Characterization of neuroblastic tumors using 18F-FDOPA PET

Meng-Yao Lu, Yen-Lin Liu, Hsiu-Hao Chang, Shiann-Tarng Jou, Yung-Li Yang, Kai-Hsin Lin, Dong-Tsamn Lin, Ya-Ling Lee, Hsinyu Lee, Pei-Yi Wu, Tsai-Yueh Luo, Lie-Hang Shen, Shiu-Feng Huang, Yung-Feng Liao, Wen-Ming Hsu, Kai-Yuan Tzen
Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine 2013, 54 (1): 42-9

UNLABELLED: Neuroblastic tumors are childhood neoplasms that possess amino acid decarboxylase (AADC) activity and can theoretically be imaged by (18)F-fluorodihydroxyphenylalanine ((18)F-FDOPA) PET, a new diagnostic tool for neuroendocrine tumors. In this study, we explored the accuracy and clinical role of (18)F-FDOPA PET in neuroblastic tumors.

METHODS: From 2008 to 2011, patients with tissue-proven neuroblastic tumors receiving (18)F-FDOPA PET at initial diagnosis or during follow-ups were enrolled. The sensitivity and specificity of (18)F-FDOPA PET were compared with those of (123)I-metaiodobenzylguanidine ((123)I-MIBG) scintigraphy and (18)F-FDG PET, using tumor histology as the standard. The maximum standardized uptake value and tumor-to-liver uptake ratio on (18)F-FDOPA PET were measured and correlated with AADC messenger RNA level in tumor tissue.

RESULTS: Fifty tumors from 34 patients, including 42 neuroblastic tumors and 8 lesions without viable tumor cells, were eligible for analysis. (18)F-FDOPA PET successfully detected neuroblastic tumors of different histologic types in various anatomic sites, at a sensitivity of 97.6% (87.4%-99.9%) and a specificity of 87.5% (47.3%-99.7%). In tumors with concomitant studies, (18)F-FDOPA PET demonstrated a higher sensitivity than (123)I-MIBG scintigraphy (n = 18; P = 0.0455) or (18)F-FDG PET (n = 46; P = 0.0455). Among the 18 tumors with concomitant (123)I-MIBG scans, 4 tumors with viable cells were (123)I-MIBG-negative but were successfully detected by (18)F-FDOPA PET. The tumor uptake of (18)F-FDOPA significantly correlated with AADC expression (n = 15 nonhepatic tumors; maximum standardized uptake value, P = 0.0002; tumor-to-liver uptake ratio, P < 0.0001).

CONCLUSION: (18)F-FDOPA PET showed high sensitivity and specificity in detecting and tracking neuroblastic tumors in this preliminary study with a small cohort of patients and might be complementary to (123)I-MIBG scintigraphy and (18)F-FDG PET. By correlating with AADC expression, (18)F-FDOPA PET might serve as a useful imaging tool for the functional assessment of neuroblastic tumors.

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