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The role of 6-[¹⁸F]fluorodopamine positron emission tomography in the localization of adrenal pheochromocytoma associated with von Hippel–Lindau syndrome

Reproductive Biology and Medicine Branch, Section on Medical Neuroendocrinology, National Institute of Child Health and Human Development, Building 10, CRC, 1-East, Room 1-3140, 10 Center Drive, MSC-1109, Bethesda, Maryland 20892, USA, ¹ Nuclear Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892-1583, USA, ² Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland 20892, USA and ³ Clinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland 20892, USA

(Correspondence should be addressed to K Pacak; Email: karel{at}mail.nih.gov)

Objective: [^123/131I]metaiodobenzylguanidine (MIBG) scintigraphy is considered as the gold standard in the localization of pheochromocytoma. However, this method has less optimal sensitivity for the detection of pheochromocytoma associated with von Hippel–Lindau (VHL). Our preliminary results suggest that this is partially due to the low expression of cell membrane norepinephrine transporter system in VHL-related pheochromocytoma cells. Another probable cause may be the low affinity that [^123/131I]MIBG has for these cells. Recently, 6-[¹⁸F]fluorodopamine ([¹⁸F]DA) positron emission tomography (PET) has been introduced as a novel functional imaging modality with high sensitivity for pheochromocytoma. Therefore, we investigated whether [¹⁸F]DA PET is more effective than [^123/131I]MIBG scintigraphy in the diagnostic localization of VHL-related adrenal pheochromocytoma.

Materials and methods: In this study, we evaluated seven VHL patients in whom adrenal pheochromocytomas were confirmed by histopathology results. Adrenal pheochromocytomas were localized using computed tomography (CT), magnetic resonance imaging (MRI), [^123/131I]MIBG scintigraphy and [¹⁸F]DA PET.

Results: [¹⁸F]DA PET localized pheochromocytoma in all the seven patients, as did in CT. In contrast, three out of the seven had negative results utilizing [^123/131I]MIBG scintigraphy and one out of the six patients had negative MRI results.

Conclusions: [¹⁸F]DA PET was found to show more promising results when compared with [^123/131I]MIBG scintigraphy in the diagnostic localization of VHL-related adrenal pheochromocytoma, with a 100% rate of localization. Thus, [¹⁸F]DA PET in conjunction with CT/MRI should be considered as an effective method for the proper localization of VHL-related adrenal pheochromocytoma.

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