaging modalities commonly used in adrenal imaging.
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Affiliation(s)
- Domenico Albano
- Unità di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
| | - Francesco Agnello
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Federico Midiri
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Giusy Pecoraro
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Alberto Bruno
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Pierpaolo Alongi
- Department of Radiological Sciences, Nuclear Medicine Service, Fondazione Istituto G. Giglio, Contrada Pietrapollastra-Pisciotto, 90015, Cefalu, Italy
| | - Patrizia Toia
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Giuseppe Di Buono
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Antonino Agrusa
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Luca Maria Sconfienza
- Unità di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Salvatore Pardo
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Ludovico La Grutta
- Department PROMISE, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Massimo Midiri
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Massimo Galia
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy
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23
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Helali M, Moreau M, Le Fèvre C, Heimburger C, Bund C, Goichot B, Veillon F, Hubelé F, Charpiot A, Noel G, Imperiale A. 18F-FDOPA PET/CT Combined with MRI for Gross Tumor Volume Delineation in Patients with Skull Base Paraganglioma. Cancers (Basel) 2019; 11:cancers11010054. [PMID: 30626096 PMCID: PMC6360018 DOI: 10.3390/cancers11010054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/30/2018] [Accepted: 01/02/2019] [Indexed: 11/16/2022] Open
Abstract
In this simulation study, we assessed differences in gross tumor volume (GTV) in a series of skull base paragangliomas (SBPGLs) using magnetic resonance imaging (MRI), 18F-dihydroxyphenylalanine (18F-FDOPA) combined positron emission tomography/computed tomography (PET/CT), and 18F-FDOPA PET/MRI images obtained by rigid alignment of PET and MRI. GTV was delineated in 16 patients with SBPGLs on MRI (GTVMRI), 18F-FDOPA PET/CT (GTVPET), and combined PET/MRI (GTVPET/MRI). GTVPET/MRI was the union of GTVMRI and GTVPET after visual adjustment. Three observers delineated GTVMRI and GTVPET/MRI independently. Excellent interobserver reproducibility was found for both GTVMRI and GTVPET/MRI. GTVPET and GTVMRI were not significantly different. However, there was some spatial difference between the locations of GTVMRI, GTVPET, and GTVPET/MRI. The Dice similarity coefficient median value was 0.4 between PET/CT and MRI, and 0.8 between MRI and PET/MRI. The combined use of PET/MRI produced a larger GTV than MRI alone. Nevertheless, both the target-delivered dose and organs-at-risk conservancy were respected when treatment was planned on the PET/MRI-matched data set. Future integration of 18F-FDOPA PET/CT into clinical practice will be necessary to evaluate the influence of this diagnostic modality on SBPGL therapeutic management. If the clinical utility of 18F-FDOPA PET/CT and/or PET/MRI is confirmed, GTVPET/MRI should be considered for tailored radiotherapy planning in patients with SBPGL.
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Affiliation(s)
- Mehdi Helali
- Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, 67098 Strasbourg, France.
| | - Matthieu Moreau
- Radiophysics, Centre Paul-Strauss, UNICANCER, 67065 Strasbourg, France.
| | - Clara Le Fèvre
- Radiotherapy, Centre Paul-Strauss, 67065 Strasbourg, France.
| | - Céline Heimburger
- Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, 67098 Strasbourg, France.
- ICube, University of Strasbourg/CNRS (UMR 7357) and FMTS, Faculty of Medicine, 67000 Strasbourg, France.
| | - Caroline Bund
- Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, 67098 Strasbourg, France.
- ICube, University of Strasbourg/CNRS (UMR 7357) and FMTS, Faculty of Medicine, 67000 Strasbourg, France.
| | - Bernard Goichot
- Internal Medicine, University Hospitals of Strasbourg, Strasbourg University, 67098 Strasbourg, France.
| | - Francis Veillon
- Radiology, University Hospitals of Strasbourg, Strasbourg University, 67098 Strasbourg, France.
| | - Fabrice Hubelé
- Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, 67098 Strasbourg, France.
- ICube, University of Strasbourg/CNRS (UMR 7357) and FMTS, Faculty of Medicine, 67000 Strasbourg, France.
| | - Anne Charpiot
- Otolaryngology and Maxillofacial Surgery, University Hospitals of Strasbourg, 67098 Strasbourg, France.
| | - Georges Noel
- Radiotherapy, Centre Paul-Strauss, 67065 Strasbourg, France.
- Université de Strasbourg, CNRS, IPHC UMR 7178, Centre Paul Strauss, UNICANCER, 67065 Strasbourg, France.
| | - Alessio Imperiale
- Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, 67098 Strasbourg, France.
- ICube, University of Strasbourg/CNRS (UMR 7357) and FMTS, Faculty of Medicine, 67000 Strasbourg, France.
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Early 18F-FDOPA PET/CT imaging after carbidopa premedication as a valuable diagnostic option in patients with insulinoma. Eur J Nucl Med Mol Imaging 2019; 46:686-695. [DOI: 10.1007/s00259-018-4245-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/19/2018] [Indexed: 12/19/2022]
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18F-FDOPA PET/CT of Nonfunctioning Paraganglioma of the Gastroepiploic Pedicle. Clin Nucl Med 2018; 43:e326-e328. [PMID: 30004936 DOI: 10.1097/rlu.0000000000002185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the case of a 54-year-old woman with a nonfunctioning paraganglioma arising from the gastroepiploic pedicle demonstrated by F-FDOPA PET/CT. Because gastroepiploic arcade can be assimilated to the gastric mesentery, this tumor has been classified as a mesenteric paraganglioma (PGL). Neural crest cells are a multipotent population of cells characterized by effective migratory properties potentially explaining PGL atypical localization as in the mesentery. Mesenteric PGLs are often nonfunctioning and can mimic gastric, colic, or pancreatic primary tumor because of their anatomical boundaries, making more difficult the diagnosis on preoperative imaging.
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