11C-Hydroxyephedrine Positron Emission Tomography Imaging of Pheochromocytoma: A Single Center Experience over 11 Years

Shinji Yamamoto, Per Hellman, Cecilia Wassberg, Anders Sundin
2012 Journal of Clinical Endocrinology and Metabolism  
Context: Localization of the primary tumor and detection of metastases are essential for preoperative planning and postoperative management of pheochromocytoma. When computed tomography (CT) and magnetic resonance imaging are inadequate, functional imaging adds important information in this respect. Objective: In this study the efficacy of positron emission tomography (PET) and PET/CT with 11 Chydroxyephedrine (HED) was evaluated. Design: HED-PET (n ϭ 69) and PET/CT (n ϭ 101) examinations of
more » ... patients were analyzed, of which 103 were performed before surgery and 67 postoperatively. Image findings were evaluated and tracer uptake in tumors measured as the maximum standardized uptake value (SUVmax), which was compared with histopathological and clinical data. Results: Sixty HED-PET and PET/CT examinations were positive, with no false-positive and six falsenegative examinations (sensitivity 91%, specificity 100%). Sensitivity of HED-PET in multiple endocrine neoplasia type II patients was lower (73%) with 100% specificity. The mean SUVmax was significantly higher when sympathetic symptoms were present and in metastases compared with primary tumors. The SUVmax correlated significantly with plasma normetanephrine and urinary norepinephrine. The mean SUVmax in HED-positive primary tumors was significantly higher than in normal adrenal glands. Conclusion: HED-PET and PET/CT demonstrated 91% sensitivity and maximum specificity but with lower sensitivity in multiple endocrine neoplasia type II patients. The degree of HED accumulation (SUVmax) in the tumors correlated to malignancy and biochemical data. (J Clin Endocrinol Metab Abbreviations: CT, Computed tomography; FDG, 18F-fluoro-2-deoxy-glucose; FOV, field of view; HED, 11 C-hydroxyephedrine; MIBG, 123 I-metaiodo-benzyl-guanidine; MEN II, multiple endocrine neoplasia type II; MRI, magnetic resonance imaging; NF1, neurofibromatosis type 1; PET, positron emission tomography; ROI, regions of interest; SDHB, succinyl dehydrogenase subunit B; SPECT, single-photon computed emission tomography; SUV, standardized uptake value; SUVaverage, average SUV; SUVliver, SUVaverage in liver was recorded as a normal tissue reference; SUVmax, SUV for the pixel with the highest uptake; VHL, von Hippel-Lindau. O R I G I N A L A R T I C L E E n d o c r i n e C a r e J Clin Endocrinol Metab, July 2012, 97(7):2423-2432 jcem.endojournals.org 2423 2424 Yamamoto et al. Hydroxyephedrine PET of Pheochromocytoma J Clin Endocrinol Metab, July 2012, 97(7):2423-2432 Plasma chromogranin A (nmol/liter) (reference Ͻ4) 1.8 -131, 7.6 (n ϭ 46) 0.8 -25, 4.1 (n ϭ 74) Plasma normetanephrine (nmol/liter) (reference Ͻ0.6) 0.2-16, 1.0 (n ϭ 35) 0.2-4,8, 0.5 (n ϭ 63) Plasma metanephrine (nmol/liter) (reference Ͻ0.3). UD -34, 0.2 (n ϭ 35) UD Ϫ 0.5, 0.2 (n ϭ 62) Urinary norepinephrine (nmol/d) (reference 60 -400) UD Ϫ 19130, 761 (n ϭ 56) UD Ϫ 1800, 406 (n ϭ 79) Urinary norepinephrine/creatinine (mol/mol) (reference 4 -32) UD Ϫ 1218, 46 (n ϭ 50) UD Ϫ 168, 36.2 (n ϭ 67) Urinary epinephrine (nmol/d) (reference Ͻ90) UD Ϫ 33322, 81 (n ϭ 54) UD Ϫ 1025, 37 (n ϭ 71) Urinary epinephrine/creatinine (mol/mol) (reference 0.3-9) UD Ϫ 1983, 7.2 (n ϭ 50) UD Ϫ 74, 3.4 (n ϭ 58) Urinary normetanephrine (nmol/d) (reference 60 -400) UD Ϫ 99.2, 2.8 (n ϭ 25) UD Ϫ 6.2, 2.5 (n ϭ 37) Urinary normetanephrine/creatinine (mol/mol) (reference 20 -190) UD Ϫ 5905, 408 (n ϭ 24) UD Ϫ 581, 271 (n ϭ 32) Urinary metanephrine (nmol/d) (reference Ͻ1.5) UD Ϫ 1152, 1.8 (n ϭ 23) UD Ϫ 1176, 0.8 (n ϭ 33) Urinary metanephrine/creatinine (mol/mol) (reference15-100) UD Ϫ 2711, 101.5 (n ϭ 23) UD Ϫ 177, 81 (n ϭ 31) Urinary methoxytyramine (nmol/d (reference Ͻ1.6) UD Ϫ 303, 1.1 (n ϭ 24) UD Ϫ 65, 1.3 (n ϭ 31) Urinary methoxytyramine/creatinine (mol/mol) (reference 40 -135) UD Ϫ 5609, 102.5 (n ϭ 22) UD Ϫ 444, 123.5 (n ϭ 30) 2428 Yamamoto et al.
doi:10.1210/jc.2011-3342 pmid:22563107 fatcat:bigrflutbrdnfecfcqfsfohnti