title: 6-[F-18]Fluoro-L-dihydroxyphenylalanine positron emission tomography is superior to conventional imaging with (123)I-metaiodobenzylguanidine scintigraphy, computer tomography, and magnetic resonance imaging in localizing tumors causing catecholamine excess.
abstract: BACKGROUND
  Catecholamine excess is rare, but symptoms may be life threatening.
  
  
  OBJECTIVE
  The objective of the study was to investigate the sensitivity of 6-[F-18]fluoro-l-dihydroxyphenylalanine positron emission tomography ((18)F-DOPA PET), compared with (123)I-metaiodobenzylguanidine ((123)I-MIBG) scintigraphy and computer tomography (CT)/magnetic resonance imaging (MRI) for tumor localization in patients with catecholamine excess.
  
  
  METHODS
  All consecutive patients with catecholamine excess visiting the University Medical Center Groningen, Groningen, The Netherlands, between March 2003 and January 2008 were eligible.
  
  
  METHODS
  Forty-eight patients were included. The final diagnosis was pheochromocytoma in 40, adrenal hyperplasia in two, paraganglioma in two, ganglioneuroma in one, and unknown in three.
  
  
  METHODS
  Sensitivities and discordancy between (18)F-DOPA PET, (123)I-MIBG, and CT or MRI were analyzed for individual patients and lesions. Metanephrines and 3-methoxytyramine in plasma and urine and uptake of (18)F-DOPA with PET were measured to determine the whole-body metabolic burden and correlated with biochemical tumor activity. The gold standard was a composite reference standard.
  
  
  RESULTS
  (18)F-DOPA PET showed lesions in 43 patients, (123)I-MIBG in 31, and CT/MRI in 32. Patient-based sensitivity for (18)F-DOPA PET, (123)I-MIBG, and CT/MRI was 90, 65, and 67% (P < 0.01 for (18)F-DOPA PET vs. both (123)I-MIBG and CT/MRI, P = 1.0 (123)I-MIBG vs. CT/MRI). Lesion-based sensitivities were 73, 48, and 44% (P < 0.001 for (18)F-DOPA PET vs. both (123)I-MIBG and CT/MRI, P = 0.51 (123)I-MIBG vs. CT/MRI). The combination of (18)F-DOPA PET with CT/MRI was superior to (123)I-MIBG with CT/MRI (93 vs. 76%, P < 0.001). Whole-body metabolic burden measured with (18)F-DOPA PET correlated with plasma normetanephrine (r = 0.82), urinary normetanephrine (r = 0.84), and metanephrine (r = 0.57).
  
  
  CONCLUSIONS
  To localize tumors causing catecholamine excess, (18)F-DOPA PET is superior to (123)I-MIBG scintigraphy and CT/MRI.
authors.affiliation: Department of Medical Oncology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands.
authors.forename: Helle-Brit
authors.initials: HB
authors.lastname: Fiebrich
authors.forename: Adrienne H
authors.initials: AH
authors.lastname: Brouwers
authors.forename: Michiel N
authors.initials: MN
authors.lastname: Kerstens
authors.forename: Milan E J
authors.initials: ME
authors.lastname: Pijl
authors.forename: Ido P
authors.initials: IP
authors.lastname: Kema
authors.forename: Johan R
authors.initials: JR
authors.lastname: de Jong
authors.forename: Pieter L
authors.initials: PL
authors.lastname: Jager
authors.forename: Philip H
authors.initials: PH
authors.lastname: Elsinga
authors.forename: Rudi A J O
authors.initials: RA
authors.lastname: Dierckx
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: van der Wal
authors.forename: Wim J
authors.initials: WJ
authors.lastname: Sluiter
authors.forename: Elisabeth G E
authors.initials: EG
authors.lastname: de Vries
authors.forename: Thera P
authors.initials: TP
authors.lastname: Links
mesh_terms: D019797:3-Iodobenzylguanidine; D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism; D000311:Adrenal Glands / Q000378:metabolism / Q000473:pathology*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002395:Catecholamines / Q000097:blood / Q000378:metabolism* / Q000652:urine; D002648:Child; D002675:Child, Preschool; D004295:Dihydroxyphenylalanine / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010235:Paraganglioma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism; D010673:Pheochromocytoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism; D049268:Positron-Emission Tomography / Q000379:methods; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002395:Catecholamines; D019275:Radiopharmaceuticals; C043437:fluorodopa F 18; D019797:3-Iodobenzylguanidine; D004295:Dihydroxyphenylalanine