Usefulness of 123I-MIBG scintigraphy in the evaluation of patients with known or suspected primary or metastatic pheochromocytoma or paraganglioma: results from a prospective multicenter trial.
Although (123)I-MIBG has been in clinical use for the imaging of pheochromocytoma for many years, a large multicenter evaluation of this agent has never been performed. The present study was designed to provide a prospective confirmation of the performance of (123)I-MIBG scintigraphy for the evaluation of patients with known or suspected primary or metastatic pheochromocytoma or paraganglioma.


METHODS
A total of 81 patients with a prior history of primary or metastatic pheochromocytoma or paraganglioma and 69 with suspected pheochromocytoma or paraganglioma based on symptoms of catecholamine excess, CT or MRI findings, or elevated catecholamine or metanephrine levels underwent whole-body planar and selected SPECT 24 h after the administration of (123)I-MIBG. Images were independently interpreted by 3 masked readers, with consensus requiring agreement of at least 2 readers. Final diagnoses were based on histopathology, correlative imaging, catecholamine or metanephrine measurements, and clinical follow-up.


RESULTS
Among 140 patients with definitive diagnoses (91, disease present; 49, disease absent), (123)I-MIBG planar scintigraphy had a sensitivity and specificity of 82%. For patients evaluated for suspected disease, sensitivity and specificity were 88% and 84%, respectively. For the subpopulations of adrenal (pheochromocytoma) and extraadrenal (paraganglioma) tumors, sensitivities were 88% and 67%, respectively. The addition of SPECT increased reader confidence but minimally affected sensitivity and specificity.


CONCLUSIONS
This prospective study demonstrated a sensitivity of 82%-88% and specificity of 82%-84% for (123)I-MIBG imaging used in the diagnostic assessment of primary or metastatic pheochromocytoma or paraganglioma.
Wiseman
Gregory A
GA
Department of Nuclear Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Pacak
Karel
K
O'Dorisio
Mary S
MS
Neumann
Donald R
DR
Waxman
Alan D
AD
Mankoff
David A
DA
Heiba
Sherif I
SI
Serafini
Aldo N
AN
Tumeh
Sabah S
SS
Khutoryansky
Natalie
N
Jacobson
Arnold F
AF
D019797:3-Iodobenzylguanidine; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010235:Paraganglioma / Q000000981:diagnostic imaging* / Q000556:secondary*; D010673:Pheochromocytoma / Q000000981:diagnostic imaging* / Q000556:secondary*; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D055815:Young Adult
D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine
Surgery. 2003 Dec;134(6):918-22; discussion 922-3
14668723
J Nucl Med. 1984 Apr;25(4):436-40
6544815
Br J Cancer. 2003 Oct 6;89(7):1383-8
14520475
J Nucl Med. 1985 Jun;26(6):576-85
2860214
Eur J Nucl Med. 1988;14(7-8):341-4
3141186
J Nucl Med. 2006 Oct;47(10):1635-42
17015899
Eur J Surg. 1998 Jan;164(1):23-8
9537705
Ann N Y Acad Sci. 2006 Aug;1073:1-20
17102067
Radiology. 1985 Jun;155(3):789-92
4001380
J Clin Oncol. 2007 Jun 1;25(16):2262-9
17538171
Eur J Endocrinol. 1999 Dec;141(6):619-24
10601965
Lancet. 2005 Aug 20-26;366(9486):665-75
16112304
Semin Nucl Med. 2006 Jul;36(3):228-47
16762613
Semin Nucl Med. 2006 Jul;36(3):212-27
16762612
Clin Nucl Med. 1995 Feb;20(2):147-52
7720307
Eur J Nucl Med. 1987;13(2):86-9
3609058
Radiol Med. 1988 Nov;76(5):466-70
3205923
Presse Med. 1984 Mar 31;13(14):863-6
6231610
J Clin Endocrinol Metab. 2001 Feb;86(2):685-93
11158032
Eur J Nucl Med Mol Imaging. 2003 Dec;30(12):BP132-9
14989227
Q J Nucl Med. 1995 Dec;39(4 Suppl 1):9-12
9002741
J Nucl Med. 1981 Apr;22(4):358-64
7205383
Int J Urol. 1999 Mar;6(3):119-24
10226821
J Nucl Med. 1994 Jul;35(7):1138-44
8014671
Anticancer Res. 2006 Mar-Apr;26(2B):1599-604
16619578
Ann Intern Med. 1981 Jun;94(6):762-7
7235418
AJR Am J Roentgenol. 2008 Apr;190(4):1085-90
18356459
J Clin Endocrinol Metab. 1985 Oct;61(4):769-72
4031017
World J Surg. 1998 Jul;22(7):689-93; discussion 694
9606283
Am J Physiol Imaging. 1986;1(2):96-103
3330445
Biometrics. 1977 Mar;33(1):159-74
843571