Sensitivity and positive predictive value of CT, MRI and 123I-MIBG scintigraphy in localizing pheochromocytomas: a prospective study

Franco Lumachi, Alberto Tregnaghi, Pietro Zucchetta, Maria Cristina Marzola, Diego Cecchin, Gaia Grassetto, Franco Bui
Nuclear Medicine Communications 2006, 27 (7): 583-7

AIM: To establish a standardized non-invasive imaging protocol for patients with pheochromocytoma undergoing surgery.

METHODS: A series of 32 consecutive patients (16 men, 16 women; median age 43 years, range 15-71 years) with biochemically confirmed pheochromocytoma underwent computed tomography (CT) scanning, magnetic resonance imaging (MRI) and meta-[I]iodobenzylguanidine (MIBG) whole-body scintigraphy prior to adrenalectomy or excision of extra-adrenal tumour (paraganglioma).

RESULTS: At final pathology no malignant pheochromocytomas were found. The tumour was right-sided in 16 (50%) patients, left-sided in 13 (41%), extra-adrenal (sympathetic ganglia, upper abdomen) in two (6%) and bilateral in one (3%) patient. Overall, the median greatest diameter (size) of the tumour was 35 mm (range, 15-90 mm). The sensitivity of CT, MRI and MIBG scintigraphy was 90%, 93% and 91%, and the specificity was 93%, 93% and 100%, respectively. The three patients with false negative scintigraphy had an intra-adrenal tumour, ranging from 20 to 50 mm in size. The presence of necrosis within the mass might justify the lack of significant uptake of radiopharmaceutical in two patients, and the small size (15 mm) of the mass in the other. There were two false positive results with both CT and MRI, and no false positive MIBG scintigraphy, which had the highest (100%) positive predictive value. The combination of MRI+MIBG scintigraphy reached 100% sensitivity and positive predictive value.

CONCLUSION: Our data suggest that this imaging protocol should be used in all patients with biochemically confirmed pheochromocytoma.

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