Diagnostic performance of [⁶⁸Ga]DOTATATE PET/CT, [¹⁸F]FDG PET/CT, MRI of the spine, and whole-body diagnostic CT and MRI in the detection of spinal bone metastases associated with pheochromocytoma and paraganglioma.

Abstract

To compare the diagnostic performance of [⁶⁸Ga]DOTATATE PET/CT, [¹⁸F]FDG PET/CT, MRI of the spine, and whole-body CT and MRI for the detection of pheochromocytoma/paraganglioma (PPGL)-related spinal bone metastases. Between 2014 and 2020, PPGL participants with spinal bone metastases prospectively underwent [⁶⁸Ga]DOTATATE PET/CT, [¹⁸F]FDG PET/CT, MRI of the cervical-thoracolumbar spine (MRI_spine), contrast-enhanced MRI of the neck and thoraco-abdominopelvic regions (MRI_WB), and contrast-enhanced CT of the neck and thoraco-abdominopelvic regions (CT_WB). Per-patient and per-lesion detection rates were calculated. Counting of spinal bone metastases was limited to a maximum of one lesion per vertebrae. A composite of all functional and anatomic imaging served as an imaging comparator. The McNemar test compared detection rates between the scans. Two-sided p values were reported. Forty-three consecutive participants (mean age, 41.7 ± 15.7 years; females, 22) with MRI_spine were included who also underwent [⁶⁸Ga]DOTATATE PET/CT (n = 43), [¹⁸F]FDG PET/CT (n = 43), MRI_WB (n = 24), and CT_WB (n = 33). Forty-one of 43 participants were positive for spinal bone metastases, with 382 lesions on the imaging comparator. [⁶⁸Ga]DOTATATE PET/CT demonstrated a per-lesion detection rate of 377/382 (98.7%) which was superior compared to [¹⁸F]FDG (72.0%, 275/382, p < 0.001), MRI_spine (80.6%, 308/382, p < 0.001), MRI_WB (55.3%, 136/246, p < 0.001), and CT_WB (44.8%, 132/295, p < 0.001). The per-patient detection rate of [⁶⁸Ga]DOTATATE PET/CT was 41/41 (100%) which was higher compared to [¹⁸F]FDG PET/CT (90.2%, 37/41, p = 0.13), MRI_spine (97.6%, 40/41, p = 1.00), MRI_WB (95.7%, 22/23, p = 1.00), and CT_WB (81.8%, 27/33, p = 0.03). [⁶⁸Ga]DOTATATE PET/CT should be the modality of choice in PPGL-related spinal bone metastases due to its superior detection rate. In a prospective study of 43 pheochromocytoma/paraganglioma participants with spinal bone metastases, [⁶⁸Ga]DOTATATE PET/CT had a superior per-lesion detection rate of 98.7% (377/382), compared to [¹⁸F]FDG PET/CT (p < 0.001), MRI of the spine (p < 0.001), whole-body CT (p < 0.001), and whole-body MRI (p < 0.001). • Data regarding head-to-head comparison between functional and anatomic imaging modalities to detect spinal bone metastases in pheochromocytoma/paraganglioma are limited. • [⁶⁸Ga]DOTATATE PET/CT had a superior per-lesion detection rate of 98.7% in the detection of spinal bone metastases associated with pheochromocytoma/paraganglioma compared to other imaging modalities: [¹⁸]F-FDG PET/CT, MRI of the spine, whole-body CT, and whole-body MRI. • [⁶⁸Ga]DOTATATE PET/CT should be the modality of choice in the evaluation of spinal bone metastases associated with pheochromocytoma/paraganglioma.