title: PET/CT comparing (68)Ga-DOTATATE and other radiopharmaceuticals and in comparison with CT/MRI for the localization of sporadic metastatic pheochromocytoma and paraganglioma.
abstract: OBJECTIVE
  Pheochromocytomas/paragangliomas (PPGLs) and their metastases are tumors that predominantly express somatostatin receptor 2 (SSR2). (68)Ga-DOTA(0)-Tyr(3)-octreotate ((68)Ga-DOTATATE) is a PET radiopharmaceutical with both high and selective affinity for SSRs. The purpose of this study was to evaluate the utility of (68)Ga-DOTATATE in comparison with other specific and nonspecific radiopharmaceuticals recommended in the current guidelines for the localization of metastatic sporadic PPGL by PET/CT.
  
  
  METHODS
  This prospective study included 22 patients (15 men, 7 women; aged 50.0 ± 13.9 years) with confirmed metastatic PPGL, a negative family history for PPGL, and negative genetic testing, who underwent (68)Ga-DOTATATE, (18)F-fluoro-2-deoxy-D-glucose ((18)F-FDG) PET/CT, and CT/MRI. Only 12 patients underwent an additional (18)F-fluorodihydroxyphenylalanine ((18)F-FDOPA) PET/CT scan and only 11 patients underwent an additional (18)F-fluorodopamine ((18)F-FDA) PET/CT scan. The rates of detection of metastatic lesions were compared among all the imaging studies. A composite of all functional and anatomical imaging studies served as the imaging comparator.
  
  
  RESULTS
  (68)Ga-DOTATATE PET/CT showed a lesion-based detection rate of 97.6 % (95 % confidence interval, CI, 95.8 - 98.7 %). (18)F-FDG PET/CT, (18)F-FDOPA PET/CT, (18)F-FDA PET/CT, and CT/MRI showed detection rates of 49.2 % (CI 44.5 - 53.6 %; p < 0.01), 74.8 % (CI 69.0 - 79.9 %); p < 0.01), 77.7 % (CI 71.5 - 82.8 %; p < 0.01), and 81.6 % (CI 77.8 - 84.8 %; p < 0.01), respectively.
  
  
  CONCLUSIONS
  The results of this study demonstrate the superiority of (68)Ga-DOTATATE PET/CT in the localization of sporadic metastatic PPGLs compared to all other functional and anatomical imaging modalities, and suggest modification of future guidelines towards this new imaging modality.
authors.affiliation: Program in Adult and Reproductive Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Building 10, CRC, Room 1E-3140, 10 Center Drive MSC-1109, Bethesda, MD, 20892, USA.|Department of Radiology and Nuclear Medicine, Section of Nuclear Medicine, University Hospital Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Janssen
authors.affiliation: Nuclear Medicine Division, Radiology & Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, 20892, USA.
authors.forename: Clara C
authors.initials: CC
authors.lastname: Chen
authors.affiliation: Positron Emission Tomography Department, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA.
authors.forename: Corina M
authors.initials: CM
authors.lastname: Millo
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, 20892, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ling
authors.affiliation: Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, Marseille, France.
authors.forename: David
authors.initials: D
authors.lastname: Taieb
authors.affiliation: Cancer Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
authors.forename: Frank I
authors.initials: FI
authors.lastname: Lin
authors.affiliation: Program in Adult and Reproductive Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Building 10, CRC, Room 1E-3140, 10 Center Drive MSC-1109, Bethesda, MD, 20892, USA.
authors.forename: Karen T
authors.initials: KT
authors.lastname: Adams
authors.affiliation: Program in Adult and Reproductive Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Building 10, CRC, Room 1E-3140, 10 Center Drive MSC-1109, Bethesda, MD, 20892, USA.
authors.forename: Katherine I
authors.initials: KI
authors.lastname: Wolf
authors.affiliation: Positron Emission Tomography Department, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Herscovitch
authors.affiliation: Endocrine Oncology Branch, National Cancer Institute, Bethesda, MD, 20892, USA.
authors.forename: Antonio T
authors.initials: AT
authors.lastname: Fojo
authors.affiliation: Department of Radiology and Nuclear Medicine, Section of Nuclear Medicine, University Hospital Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
authors.forename: Inga
authors.initials: I
authors.lastname: Buchmann
authors.affiliation: Center for Cancer Research, National Cancer Institute, Bethesda, MD, 20892, USA.
authors.forename: Electron
authors.initials: E
authors.lastname: Kebebew
authors.affiliation: Program in Adult and Reproductive Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Building 10, CRC, Room 1E-3140, 10 Center Drive MSC-1109, Bethesda, MD, 20892, USA. karel@mail.nih.gov.
authors.forename: Karel
authors.initials: K
authors.lastname: Pacak
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009942:Organometallic Compounds; D010235:Paraganglioma / Q000000981:diagnostic imaging* / Q000556:secondary*; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
chemical_list: D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; C513399:gallium Ga 68 dotatate
keywords: 18F-FDG; 68Ga-DOTATATE; Metastatic; Paraganglioma; Pheochromocytoma