title: 123I-metaiodobenzylguanidine (MIBG) scintigraphy for the detection of adrenal and extra-adrenal phaeochromocytomas: CT and MRI correlation.
abstract: BACKGROUND
  Evidence regarding the accuracy of [(123)I] metaiodobenzylguanidine (MIBG) imaging for phaeochromocytoma localization is currently limited to small series.
  
  
  OBJECTIVE
  We present the largest series of primary phaeochromocytomas in which the performance of [(123)I]MIBG has been evaluated and correlated with cross-sectional imaging.
  
  
  METHODS
  We identified 76 patients with both preoperative [(123)I]MIBG and cross-sectional imaging for confirmed primary phaeochromocytoma between 1995 and 2005 at our institution. This comprised 60 adrenal tumours in 55 patients and 33 extra-adrenal tumours in 23 patients (2 patients had both adrenal and extra-adrenal tumours). Phaeochromocytoma metastases were not evaluated.
  
  
  METHODS
  [(123)I]MIBG studies were independently reviewed and correlated with CT and MRI examinations, as well as tumour functional status, to identify features that may predict a false negative [(123)I]MIBG result.
  
  
  RESULTS
  The overall sensitivity of [(123)I]MIBG was 75%. Tumour detection was lower for extra-adrenal (58%) vs. adrenal (85%) phaeochromocytomas (P = 0.005). For extra-adrenal tumours, [(123)I]MIBG demonstrated 8 of 14 carotid body, 2 of 2 intrathoracic, 8 of 14 retroperitoneal and 2 of 3 pelvic phaeochromocytomas. Overall, MRI and CT demonstrated 68 of 68 and 72 of 74 primary phaeochromocytomas, respectively. Tumour size correlated with [(123)I]MIBG uptake for adrenal (P = 0.009) but not extra-adrenal tumours. When tumours were adjusted for size, no other imaging feature or functional status correlated with [(123)I]MIBG negativity, although two large [(123)I]MIBG negative adrenal tumours contained large areas of necrosis or haemorrhage.
  
  
  CONCLUSIONS
  Extra-adrenal and small adrenal phaeochromocytomas are more likely to result in false negatives on [(123)I]MIBG. Tumoural necrosis or haemorrhage do not consistently relate to [(123)I]MIBG uptake, although adrenal phaeochromocytomas containing minimal solid tissue due to extensive necrosis may predict a negative [(123)I]MIBG result.
authors.affiliation: Department of Academic Radiology, St. Bartholomew's Hospital, London, UK.
authors.forename: Kunwar S S
authors.initials: KS
authors.lastname: Bhatia
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: Ismail
authors.forename: Anju
authors.initials: A
authors.lastname: Sahdev
authors.forename: Andrea G
authors.initials: AG
authors.lastname: Rockall
authors.forename: Kieran
authors.initials: K
authors.lastname: Hogarth
authors.forename: Ana
authors.initials: A
authors.lastname: Canizales
authors.forename: Norbert
authors.initials: N
authors.lastname: Avril
authors.forename: John P
authors.initials: JP
authors.lastname: Monson
authors.forename: Ashley B
authors.initials: AB
authors.lastname: Grossman
authors.forename: Rodney H
authors.initials: RH
authors.lastname: Reznek
mesh_terms: D019797:3-Iodobenzylguanidine; D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000000981:diagnostic imaging*; D011859:Radiography; D012186:Retroperitoneal Neoplasms / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D013899:Thoracic Neoplasms / Q000000981:diagnostic imaging; D014055:Tomography, Emission-Computed / Q000379:methods*; D055815:Young Adult
chemical_list: D019797:3-Iodobenzylguanidine