6-[F-18]Fluoro-L-dihydroxyphenylalanine positron emission tomography is superior to conventional imaging with (123)I-metaiodobenzylguanidine scintigraphy, computer tomography, and magnetic resonance imaging in localizing tumors causing catecholamine excess

J Clin Endocrinol Metab. 2009 Oct;94(10):3922-30. doi: 10.1210/jc.2009-1054. Epub 2009 Jul 21.


Context: Catecholamine excess is rare, but symptoms may be life threatening.

Objective: The objective of the study was to investigate the sensitivity of 6-[F-18]fluoro-l-dihydroxyphenylalanine positron emission tomography ((18)F-DOPA PET), compared with (123)I-metaiodobenzylguanidine ((123)I-MIBG) scintigraphy and computer tomography (CT)/magnetic resonance imaging (MRI) for tumor localization in patients with catecholamine excess.

Design and setting: All consecutive patients with catecholamine excess visiting the University Medical Center Groningen, Groningen, The Netherlands, between March 2003 and January 2008 were eligible.

Patients: Forty-eight patients were included. The final diagnosis was pheochromocytoma in 40, adrenal hyperplasia in two, paraganglioma in two, ganglioneuroma in one, and unknown in three.

Main outcome measures: Sensitivities and discordancy between (18)F-DOPA PET, (123)I-MIBG, and CT or MRI were analyzed for individual patients and lesions. Metanephrines and 3-methoxytyramine in plasma and urine and uptake of (18)F-DOPA with PET were measured to determine the whole-body metabolic burden and correlated with biochemical tumor activity. The gold standard was a composite reference standard.

Results: (18)F-DOPA PET showed lesions in 43 patients, (123)I-MIBG in 31, and CT/MRI in 32. Patient-based sensitivity for (18)F-DOPA PET, (123)I-MIBG, and CT/MRI was 90, 65, and 67% (P < 0.01 for (18)F-DOPA PET vs. both (123)I-MIBG and CT/MRI, P = 1.0 (123)I-MIBG vs. CT/MRI). Lesion-based sensitivities were 73, 48, and 44% (P < 0.001 for (18)F-DOPA PET vs. both (123)I-MIBG and CT/MRI, P = 0.51 (123)I-MIBG vs. CT/MRI). The combination of (18)F-DOPA PET with CT/MRI was superior to (123)I-MIBG with CT/MRI (93 vs. 76%, P < 0.001). Whole-body metabolic burden measured with (18)F-DOPA PET correlated with plasma normetanephrine (r = 0.82), urinary normetanephrine (r = 0.84), and metanephrine (r = 0.57).

Conclusion: To localize tumors causing catecholamine excess, (18)F-DOPA PET is superior to (123)I-MIBG scintigraphy and CT/MRI.

Publication types

  • Comparative Study

MeSH terms

  • 3-Iodobenzylguanidine
  • Adolescent
  • Adrenal Gland Neoplasms / diagnosis*
  • Adrenal Gland Neoplasms / diagnostic imaging
  • Adrenal Gland Neoplasms / metabolism
  • Adrenal Glands / metabolism
  • Adrenal Glands / pathology*
  • Adult
  • Aged
  • Biomarkers / metabolism
  • Catecholamines / blood
  • Catecholamines / metabolism*
  • Catecholamines / urine
  • Child
  • Child, Preschool
  • Dihydroxyphenylalanine / analogs & derivatives
  • Female
  • Humans
  • Hyperplasia / diagnosis
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Paraganglioma / diagnosis*
  • Paraganglioma / diagnostic imaging
  • Paraganglioma / metabolism
  • Pheochromocytoma / diagnosis*
  • Pheochromocytoma / diagnostic imaging
  • Pheochromocytoma / metabolism
  • Positron-Emission Tomography* / methods
  • Prospective Studies
  • Radiopharmaceuticals
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed*
  • Young Adult


  • Biomarkers
  • Catecholamines
  • Radiopharmaceuticals
  • fluorodopa F 18
  • 3-Iodobenzylguanidine
  • Dihydroxyphenylalanine