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Aim/Introduction <p>[<sup>18</sup>F]FDOPA PET/CT is one of the most frequently used functional imaging modalities for the diagnosis of pheochromocytoma and paraganglioma (PPGL). The biochemical secretion type of PPGL is crucial for patient management, being linked to varying aggressiveness and metastatic risk. The aim of this study is to compare the biochemical phenotype and secretion with uptake intensity and tumour volume on [<sup>18</sup>F]FDOPA PET/CT.</p> Methods <p>All patients with sympathetic PPGL undergoing [<sup>18</sup>F]FDOPA PET/CT and laboratory analysis at first diagnosis at LMU University Hospital between 03/2012 and 11/2023 were included. Metabolic tumour volume (MTV), SUVmax, SUVmean and total lesion uptake (TLU) were compared to biochemical secretion using Rho-Spearman’s correlation and linear regression correcting for age, gender and secretion type. Biochemical phenotypes were compared with Mann-Whitney-U-test, ROC analysis was used to test the diagnostic discriminative power of radioligand uptake.</p> Results <p>71 of 74 PPGL were [<sup>18</sup>F]DOPA-positive. TLU and MTV showed a moderate to strong correlation with plasma and urinary normetanephrines (<i>R</i> = 0.68–0.82, <i>p</i> &lt; 0.001), plasma 3-methoxytyramine (<i>R</i> = 0.50, <i>p</i> = 0.003) and urinary metanephrines (<i>R</i> = 0.69–0.80, <i>p</i> &lt; 0.001). Regression analysis revealed a significant relationship between biochemical secretion and TLU (r<sup>2</sup> = 0.45–0.52, <i>p</i> &lt; 0.001). Compared to adrenergic PPGL, noradrenergic PPGL demonstrated an increased radioligand uptake (<i>p</i> &lt; 0.001). ROC analysis identified thresholds for SUVmax ( &gt; 12.1) and SUVmean ( &gt; 6.95) that moderately distinguished both phenotypes (AUC = 0.75-0.76).</p> Conclusion <p>Radioligand uptake on [<sup>18</sup>F ]FDOPA PET/CT is associated with the biochemical phenotype of PPGL. This finding may facilitate the metabolic profiling of patients with suspected impaired or delayed laboratory results. Normetanephrine concentrations in plasma and 24-hour urine may be employed as predictive markers of MTV and TLU.</p>

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Quantitative [18F]FDOPA PET/CT for the characterization of biochemical phenotypes in paraganglioma and pheochromocytoma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月24日

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  • Paul Dahlmann,
  • Meike Onkes,
  • Sophie Kunte,
  • Matthias K. Auer,
  • Ulrike Disko,
  • Katharina Wang,
  • Christian Lottspeich,
  • Isabel Stüfchen,
  • Júnia R.O.L. Schweizer,
  • Nabeel Mansour,
  • Matthias Brendel,
  • Christine Schmid-Tannwald,
  • Alessa Fischer,
  • Svenja Nölting,
  • Christoph J. Auernhammer,
  • Martin Reincke,
  • Martin Bidlingmaier,
  • Rudolf A. Werner,
  • Matthias Kroiss,
  • Friederike Völter

摘要

Aim/Introduction

[18F]FDOPA PET/CT is one of the most frequently used functional imaging modalities for the diagnosis of pheochromocytoma and paraganglioma (PPGL). The biochemical secretion type of PPGL is crucial for patient management, being linked to varying aggressiveness and metastatic risk. The aim of this study is to compare the biochemical phenotype and secretion with uptake intensity and tumour volume on [18F]FDOPA PET/CT.

Methods

All patients with sympathetic PPGL undergoing [18F]FDOPA PET/CT and laboratory analysis at first diagnosis at LMU University Hospital between 03/2012 and 11/2023 were included. Metabolic tumour volume (MTV), SUVmax, SUVmean and total lesion uptake (TLU) were compared to biochemical secretion using Rho-Spearman’s correlation and linear regression correcting for age, gender and secretion type. Biochemical phenotypes were compared with Mann-Whitney-U-test, ROC analysis was used to test the diagnostic discriminative power of radioligand uptake.

Results

71 of 74 PPGL were [18F]DOPA-positive. TLU and MTV showed a moderate to strong correlation with plasma and urinary normetanephrines (R = 0.68–0.82, p < 0.001), plasma 3-methoxytyramine (R = 0.50, p = 0.003) and urinary metanephrines (R = 0.69–0.80, p < 0.001). Regression analysis revealed a significant relationship between biochemical secretion and TLU (r2 = 0.45–0.52, p < 0.001). Compared to adrenergic PPGL, noradrenergic PPGL demonstrated an increased radioligand uptake (p < 0.001). ROC analysis identified thresholds for SUVmax ( > 12.1) and SUVmean ( > 6.95) that moderately distinguished both phenotypes (AUC = 0.75-0.76).

Conclusion

Radioligand uptake on [18F ]FDOPA PET/CT is associated with the biochemical phenotype of PPGL. This finding may facilitate the metabolic profiling of patients with suspected impaired or delayed laboratory results. Normetanephrine concentrations in plasma and 24-hour urine may be employed as predictive markers of MTV and TLU.