title: Localization and prediction of malignant potential in recurrent pheochromocytoma/paraganglioma (PCC/PGL) using 18F-FDG PET/CT.
abstract: BACKGROUND
  To our knowledge, data are lacking on the role of 18F-FDG PET/CT in the localization and prediction of neuroendocrine tumors, in particular the pheochromocytoma/paraganglioma (PCC/PGL) group.
  
  
  OBJECTIVE
  To evaluate the role of 18F-FDG PET/CT in localizing and predicting the malignant potential of PCC/PGL.
  
  
  METHODS
  Twenty-three consecutive patients with a history of PCC/PGL, presenting with symptoms related to catecholamine excess, underwent 18F-FDG PET/CT. Final confirmation of the diagnosis was made using the composite references. PET/CT findings were analyzed on a per-lesion basis and a per-patient basis. Tumor SUVmax was analyzed to predict the dichotomization of patient endpoints for the local disease and metastatic groups.
  
  
  RESULTS
  We investigated 23 patients (10 men, 13 women) with a mean age of 46.43 ± 3.70 years. Serum catecholamine levels were elevated in 82.60% of these patients. There were 136 sites (mean SUVmax: 16.39 ± 3.47) of validated disease recurrence. The overall sensitivities for diagnostic CT, FDG PET, and FDG PET/CT were 86.02%, 87.50%, and 98.59%, respectively. Based on the composite references, 39.10% of patients had local disease. There were significant differences in the SUVmax distribution between the local disease and metastatic groups; a significant correlation was noted when a SUVmax cut-off was set at 9.2 (P<0.05).
  
  
  CONCLUSIONS
  In recurrent PCC/PGL, diagnostic 18F-FDG PET/CT is a superior tool in the localization of recurrent tumors. Tumor SUVmax is a potentially useful predictor of malignant tumor potential.
authors.affiliation: Centre for Diagnostic Nuclear Imaging, Faculty of Medicine and Health Science, University Putra Malaysia, Serdang, Selangor, Malaysia ahmadsaadff@gmail.com.
authors.forename: Ahmad Saad Fathinul
authors.initials: AS
authors.lastname: Fikri
authors.affiliation: Univ.-KlinikfürNuklearmedizin, Innsbruck, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Kroiss
authors.affiliation: Centre for Diagnostic Nuclear Imaging, Faculty of Medicine and Health Science, University Putra Malaysia, Serdang, Selangor, Malaysia.
authors.forename: A Z F
authors.initials: AZ
authors.lastname: Ahmad
authors.affiliation: Medical Department, Hospital Putrajaya, Putrajaya, Malaysia.
authors.forename: H
authors.initials: H
authors.lastname: Zanariah
authors.affiliation: Department of Radiology, the University of Melbourne, Centre for Molecular Imaging, The Peter MacCallum, Cancer Centre, East Melbourne, Victoria, Australia.
authors.forename: W F E
authors.initials: WF
authors.lastname: Lau
authors.affiliation: Univ.-KlinikfürNuklearmedizin, Innsbruck, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Uprimny
authors.affiliation: Univ.-KlinikfürNuklearmedizin, Innsbruck, Austria.
authors.forename: E
authors.initials: E
authors.lastname: Donnemiller
authors.affiliation: Univ.-KlinikfürNuklearmedizin, Innsbruck, Austria.
authors.forename: D
authors.initials: D
authors.lastname: Kendler
authors.affiliation: Centre for Diagnostic Nuclear Imaging, Faculty of Medicine and Health Science, University Putra Malaysia, Serdang, Selangor, Malaysia.
authors.forename: A J
authors.initials: AJ
authors.lastname: Nordin
authors.affiliation: Univ.-KlinikfürNuklearmedizin, Innsbruck, Austria.
authors.forename: I J
authors.initials: IJ
authors.lastname: Virgolini
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging*; D000328:Adult; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local; D010235:Paraganglioma / Q000000981:diagnostic imaging*; D010673:Pheochromocytoma / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: 18F-FDG PET/CT; SUVmax; malignant potential; neuroendocrine; pheochromocytoma/paraganglioma; predictor; recurrence