Value of 123I-MIBG Scintigraphy in Paraganglioma.
OBJECTIVE
The aim of the study was to evaluate the current role of (123)I-MIBG scintigraphy in the detection and follow-up of patients with paragangliomas.


METHODS
117 patients were referred for diagnostic (123)I-MIBG scintigraphy based on a strong clinical suspicion, positive familial history and genetic testing, or for follow-up of paragangliomas.(123)I-MIBG images were analyzed and correlated with (111)In-octreotide scintigraphy, CT or MRI results. Accuracy of the imaging method was calculated per patient and per tumor per site.


RESULTS
A total of 117 patients were referred for (123)I-MIBG diagnostic imaging; 80 patients were diagnosed with paraganglioma; 66 patients had a single neuroendocrine tumor and 14 patients multiple tumors. The total number of all lesions in these patients was 172. (123)I-MIBG scintigraphy demonstrated 65 lesions in 56 patients (overall sensitivity: 56.3%, specificity: 84%). Lesion-per-site analysis revealed that sensitivity and specificity significantly varied per tumor site (lowest sensitivity for the head and neck: 17.5% and lowest specificity for the abdomen: 87.5%). Hormones were elevated in 85 patients: 55 (123)I-MIBG tumors were positive and 35 tumors were negative. In 16 patients (13.7%) with a genetic burden and a single neuroendocrine tumor, (123)I-MIBG whole-body imaging was successful at detecting a second tumor. In 2 patients (1.7%) with paragangliomas, (123)I-MIBG unexpectedly detected metastases, so the restaging was properly done.


CONCLUSIONS
(123)I-MIBG scintigraphy remains important in pheochromocytoma and functioning neuroendocrine tumors. The value of (123)I-MIBG scintigraphy is high in familial syndromes with multiple neuroendocrine tumors at different sites, multifocal tumors, and relapsing and metastatic disease.
Institute of Nuclear Medicine, Clinical Center of the Sarajevo University, Sarajevo, Bosnia and Herzegovina.
Renata
R
Milardovic
Eleonora P M
EP
Corssmit
Marcel
M
Stokkel
D019797:3-Iodobenzylguanidine; D000008:Abdominal Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007205:Indium Radioisotopes; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D015282:Octreotide; D010235:Paraganglioma / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology; D010673:Pheochromocytoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D011877:Radionuclide Imaging / Q000379:methods*; D019275:Radiopharmaceuticals; D013899:Thoracic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D007205:Indium Radioisotopes; D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine; D015282:Octreotide