DOI: 10.1097/rlu.0000000000004963 ISSN: 1536-0229

A Prospective Comparative Study of 18F-FDOPA PET/CT Versus 123I-MIBG Scintigraphy With SPECT/CT for the Diagnosis of Pheochromocytoma and Paraganglioma

Changhwan Sung, Hyo Sang Lee, Dong Yun Lee, Yong-il Kim, Jae Eun Kim, Sang Ju Lee, Seung Jun Oh, Tae-Yon Sung, Yu-Mi Lee, Young Hoon Kim, Beom-Jun Kim, Jung-Min Koh, Seung Hun Lee, Jin-Sook Ryu
  • Radiology, Nuclear Medicine and imaging
  • General Medicine


This study aimed to compare the diagnostic performances of 18F-FDOPA PET/CT and 123I-MIBG scintigraphy with SPECT/CT for detection of pheochromocytoma and paraganglioma (PPGL).

Patients and Methods

We conducted a prospective, single-institution comparative study. Patients suspected of having PPGL or those showing recurrence and/or distant metastasis of PPGL were enrolled. The primary objective was to affirm the noninferiority of 18F-FDOPA PET/CT for diagnostic sensitivity. Both 123I-MIBG scintigraphy with SPECT/CT (at 4 and 24 hours) and 18F-FDOPA PET/CT (at 5 and 60 minutes after radiotracer administration) were performed. The final diagnosis was established either pathologically or via clinical follow-up. Nuclear physicians, unaware of the clinical data, undertook image analysis.


Thirty-two patients were evaluated: 14 of 21 with an initial diagnosis and 9 of 11 with recurrence/metastasis had PPGLs in their final diagnoses. In patient-based analyses, 18F-FDOPA PET/CT (95.7%) exhibited noninferior sensitivity compared with 123I-MIBG SPECT/CT (91.3%), within the predetermined noninferiority margin of −12% by a 95% confidence interval lower limit of −10%. Both modalities showed no significant difference in specificity (88.9% vs 88.9%). In the region-based analysis for the recurrence/metastasis group, 18F-FDOPA PET/CT demonstrated significantly higher sensitivity compared with 123I-MIBG SPECT/CT (86.2% vs 65.5%, P = 0.031) and superior interobserver agreement (κ = 0.94 vs 0.85). The inclusion of an early phase in dual-phase 18F-FDOPA PET/CT slightly improved diagnostic performance, albeit not to a statistically significant degree.


18F-FDOPA PET/CT demonstrated noninferior sensitivity and comparable specificity to 123I-MIBG SPECT/CT in the diagnosing PPGL. Notably, in the assessment of PPGL recurrence and metastasis, 18F-FDOPA PET/CT outperformed 123I-MIBG SPECT/CT in terms of both sensitivity and interobserver agreement.

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