68Ga-DOTATOC PET/CT in the localization of head and neck paraganglioma compared with 18F-DOPA PET/CT and 123I-MIBG SPECT/CT

Abstract Purpose 18 F-Fluoro-L-dihydroxyphenylalanine ( 18 F-DOPA) PET offers high sensitivity and specificity in the imaging of non-malignant head and neck paraganglioma (HNPGL) but lower sensitivity in metastatic disease of these neuroendocrine tumours (NET). In contrast to the radiotracer 18 F-DOPA, both 123 I-meta-iodo-benzylguanidine ( 123 I-MIBG) and 68 Ga-DOTA-Tyr3-octreotide ( 68 Ga-DOTA-TOC) offer valuable clinical information on norepinephrine and somatostatin (SST) receptor status for planning 131 I-MIBG and radionuclide peptide therapy (PRRT), respectively. Therefore, we compared 68 Ga-DOTA-TOC and 18 F-DOPA PET/CT with 123 I-MIBG planar and SPECT/CT imaging, for the detection of HNPGL. Combined cross-sectional imaging was the reference standard. Methods A total of 3 men and 7 women (age range 22 to 73 years) with anatomical and/or histologically proven HNPGL were included in this study. Of these patients, 3 patients had metastatic HNPGL. Comparative evaluation included morphological imaging with CT and functional imaging with 68 Ga-DOTA-TOC and 18 F-DOPA PET, including 123 I-MIBG imaging. The imaging results were analysed on a per-patient and per-lesion basis. Results On a per-patient analysis, the detection rate of both 68 Ga-DOTA-TOC PET/CT and 18 F-DOPA PET/CT was 100%, that of planar 123 I-MIBG imaging 10.0% and that of SPECT/CT 20.0%. On a per-lesion basis and in reference to diagnostic CT, the sensitivity of 68 Ga-DOTA-TOC PET/CT was 100% (McNemar, P 18 F-DOPA PET/CT was 66.7% (McNemar, P 123 I-MIBG imaging was 3.7% (McNemar, P P 68 Ga-DOTA-TOC PET identified 29 lesions and anatomical imaging identified 27 lesions. 18 F-DOPA PET identified 18 lesions, whereas planar 123 I-MIBG imaging identified 1 lesion and SPECT/CT 2 lesions. Conclusion 68 Ga-DOTA-TOC PET/CT is superior for imaging, non-malignant and metastatic HNPGL compared to 18 F-DOPA PET/CT and planar 123 I-MIBG imaging, including SPECT/CT, particularly in bone lesions. Combined functional/anatomical imaging ( 68 Ga-DOTA-TOC PET/CT) enables excellent delineation of tumour extent in these rare tumour entities. Compared to 123 I-MIBG scintigraphy, 68 Ga-DOTA-TOC PET appears far more useful for planning radionuclide therapy in patients with surgically inoperable tumours or metastatic disease.