title: Prospective comparison of (68)Ga-DOTATATE and (18)F-FDOPA PET/CT in patients with various pheochromocytomas and paragangliomas with emphasis on sporadic cases.
abstract: OBJECTIVE
  Pheochromocytomas/paragangliomas (PHEOs/PGLs) overexpress somatostatin receptors and recent studies have already shown excellent results in the localization of these tumors using (68)Ga-labeled somatostatin analogs ((68)Ga-DOTA-SSA), especially in patients with germline succinate dehydrogenase subunit B gene (SDHB) mutations and head and neck PGLs (HNPGLs). The value of (68)Ga-DOTA-SSA has to be established in sporadic cases, including PHEOs. Thus, the aim of this study was to compare (68)Ga-DOTATATE PET/CT, (18)F-FDOPA PET/CT, and conventional imaging in patients with various PHEOs/PGLs with a special emphasis on sporadic cases, including those located in the adrenal gland.
  
  
  METHODS
  (68)Ga-DOTATATE, (18)F-FDOPA PET/CT, and conventional imaging (contrast-enhanced CT and MRI with MR angiography sequences) were prospectively performed in 30 patients (8 with SDHD mutations, 1 with a MAX mutation and 21 sporadic cases) with PHEO/PGL at initial diagnosis or relapse.
  
  
  RESULTS
  The patient-based sensitivities were 93 % (28/30), 97 % (29/30), and 93 % (28/30) for (68)Ga-DOTATATE PET/CT, (18)F-FDOPA PET/CT, and conventional imaging, respectively. The lesion-based sensitivities were 93 % (43/46), 89 % (41/46), and 76 % (35/46) for (68)Ga-DOTATATE PET/CT, (18)F-FDOPA PET/CT, and conventional imaging respectively (p = 0.042). (68)Ga-DOTATATE PET/CT detected a higher number of HNPGLs (30/30) than (18)F-FDOPA PET/CT (26/30; p = 0.112) and conventional imaging (24/30; p = 0.024). (68)Ga-DOTATATE PET/CT missed two PHEOs of a few millimeters in size and a large recurrent PHEO. One lesion was considered false-positive on (68)Ga-DOTATATE PET/CT and corresponded to a typical focal lesion of fibrous dysplasia on MRI. Among the 11 lesions missed by conventional imaging, 7 were detected by conventional imaging with knowledge of the PET results (4 HNPGLs, 2 LNs, and 1 recurrent PHEO).
  
  
  CONCLUSIONS
  (68)Ga-DOTATATE PET/CT is the most sensitive tool in the detection of HNPGLs, especially SDHD-related tumors, which may be very small and fail to concentrate sufficient (18)F-FDOPA. The present study further expands the use of (68)Ga-DOTATATE for all patients with HNPGLs, regardless of their genotype. (68)Ga-DOTATATE PET/CT may be inferior to (18)F-FDOPA PET/CT in the detection PHEOs.
authors.affiliation: Department of Nuclear Medicine, La Timone & North University Hospital, Aix-Marseille University, Marseille, France.|European Center for Research in Medical Imaging, Aix-Marseille University, Marseille, France.|Institut Paoli-Calmettes, Inserm UMR1068 Marseille Cancerology Research Center, Marseille, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Archier
authors.affiliation: Department of Medical Imaging, Conception Hospital, Aix-Marseille University, Marseille, France.
authors.forename: Arthur
authors.initials: A
authors.lastname: Varoquaux
authors.affiliation: Department of Nuclear Medicine, La Timone & North University Hospital, Aix-Marseille University, Marseille, France.|Department of Radiopharmacy, La Timone & North University Hospital, Aix-Marseille University, Marseille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Garrigue
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Conception Hospital, Aix-Marseille University, Marseille, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Montava
authors.affiliation: Department of Endocrine Surgery, Conception Hospital, Aix-Marseille University, Marseille, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Guerin
authors.affiliation: Department of Nuclear Medicine, La Timone & North University Hospital, Aix-Marseille University, Marseille, France.|European Center for Research in Medical Imaging, Aix-Marseille University, Marseille, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Gabriel
authors.affiliation: Department of Medical Imaging, Conception Hospital, Aix-Marseille University, Marseille, France.
authors.forename: Eva
authors.initials: E
authors.lastname: Beschmout
authors.affiliation: Department of Endocrinology, Conception Hospital, Aix-Marseille University, Marseille, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Morange
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Conception Hospital, Aix-Marseille University, Marseille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Fakhry
authors.affiliation: Department of Endocrinology, Conception Hospital, Aix-Marseille University, Marseille, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Castinetti
authors.affiliation: Department of Endocrine Surgery, Conception Hospital, Aix-Marseille University, Marseille, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Sebag
authors.affiliation: Laboratory of Biochemistry and Molecular Biology, Conception Hospital, Aix-Marseille, University, Marseille, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Barlier
authors.affiliation: Department of Public Health, Aix-Marseille University, Marseille, France.
authors.forename: Anderson
authors.initials: A
authors.lastname: Loundou
authors.affiliation: Department of Nuclear Medicine, La Timone & North University Hospital, Aix-Marseille University, Marseille, France.|Department of Radiopharmacy, La Timone & North University Hospital, Aix-Marseille University, Marseille, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Guillet
authors.affiliation: Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health, Bethesda, MD, 20892, USA.
authors.forename: Karel
authors.initials: K
authors.lastname: Pacak
authors.affiliation: Department of Nuclear Medicine, La Timone & North University Hospital, Aix-Marseille University, Marseille, France. david.taieb@ap-hm.fr.|European Center for Research in Medical Imaging, Aix-Marseille University, Marseille, France. david.taieb@ap-hm.fr.|Institut Paoli-Calmettes, Inserm UMR1068 Marseille Cancerology Research Center, Marseille, France. david.taieb@ap-hm.fr.
authors.forename: David
authors.initials: D
authors.lastname: Taïeb
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004295:Dihydroxyphenylalanine / Q000031:analogs & derivatives*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D010235:Paraganglioma / Q000000981:diagnostic imaging*; D010673:Pheochromocytoma / Q000000981:diagnostic imaging*; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D009942:Organometallic Compounds; C043437:fluorodopa F 18; D004295:Dihydroxyphenylalanine; C513399:gallium Ga 68 dotatate
keywords: Gallium radioisotopes; Neuroendocrine; Paragangliomas; Positron emission tomography; Somatostatin