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Introduction <p>[<sup>18</sup>F]FDOPA PET/CT is widely used in the diagnostic work-up of pheochromocytoma and paraganglioma (PPGL), with the latter entity classified into genetic clusters 1a, 1b, and 2 and sporadic tumours, reflecting varying aggressiveness. We aimed to assess diagnostic performance and quantitative [<sup>18</sup>F]FDOPA uptake across genetic clusters.</p> Methods <p>Consecutive PPGL patients with [<sup>18</sup>F]FDOPA PET/CT at initial diagnosis and available information on germline and/or somatic testing were included. Patients were grouped into genetic clusters. PET quantification included metabolic tumour volume (MTV) and maximum SUV(SUV<sub>max</sub>), mean SUV(SUV<sub>mean</sub>) and tumour-to-background ratio (TBR, SUV<sub>max</sub>/liver SUV<sub>mean</sub>). The diameter of the primary was determined on CT. The diagnostic sensitivity for detecting PPGL lesions was assessed visually and with a TBR threshold &gt; 2. Lesion- and patient-based sensitivities were calculated. Subgroups were compared using non-parametric tests with multiplicity control.</p> Results <p>69 patients presenting with 86 tumour lesions were analyzed. Patient-based sensitivity was 97.1% (67/69; 95%-CI 89.9–99.7) and lesion-based sensitivity 94.2% (81/86; 95%-CI 87.0-98.1%). Lesion-based sensitivity was 96.3% in non-metastatic disease (77/80; 95%-CI 89.4–99.2%) and 66.7% in metastatic disease [4/6; 95%-CI 22.3–95.7%]). Quantitative analysis showed a high image contrast (median TBR: 6.9). Cluster 2 showed less uptake intensity than sporadic, cluster 1a and cluster 1b tumours (TBR/SUV<sub>mean</sub>/SUV<sub>max</sub>, <i>p</i> = 0.003–0.025). MTV was larger in cluster 1b and sporadic cases than in cluster 2 (<i>p</i> = 0.011–0.018), whereas tumour diameter on CT did not differ between groups (<i>p</i> = 0.086–0.927).</p> Conclusion <p>[<sup>18</sup>F]FDOPA PET/CT provides excellent image contrast in non-metastasized PPGL and can differentiate between varying genetic clusters, while morphological imaging failed for subtype segregation.</p>

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Genotype-dependent [18F]FDOPA uptake: quantitative evidence from a genetically stratified PPGL cohort

  • 期刊论文

  • 发表日期：

    2026年6月26日

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  • Paul Dahlmann,
  • Maria Geuss,
  • Matthias Auer,
  • Ulrike Disko,
  • Katharina Wang,
  • Nabeel Mansour,
  • Christine Schmid-Tannwald,
  • Svenja Nölting,
  • Nicole Reisch,
  • Martin Reincke,
  • Christian Lottspeich,
  • Matthias Kroiss,
  • Rudolf A. Werner,
  • Friederike Völter

摘要

Introduction

[18F]FDOPA PET/CT is widely used in the diagnostic work-up of pheochromocytoma and paraganglioma (PPGL), with the latter entity classified into genetic clusters 1a, 1b, and 2 and sporadic tumours, reflecting varying aggressiveness. We aimed to assess diagnostic performance and quantitative [18F]FDOPA uptake across genetic clusters.

Methods

Consecutive PPGL patients with [18F]FDOPA PET/CT at initial diagnosis and available information on germline and/or somatic testing were included. Patients were grouped into genetic clusters. PET quantification included metabolic tumour volume (MTV) and maximum SUV(SUVmax), mean SUV(SUVmean) and tumour-to-background ratio (TBR, SUVmax/liver SUVmean). The diameter of the primary was determined on CT. The diagnostic sensitivity for detecting PPGL lesions was assessed visually and with a TBR threshold > 2. Lesion- and patient-based sensitivities were calculated. Subgroups were compared using non-parametric tests with multiplicity control.

Results

69 patients presenting with 86 tumour lesions were analyzed. Patient-based sensitivity was 97.1% (67/69; 95%-CI 89.9–99.7) and lesion-based sensitivity 94.2% (81/86; 95%-CI 87.0-98.1%). Lesion-based sensitivity was 96.3% in non-metastatic disease (77/80; 95%-CI 89.4–99.2%) and 66.7% in metastatic disease [4/6; 95%-CI 22.3–95.7%]). Quantitative analysis showed a high image contrast (median TBR: 6.9). Cluster 2 showed less uptake intensity than sporadic, cluster 1a and cluster 1b tumours (TBR/SUVmean/SUVmax, p = 0.003–0.025). MTV was larger in cluster 1b and sporadic cases than in cluster 2 (p = 0.011–0.018), whereas tumour diameter on CT did not differ between groups (p = 0.086–0.927).

Conclusion

[18F]FDOPA PET/CT provides excellent image contrast in non-metastasized PPGL and can differentiate between varying genetic clusters, while morphological imaging failed for subtype segregation.