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Acta Radiol. 2014 Jun;55(5):631-40. doi: 10.1177/0284185113504330. Epub 2013 Sep 14.

Localization and prediction of malignant potential in recurrent pheochromocytoma/paraganglioma (PCC/PGL) using 18F-FDG PET/CT.

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  • 1Centre for Diagnostic Nuclear Imaging, Faculty of Medicine and Health Science, University Putra Malaysia, Serdang, Selangor, Malaysia
  • 2Univ.-KlinikfürNuklearmedizin, Innsbruck, Austria.
  • 3Centre for Diagnostic Nuclear Imaging, Faculty of Medicine and Health Science, University Putra Malaysia, Serdang, Selangor, Malaysia.
  • 4Medical Department, Hospital Putrajaya, Putrajaya, Malaysia.
  • 5Department of Radiology, the University of Melbourne, Centre for Molecular Imaging, The Peter MacCallum, Cancer Centre, East Melbourne, Victoria, Australia.



To our knowledge, data are lacking on the role of 18F-FDG PET/CT in the localization and prediction of neuroendocrine tumors, in particular the pheochromocytoma/paraganglioma (PCC/PGL) group.


To evaluate the role of 18F-FDG PET/CT in localizing and predicting the malignant potential of PCC/PGL.


Twenty-three consecutive patients with a history of PCC/PGL, presenting with symptoms related to catecholamine excess, underwent 18F-FDG PET/CT. Final confirmation of the diagnosis was made using the composite references. PET/CT findings were analyzed on a per-lesion basis and a per-patient basis. Tumor SUVmax was analyzed to predict the dichotomization of patient endpoints for the local disease and metastatic groups.


We investigated 23 patients (10 men, 13 women) with a mean age of 46.43 ± 3.70 years. Serum catecholamine levels were elevated in 82.60% of these patients. There were 136 sites (mean SUVmax: 16.39 ± 3.47) of validated disease recurrence. The overall sensitivities for diagnostic CT, FDG PET, and FDG PET/CT were 86.02%, 87.50%, and 98.59%, respectively. Based on the composite references, 39.10% of patients had local disease. There were significant differences in the SUVmax distribution between the local disease and metastatic groups; a significant correlation was noted when a SUVmax cut-off was set at 9.2 (P<0.05).


In recurrent PCC/PGL, diagnostic 18F-FDG PET/CT is a superior tool in the localization of recurrent tumors. Tumor SUVmax is a potentially useful predictor of malignant tumor potential.


18F-FDG PET/CT; SUVmax; malignant potential; neuroendocrine; pheochromocytoma/paraganglioma; predictor; recurrence

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