title: Superiority of [68Ga]-DOTATATE PET/CT to Other Functional Imaging Modalities in the Localization of SDHB-Associated Metastatic Pheochromocytoma and Paraganglioma.
abstract: OBJECTIVE
  Patients with succinate dehydrogenase subunit B(SDHB) mutation-related pheochromocytoma/paraganglioma (PHEO/PGL) are at a higher risk for metastatic disease than other hereditary PHEOs/PGLs. Current therapeutic approaches are limited, but the best outcomes are based on the early and proper detection of as many lesions as possible. Because PHEOs/PGLs overexpress somatostatin receptor 2 (SSTR2), the goal of our study was to assess the clinical utility of [(68)Ga]-DOTA(0)-Tyr(3)-octreotate ([(68)Ga]-DOTATATE) positron emission tomography/computed tomography (PET/CT) and to evaluate its diagnostic utility in comparison with the currently recommended functional imaging modalities [(18)F]-fluorodopamine ([(18)F]-FDA), [(18)F]-fluorodihydroxyphenylalanine ([(18)F]-FDOPA), [(18)F]-fluoro-2-deoxy-d-glucose ([(18)F]- FDG) PET/CT as well as CT/MRI.
  
  
  METHODS
  [(68)Ga]-DOTATATE PET/CT was prospectively performed in 17 patients with SDHB-related metastatic PHEOs/PGLs. All patients also underwent [(18)F]-FDG PET/CT and CT/MRI, with 16 of the 17 patients also receiving [(18)F]-FDOPA and [(18)F]-FDA PET/CT scans. Detection rates of metastatic lesions were compared between all these functional imaging studies. A composite synthesis of all used functional and anatomical imaging studies served as the imaging comparator.
  
  
  RESULTS
  [(68)Ga]-DOTATATE PET/CT demonstrated a lesion-based detection rate of 98.6% [95% confidence interval (CI), 96.5%-99.5%], [(18)F]-FDG, [(18)F]-FDOPA, [(18)F]-FDA PET/CT, and CT/MRI showed detection rates of 85.8% (CI, 81.3%-89.4%; P < 0.01), 61.4% (CI, 55.6%-66.9%; P < 0.01), 51.9% (CI, 46.1%-57.7%; P < 0.01), and 84.8% (CI, 80.0%-88.5%; P < 0.01), respectively.
  
  
  CONCLUSIONS
  [(68)Ga]-DOTATATE PET/CT showed a significantly superior detection rate to all other functional and anatomical imaging modalities and may represent the preferred future imaging modality in the evaluation of SDHB-related metastatic PHEO/PGL.
authors: Program in Adult and Reproductive Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland. Department of Radiology and Nuclear Medicine, Section of Nuclear Medicine, University Hospital Schleswig Holstein, Campus Lübeck, Lübeck, Germany.
authors: Ingo
authors: I
authors: Janssen
authors: Nuclear Medicine Department, Bichat Hospital, Paris, France.
authors: Elise M
authors: EM
authors: Blanchet
authors: Program in Adult and Reproductive Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland.
authors: Karen
authors: K
authors: Adams
authors: Nuclear Medicine Division, Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, Maryland.
authors: Clara C
authors: CC
authors: Chen
authors: Positron Emission Tomography Department, NIH Clinical Center, NIH, Bethesda, Maryland.
authors: Corina M
authors: CM
authors: Millo
authors: Positron Emission Tomography Department, NIH Clinical Center, NIH, Bethesda, Maryland.
authors: Peter
authors: P
authors: Herscovitch
authors: Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, Marseille, France.
authors: David
authors: D
authors: Taieb
authors: Endocrine Oncology Branch, National Cancer Institute, Bethesda, Maryland.
authors: Electron
authors: E
authors: Kebebew
authors: Department of Internal Medicine I, University Hospital Schleswig Holstein, Campus Lübeck, Lübeck, Germany.
authors: Hendrik
authors: H
authors: Lehnert
authors: Center for Cancer Research, National Cancer Institute, Bethesda, Maryland.
authors: Antonio T
authors: AT
authors: Fojo
authors: Program in Adult and Reproductive Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland. karel@mail.nih.gov.
authors: Karel
authors: K
authors: Pacak
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009362:Neoplasm Metastasis; D009942:Organometallic Compounds; D010235:Paraganglioma / Q000175:diagnosis* / Q000235:genetics* / Q000628:therapy; D010673:Pheochromocytoma / Q000175:diagnosis* / Q000235:genetics* / Q000628:therapy; D049268:Positron-Emission Tomography / Q000379:methods; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013385:Succinate Dehydrogenase / Q000235:genetics*; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
chemical_list: D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; C513399:gallium Ga 68 dotatate; C108095:SDHB protein, human; D013385:Succinate Dehydrogenase