Imaging characterization of benign and malignant pheochromocytoma or paraganglioma: comparison between MIBG uptake and M
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ORIGINAL ARTICLE
Imaging characterization of benign and malignant pheochromocytoma or paraganglioma: comparison between MIBG uptake and MR signal intensity ratio Simone Maurea • Alberto Cuocolo • Massimo Imbriaco Teresa Pellegrino • Mario Fusari • Renato Cuocolo • Raffaele Liuzzi • Marco Salvatore
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Received: 26 January 2012 / Accepted: 18 June 2012 / Published online: 1 July 2012 Ó The Japanese Society of Nuclear Medicine 2012
Abstract Objective We compared metaiodobenzylguanidine (MIBG) uptake and magnetic resonance (MR) signal intensity ratio in differentiating benign and malignant disease in patients with pheochromocytoma or paraganglioma. Methods Eighteen patients (9 men, mean age 37 ± 8 years) with pheochromocytoma or paraganglioma underwent MR imaging and iodine-131 MIBG scintigraphy. MR signal intensity ratio was measured on T1 and T2-weighted images using region of interest analysis and intensity ratio of MIBG uptake was calculated for each tumor lesion on 48 h images. Results A total of 28 tumor lesions was analyzed of which 12 were benign and 16 malignant. MIBG uptake intensity ratio was significantly higher in malignant lesions compared to benign (5.2 ± 2.4 and 2.9 ± 1.4, respectively, p \ 0.01). On the contrary, no significant difference in tumor size and MR signal intensity ratio between malignant and benign tumor lesions was observed.
This paper was presented at the Congress of the European Society of Radiology (10.1594/ecr2012/C-0623), Vienna, 1–5 March 2012. S. Maurea (&) A. Cuocolo M. Imbriaco M. Fusari M. Salvatore Department of Biomorphological and Functional Sciences, University Federico II, Naples, Italy e-mail: [email protected] S. Maurea A. Cuocolo M. Imbriaco T. Pellegrino R. Liuzzi M. Salvatore Institute of Biostructures and Bioimages, National Council of Research, Naples, Italy R. Cuocolo SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy
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Conclusions In patients with pheochromocytoma or paraganglioma, iodine-131 MIBG uptake is able to differentiate between benign and malignant disease, while MR imaging is not useful for this purpose. The higher MIBG uptake observed in malignant lesions could reflect major tumor storage of catecholamines compared to benign lesions. Keywords MIBG MR Benign Malignant Pheochromocytoma Paraganglioma
Introduction Pheochromocytoma and paraganglioma are chromaffin tissue tumors localized, respectively, in the adrenal medulla or in extra-adrenal sites with the specific characteristics to secrete catecholamines; the more frequent appearance is the sporadic form with unilateral benign involvement of a single gland, but the possibility of bilateral, extra-adrenal, or multiple localization as well as familiar or malignant forms occur in 10 % of cases. The extra-adrenal tumor lesions seem to have a higher incidence of malignancy; for the World Health Organization, pheochromocytoma is malignant when metastases occur and the prevalence of malignant dedifferentiation depends on the underlying genetic mutation
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