Purpose

To compare the detection ability of ⁶⁸Ga-labelled DOTA-l-Nal3-octreotide ([⁶⁸Ga]Ga-DOTA-NOC) and 6-[¹⁸F]fluoro-L-3,4-dihydroxyphenylalanine ([¹⁸F]DOPA) in patients with phaeochromocytomas and paragangliomas (PPGLs) of different origins and gene mutations, such as germline succinate dehydrogenase complex genes (SDHx).

Methods

Eighty-five patients with histopathologically confirmed PPGLs who underwent both [⁶⁸Ga]Ga-DOTA-NOC and [¹⁸F]DOPA PET/CT from March 2017 to June 2023 were enrolled in this retrospective study. For comparative analyses, PPGLs were classified as phaeochromocytoma (PCC), sympathetic paraganglioma (sPGL), and head/neck paraganglioma (HNPGL). Detection rates were analyzed on per-patient and per-lesion bases and compared using the Chi-square/Fischer’s exact test.

Results

Among 85 patients with PPGLs (48 males; 43 years ± 17 [SD]), the patient-based detection rates of [⁶⁸Ga]Ga-DOTA-NOC and [¹⁸F]DOPA PET/CT were 87.1% (74/85) and 89.4% (76/85), respectively (p = 0.634), and the lesion-based detection rates were 80.8% (479/593) and 71.2% (422/593), respectively (p < 0.001). Only one patient with a recurrent PCC presented double-negative imaging, while 66 patients exhibited double-positive imaging. The remaining patients were either [⁶⁸Ga]Ga-DOTA-NOC-negative/[¹⁸F]DOPA-positive (n = 10) or [⁶⁸Ga]Ga-DOTA-NOC-positive/[¹⁸F]DOPA-negative (n = 8). In subgroup analyses, [⁶⁸Ga]Ga-DOTA-NOC PET/CT detected significantly more metastases of sPGL (91.1%, 236/259) and SDHx-related PPGL (89.6%, 86/96) than [¹⁸F]DOPA PET/CT (48.6%[126/259] and 50.0%[48/96], respectively; both p < 0.001). However, [¹⁸F]DOPA showed significantly higher detection rates of PCC in both primary/recurrent and metastatic lesions (94.3%[50/53] vs. 62.3%[33/53] and 87.9%[174/198] vs. 69.2%[137/198], respectively; both p < 0.001). Regarding metastases in different organs, [⁶⁸Ga]Ga-DOTA-NOC PET/CT detected more lesions than [¹⁸F]DOPA PET/CT in bone (96.2%[176/183] vs. 66.1%[121/183]; p < 0.001) and lymph nodes (82.0%[73/89] vs. 53.9%[48/89]; p < 0.001) but less lesions in peritoneum (20%[4/20] vs. 100%[20/20]; p < 0.001).

Conclusion

[⁶⁸Ga]Ga-DOTA-NOC and [¹⁸F]DOPA are complementary in diagnosing PPGL under the appropriate clinical setting. [⁶⁸Ga]Ga-DOTA-NOC should be considered as the ideal first-line tracer for detecting metastases of sPGL and SDHx-related tumours, whereas [¹⁸F]DOPA may be the optimal tracer for evaluating non-SDHx-related PCC, especially in detecting primary lesions and monitoring recurrence.

中文翻译：

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[68Ga]Ga-DOTA-NOC 与 [18F]DOPA PET/CT 在嗜铬细胞瘤和副神经节瘤不同患者队列中的头对头比较

目的

比较⁶⁸ Ga 标记的 DOTA-l-Nal3-奥曲肽 ([ ⁶⁸ Ga]Ga-DOTA-NOC) 和 6-[ ¹⁸ F]氟-L-3,4-二羟基苯丙氨酸 ([ ¹⁸ F]DOPA)的检测能力）患有不同来源和基因突变的嗜铬细胞瘤和副神经节瘤（PPGL）患者，例如种系琥珀酸脱氢酶复合物基因（SDHx）。

方法

2017 年 3 月至 2023 年 6 月期间，85 名经组织病理学证实的 PPGL 患者接受了 [ ⁶⁸ Ga]Ga-DOTA-NOC 和 [ ¹⁸ F]DOPA PET/CT 治疗，被纳入这项回顾性研究。为了进行比较分析，PPGL 被分类为嗜铬细胞瘤 (PCC)、交感神经副神经节瘤 (sPGL) 和头/颈副神经节瘤 (HNPGL)。对每个患者和每个病变的检出率进行分析，并使用卡方/费舍尔精确检验进行比较。

结果

在 85 名 PPGL 患者（48 名男性；43 岁 ± 17 [SD]）中，[ ⁶⁸ Ga]Ga-DOTA-NOC 和 [ ¹⁸ F]DOPA PET/CT 的基于患者的检出率为 87.1% (74/85 ）和 89.4%（76/85）（p  = 0.634），基于病变的检出率分别为 80.8%（479/593）和 71.2%（422/593）（p  < 0.001）。只有 1 名复发 PCC 患者呈现双阴性影像，而 66 名患者呈现双阳性影像。其余患者为[ ⁶⁸ Ga]Ga-DOTA-NOC 阴性/[ ¹⁸ F]DOPA 阳性（n  = 10）或[ ⁶⁸ Ga]Ga-DOTA-NOC 阳性/[ ¹⁸ F]DOPA 阴性（n  = 8）。在亚组分析中，[ ⁶⁸ Ga]Ga-DOTA-NOC PET/CT 检测到的 sPGL (91.1%, 236/259) 和SDHx相关 PPGL (89.6%, 86/96) 转移明显多于 [ ¹⁸ F]DOPA PET /CT（分别为 48.6%[126/259] 和 50.0%[48/96]；均p  < 0.001）。然而，[ ¹⁸ F]DOPA 在原发性/复发性和转移性病变中显示出显着更高的 PCC 检出率（94.3%[50/53] vs. 62.3%[33/53] 和 87.9%[174/198] vs. 69.2分别为 %[137/198]；均p  < 0.001）。对于不同器官的转移，[ ⁶⁸ Ga]Ga-DOTA-NOC PET/CT 比 [ ¹⁸ F]DOPA PET/CT 检测到更多的骨病灶（96.2%[176/183] vs. 66.1%[121/183]；p  < 0.001）和淋巴结（82.0%[73/89] vs. 53.9%[48/89]；p  < 0.001），但腹膜病变较少（20%[4/20] vs. 100%[20/20] ]；p  < 0.001）。

结论

在适当的临床环境下，[ ⁶⁸ Ga]Ga-DOTA-NOC 和[ ¹⁸ F]DOPA 在诊断 PPGL 方面是互补的。 [ ^{68 Ga]Ga-DOTA-NOC 应被视为检测 sPGL 和}SDHx相关肿瘤转移的理想一线示踪剂，而 [ ¹⁸ F]DOPA 可能是评估非SDHx相关 PCC 的最佳示踪剂，特别是在检测原发病变和监测复发方面。