Adrenal tracer uptake by 18F-FDOPA PET/CT in patients with pheochromocytoma and controls

• Published in: European journal of nuclear medicine and molecular imaging Vol. 46; no. 7; pp. 1560 - 1566
• Main Authors: Noordzij, Walter, Glaudemans, Andor W. J. M., Schaafsma, Mirte, van der Horst-Schrivers, Anouk N. A., Slart, Riemer H. J. A., van Beek, André P., Kerstens, Michiel N.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2019; Springer Nature B.V
• Subjects: Adrenal glands; Adrenalectomy; Cardiology; Computed tomography; Diagnostic systems; Dihydroxyphenylalanine; Disease control; Fluorine isotopes; Image reconstruction; Imaging; Localization; Medicine; Medicine & Public Health; Nuclear Medicine; Oncology; Original; Original Article; Orthopedics; Patients; Pheochromocytoma; Positron emission; Radiology; Regression analysis; Sensitivity analysis; Statistical analysis; Tomography; Normative data; F-FDOPA; Pheochromocytoma; Adrenal glands
• ISSN: 1619-7070; 1619-7089; 1619-7089
• DOI: 10.1007/s00259-019-04332-5

Context 18 F-FDOPA PET/CT accurately localizes pheochromocytoma in patients with an established biochemical diagnosis. However, cut-off 18 F-FDOPA levels of standardized uptake values (SUV max ) for both normal adrenal glands and pheochromocytoma are lacking. Objective Objectives of this study were to determine (1) reference maximum standardized uptake values (SUVmax) for normal adrenal 18 F-DOPA tracer uptake and (2) the optimal diagnostic approach for pheochromocytoma localization by using 18 F-DOPA SUVmax across a series of cut-off points: the affected adrenal gland (inter-individual analysis), the difference in SUVmax between the affected adrenal gland and the contralateral normal adrenal gland (intra-individual analysis), or a combination of these two. Patients and methods All patients with histologically confirmed pheochromocytoma diagnosed at our center between November 2009 and December 2017 were retrospectively analysed. Only those patients who underwent an 18 F-FDOPA PET/CT-scan for localization purposes before adrenalectomy were included for further analysis. The control group consisted of patients who underwent 18 F-FDOPA PET/CT for other indications and who had no genetic susceptibility for developing a pheochromocytoma. SUV max of the volume of interest surrounding the adrenal glands was determined on EARL reconstructed images. Receiver operating characteristic (ROC) analysis was performed for adrenal gland SUV max and intra-individual difference in SUV max between affected and normal adrenal gland. In addition, binary logistic regression was performed for ROC analysis of the combined parameters. Results In total, 47 histologically confirmed pheochromocytomas were diagnosed in 45 patients, and 245 disease control patients were identified. In the control group, no statistical differences between the SUV max of left and right adrenal glands were observed, and uptake values in both adrenal glands correlated significantly with each other (r = 0.865, p  < 0.001). Median (range) adrenal gland SUV max in pheochromocytomas and in the control group was 12 (2.6–50) and 2.9 (1.1–6.6), respectively ( p  < 0.001). ROC analysis revealed 93% sensitivity and 85% specificity at an SUV max cut-off value of 4.1 (area under the curve (AUC) = 0.951), and 93% sensitivity and 96% specificity at an intra-individual SUV max difference between the affected and normal adrenal gland of 1.0 (AUC = 0.992). The combination of both variables increased the AUC to 0.995. Conclusions 18 F-FDOPA PET/CT distinguishes pheochromocytoma from normal adrenal glands with the highest diagnostic accuracy when combining the SUVmax of the affected adrenal gland with the difference in SUV max between affected and normal adrenal gland.