Comparison of 18F-fluoro-L-DOPA, 18F-fluoro-deoxyglucose, and 18F-fluorodopamine PET and 123I-MIBG scintigraphy in the localization of pheochromocytoma and paraganglioma

J Clin Endocrinol Metab. 2009 Dec;94(12):4757-67. doi: 10.1210/jc.2009-1248. Epub 2009 Oct 28.


Context: Besides (123)I-metaiodobenzylguanidine (MIBG), positron emission tomography (PET) agents are available for the localization of paraganglioma (PGL), including (18)F-3,4-dihydroxyphenylalanine (DOPA), (18)F-fluoro-2-deoxy-D-glucose ((18)F-FDG), and (18)F-fluorodopamine ((18)F-FDA).

Objective: The objective of the study was to establish the optimal approach to the functional imaging of PGL and examine the link between genotype-specific tumor biology and imaging.

Design: This was a prospective observational study.

Intervention: There were no interventions.

Patients: Fifty-two patients (28 males, 24 females, aged 46.8 +/- 14.2 yr): 20 with nonmetastatic PGL (11 adrenal), 28 with metastatic PGL (13 adrenal), and four in whom PGL was ruled out; 22 PGLs were of the succinate dehydrogenase subunit B (SDHB) genotype.

Main outcome measures: Sensitivity of (18)F-DOPA, (18)F-FDG, and (18)F-FDA PET, (123)I-MIBG scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI) for the localization of PGL were measured.

Results: Sensitivities for localizing nonmetastatic PGL were 100% for CT and/or MRI, 81% for (18)F-DOPA PET, 88% for (18)F-FDG PET/CT, 78% for (18)F-FDA PET/CT, and 78% for (123)I-MIBG scintigraphy. For metastatic PGL, sensitivity in reference to CT/MRI was 45% for (18)F-DOPA PET, 74% for (18)F-FDG PET/CT, 76% for (18)F-FDA PET/CT, and 57% for (123)I-MIBG scintigraphy. In patients with SDHB metastatic PGL, (18)F-FDA and (18)F-FDG have a higher sensitivity (82 and 83%) than (123)I-MIBG (57%) and (18)F-DOPA (20%).

Conclusions: (18)F-FDA PET/CT is the preferred technique for the localization of the primary PGL and to rule out metastases. Second best, equal alternatives are (18)F-DOPA PET and (123)I-MIBG scintigraphy. For patients with known metastatic PGL, we recommend (18)F-FDA PET in patients with an unknown genotype, (18)F-FDG or (18)F-FDA PET in SDHB mutation carriers, and (18)F-DOPA or (18)F-FDA PET in non-SDHB patients.

Publication types

  • Research Support, N.I.H., Intramural

MeSH terms

  • 3-Iodobenzylguanidine*
  • Adolescent
  • Adrenal Gland Neoplasms / diagnostic imaging*
  • Adrenal Gland Neoplasms / genetics
  • Adult
  • Aged
  • Dihydroxyphenylalanine / analogs & derivatives*
  • Dopamine / analogs & derivatives*
  • Female
  • Fluorodeoxyglucose F18*
  • Genotype
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Paraganglioma / diagnostic imaging*
  • Paraganglioma / genetics
  • Pheochromocytoma / diagnostic imaging*
  • Pheochromocytoma / genetics
  • Positron-Emission Tomography
  • Radiopharmaceuticals*
  • Tomography, X-Ray Computed
  • Young Adult


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18
  • fluorodopa F 18
  • 3-Iodobenzylguanidine
  • 6-fluorodopamine
  • Dihydroxyphenylalanine
  • Dopamine