van der Harst E, de Herder W W, Bruining H A, Bonjer H J, de Krijger R R, Lamberts S W, van de Meiracker A H, Boomsma F, Stijnen T, Krenning E P, Bosman F T, Kwekkeboom D J
Department of Surgery, Erasmus University Hospital, 3000 CA Rotterdam, The Netherlands.
J Clin Endocrinol Metab. 2001 Feb;86(2):685-93. doi: 10.1210/jcem.86.2.7238.
Selecting the appropriate approach for resection and follow-up of pheochromocytomas (PCCs) is highly dependent upon reliable localization and exclusion of multifocal, bilateral, or metastatic disease. Metaiodobenzylguanidine (MIBG) scintigraphy was developed for functional localization of catecholamine-secreting tissues. Somatostatin receptor imaging (SRI) has a high sensitivity for localizing head and neck paragangliomas, but studies of intraabdominal PCCs are rare. In this study we review our experience of [(123)I]MIBG and SRI, performed since 1983 and 1989, respectively, in the work-up of primary and recurrent PCCs. Scintigraphic results were correlated with catecholamine secretion, size and site, malignancy, associated tumor syndromes, and morphological features. [(123)I]MIBG scans were performed in a total of 75 patients, in 70 cases before resection of primary PCCs and in 5 cases because of recurrent disease. Ninety-one PCCs were resected. The overall detection rates were 83.3% and 89.8% for PCCs larger than 1.0 cm. Multifocal disease was detected in 4 patients with [(123)I]MIBG. [(123)I]MIBG uptake correlated with greater size of PCC (r = 0.33; P = 0.008) and greater concentration of plasma epinephrine (r = 0.32; P = 0.006). [(123)I]MIBG-negative PCCs (n = 14) had significantly (P = 0.01) smaller diameters than [(123I)]MIBG-positive tumors. Furthermore, [(123)I]MIBG uptake was significantly higher in unilateral (P = 0.02), benign (P = 0.02), sporadic (P = 0.02), intraadrenal (P = 0.02), and capsular invasive (P = 0.03) PCCs than in bilateral, malignant, MEN2A/2B-related, extraadrenal, and noninvasive PCCs, respectively. The detection rate of SRI was only 25% (8 of 32) for primary benign PCCs. In 14 patients metastases occurred, which were effectively visualized with [(123)I]MIBG in 8 of 14 cases. SRI was able to detect metastases in 7 of 8 cases, including 3 [(123)I]MIBG-negative metastatic cases. In addition, [(123)I]MIBG and SRI detected 2 recurrences. In conclusion, [(123)I]MIBG uptake is correlated with the size, epinephrine production, and site of PCCs. Its role in bilateral and MEN2A/2B-related PCCs seems limited. In cases of recurrent elevation of catecholamines, localization of metastases and/or recurrence should be attempted with [(123)I]MIBG scintigraphy. In suspicious metastatic PCCs, SRI might be considered to supplement [(123)I]MIBG scintigraphy.
选择合适的方法对嗜铬细胞瘤（PCC）进行切除及随访，高度依赖于对多灶性、双侧性或转移性疾病的可靠定位及排除。间碘苄胍（MIBG）闪烁显像用于分泌儿茶酚胺组织的功能定位。生长抑素受体显像（SRI）对头颈部副神经节瘤的定位具有高敏感性，但关于腹内PCC的研究较少。在本研究中，我们回顾了自1983年和1989年起分别应用[（123）I]MIBG和SRI对原发性和复发性PCC进行检查的经验。闪烁显像结果与儿茶酚胺分泌、大小及部位、恶性程度、相关肿瘤综合征及形态学特征相关。共对75例患者进行了[（123）I]MIBG扫描，其中70例在原发性PCC切除术前进行，5例因疾病复发进行。共切除91个PCC。对于直径大于1.0 cm的PCC，总体检出率分别为83.3%和89.8%。4例患者通过[（123）I]MIBG检测到多灶性疾病。[（123）I]MIBG摄取与PCC更大的大小相关（r = 0.33；P = 0.008），与更高的血浆肾上腺素浓度相关（r = 0.32；P = 0.006）。[（123）I]MIBG阴性的PCC（n = 14）直径显著小于[（123）I]MIBG阳性肿瘤（P = 0.01）。此外，单侧（P = 0.02）、良性（P = 0.02）、散发性（P = 0.02）、肾上腺内（P = 0.02）和有包膜侵犯（P = 0.03）的PCC的[（123）I]MIBG摄取分别显著高于双侧性、恶性、MEN2A/2B相关、肾上腺外和无侵犯性的PCC。原发性良性PCC的SRI检出率仅为25%（32例中的8例）。14例患者发生转移，其中14例中的8例通过[（123）I]MIBG有效显影。SRI能够在8例中的7例检测到转移，包括3例[（123）I]MIBG阴性的转移病例。此外，[（123）I]MIBG和SRI检测到2例复发。总之，[（123）I]MIBG摄取与PCC的大小、肾上腺素产生及部位相关。其在双侧性和MEN2A/2B相关PCC中的作用似乎有限。在儿茶酚胺反复升高的情况下，应尝试通过[（123）I]MIBG闪烁显像对转移灶和/或复发进行定位。在可疑转移性PCC中，可考虑应用SRI补充[（123）I]MIBG闪烁显像。
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