Somatostatin Receptor–Directed PET/CT Can Differentiate Between Different Subtypes of Head and Neck Paragangliomas

Clinical Nuclear Medicine, vol. 48, pp. 923–927

Abstract

BACKGROUND: Given their neuroendocrine origin, head and neck paragangliomas (HNPGLs) can be imaged with somatostatin receptor (SSTR)-directed PET/CT. We aimed to determine whether the in vivo PET signal can differentiate between varying HNPGL subtypes. PATIENTS AND METHODS: Fourteen patients with HNPGL received pretherapeutic SSTR-PET/CTs using 68 Ga-DOTATOC. Six (42.9%) patients had a jugular paraganglioma (PGL-J), 5 (35.7%) were diagnosed with carotid paraganglioma (PGL-Cs), and the remaining 3 patients (21.4%) had PGL-C with pathogenic SDHx germline variants (PGL-C-SDH). A visual and quantitative assessment of the primary tumor on SSTR-PET was performed, including SUV max and target-to-background ratio (TBR). Quantitative values were then compared between subgroups of patients affected with different HNPGL entities. RESULTS: On visual assessment, all primary HNPGLs could be identified on SSTR-PET/CT. Quantification of HNPGL revealed substantially elevated SUV max in PGL-J (101.7 ± 58.5) when compared with PGL-C-SDH (13.4 ± 5.6, P < 0.05), but not when compared with PGL-C (66.7 ± 27.3, P = 0.4; PGL-C vs PGL-C-SDH, P = 0.2). TBR of PGL-J (202.9 ± 82.2), however, further differentiated between PGL-C (95.7 ± 45.4, P < 0.05) and PGL-C-SDH (20.4 ± 12.2, P < 0.01; PGL-C vs PGL-C-SDH, P = 0.3). Moreover, whole-body readout revealed metastases in 2/3 (66.7%) of PGL-C-SDH patients, with a single SSTR-expressing skeletal lesion in one subject and bipulmonary lesions in the other patient. CONCLUSIONS: In patients with HNPGL, SSTR-PET/CT identified the primary and metastatic disease and provides substantially elevated TBR, indicating excellent image contrast. PET-based quantification can also differentiate between varying HNPGL subtypes.

Authors 14

1. Yingjun Zhi corresponding

   University of Würzburg · Universitätsklinikum Würzburg

   Affiliation as printed

   Department of Otorhinolaryngology, Plastic, Aesthetic, and Reconstructive Head and Neck Surgery, University Hospital Würzburg

2. Elena Hartmann

   University of Würzburg · Comprehensive Cancer Center Mainfranken

   Affiliation as printed

   Institute of Pathology and Comprehensive Cancer Center Mainfranken, Julius-Maximilian University Würzburg

3. Philipp E. Hartrampf
   Affiliation as printed

   Department of Nuclear Medicine

4. Alexander Weich

   Universitätsklinikum Würzburg

   Affiliation as printed

   Division of Gastroenterology, Department of Internal Medicine II

   NET-Zentrum Würzburg, ENETS Center of Excellence, University Hospital Würzburg, Würzburg, Germany

5. Takahiro Higuchi

   Okayama University

   Affiliation as printed

   Department of Nuclear Medicine

   Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan

6. Thorsten Alexander Bley corresponding

   Universitätsklinikum Würzburg

   Affiliation as printed

   Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg

7. Stephan Hackenberg Aachen Department of Otorhinolaryngology, Head and Neck Surgery

   RWTH Aachen University

   Affiliation as printed

   Department of Otorhinolaryngology–Head and Neck Surgery, RWTH Aachen University, Aachen

8. Rudolf Hagen corresponding

   University of Würzburg · Universitätsklinikum Würzburg

   Affiliation as printed

   Department of Otorhinolaryngology, Plastic, Aesthetic, and Reconstructive Head and Neck Surgery, University Hospital Würzburg

9. Andreas Rosenwald

   University of Würzburg · Comprehensive Cancer Center Mainfranken

   Affiliation as printed

   Institute of Pathology and Comprehensive Cancer Center Mainfranken, Julius-Maximilian University Würzburg

10. Agmal Scherzad corresponding

    University of Würzburg · Universitätsklinikum Würzburg

    Affiliation as printed

    Department of Otorhinolaryngology, Plastic, Aesthetic, and Reconstructive Head and Neck Surgery, University Hospital Würzburg

11. Hanna Remde

    University of Würzburg · Universitätsklinikum Würzburg

    Affiliation as printed

    Division of Endocrinology, Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany

12. Martin Faßnacht

    University of Würzburg · Universitätsklinikum Würzburg

    Affiliation as printed

    Division of Endocrinology, Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany

13. Rudolf Alexander Werner

    Universitätsklinikum Würzburg

    Affiliation as printed

    Department of Nuclear Medicine

    Division of Gastroenterology, Department of Internal Medicine II

    NET-Zentrum Würzburg, ENETS Center of Excellence, University Hospital Würzburg, Würzburg, Germany

14. Sebastian E. Serfling

    Universitätsklinikum Würzburg

    Affiliation as printed

    Department of Nuclear Medicine

    NET-Zentrum Würzburg, ENETS Center of Excellence, University Hospital Würzburg, Würzburg, Germany

    Sebastian E. Serfling, MD, Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany. E-mail: [email protected]