Onkes Meike, Dahlmann Paul, Gesenhues Alena, Gacula Sean Ira G, Mansour Nabeel, Schweizer Júnia R O L, Stüfchen Isabel, Lottspeich Christian, Wang Katharina, Auer Matthias K, Brendel Matthias, Fischer Alessa, Braunschweig Till, Gildehaus Franz-Josef, Lindner Simon, Schmid-Tannwald Christine, Pfluger Thomas, Auernhammer Christoph J, Nölting Svenja, Werner Rudolf A, Reincke Martin, Bidlingmaier Martin, Kroiss Matthias, Völter Friederike
Department of Nuclear Medicine, LMU University Hospital, LMU Munich, 81377, Munich, Germany.
Department of Medical Imaging and Therapeutic Radiology, National Kidney and Transplant Institute, Quezon City, Manila, Philippines.
Eur J Nucl Med Mol Imaging. 2025 May 30. doi: 10.1007/s00259-025-07341-9.
Somatostatin-receptor (SSTR)-targeting PET/CT is widely used for diagnosis and disease monitoring of pheochromocytoma / paraganglioma (PPGL). The aim of this study was to assess the potential of the novel SSTR-targeting tracer [F]SiTATE in diagnosing PPGL by comparing imaging parameters to tumor marker levels and secretory activity in a small cohort of patients diagnosed with this rare tumor type.
This retrospective study included 34 patients with histologically confirmed PPGL who underwent [F]SiTATE-PET/CT at LMU University Hospital Munich between 10/2020 and 02/2024 as well as hormonal laboratory analysis within up to 100 days. Imaging parameters - standardized uptake values (SUVmax, SUVmean), metabolic tumor volume (MTV), and total lesion uptake (TLU) - were analyzed. Uptake was normalized to liver background (SUVmaxr, SUVmeanr). Radioligand uptake of biochemical subtypes and genotypes was compared with Mann-Whitney-U test. Correlation was tested using Spearman´s rank correlation test.
The patient-based detection rate of [F]SiTATE-PET was 96.6%. A moderate correlation was found between MTV and TLU with chromogranin A (r = 0.570-0.608, p < 0.005) and with biochemical secretion (r = 0.466-0.576, p < 0.05). Hereditary PPGL with Cluster 1 genotype showed stronger [F]SiTATE uptake compared to sporadic PPGL (SUVmeanr: p = 0.032; SUVmaxr: p = 0.051). A subgroup comparison with [⁶⁸Ga]Ga-DOTATOC-PET/CT revealed no significant difference in uptake metrics or tumor-to-background ratios.
This is the first clinical evaluation of [F]SiTATE-PET/CT in patients with PPGL. MTV and TLU measured with [F]SiTATE-PET/CT correlated well with the tumor marker chromogranin A in serum and with (nor)metanephrines in urine and plasma. Within the limits imposed by the small cohort, our results suggest that TLU and MTV in [F]SiTATE-PET/CT could be used as SSTR imaging biomarker for monitoring of disease progression and secretory activity in patients with PPGL.
靶向生长抑素受体（SSTR）的PET/CT广泛用于嗜铬细胞瘤/副神经节瘤（PPGL）的诊断和疾病监测。本研究的目的是通过在一小群诊断为这种罕见肿瘤类型的患者中比较成像参数与肿瘤标志物水平及分泌活性，评估新型靶向SSTR的示踪剂[F]SiTATE在诊断PPGL中的潜力。
这项回顾性研究纳入了34例经组织学确诊的PPGL患者，他们于2020年10月至2024年2月在慕尼黑路德维希 - 马克西米利安大学医院接受了[F]SiTATE - PET/CT检查，并在长达100天内进行了激素实验室分析。分析了成像参数——标准化摄取值（SUVmax、SUVmean）、代谢肿瘤体积（MTV）和总病灶摄取量（TLU）。摄取量以肝脏本底进行标准化（SUVmaxr、SUVmeanr）。采用Mann - Whitney - U检验比较生化亚型和基因型的放射性配体摄取情况。使用Spearman秩相关检验进行相关性检验。
基于患者的[F]SiTATE - PET检测率为96.6%。发现MTV和TLU与嗜铬粒蛋白A（r = 0.570 - 0.608，p < 0.005）以及与生化分泌（r = 0.466 - 0.576，p < 0.05）之间存在中度相关性。与散发性PPGL相比，具有1型基因型的遗传性PPGL显示出更强的[F]SiTATE摄取（SUVmeanr：p = 0.032；SUVmaxr：p = 0.051）。与[⁶⁸Ga]Ga - DOTATOC - PET/CT的亚组比较显示，摄取指标或肿瘤与本底比值无显著差异。
这是对PPGL患者进行[F]SiTATE - PET/CT的首次临床评估。用[F]SiTATE - PET/CT测量的MTV和TLU与血清中的肿瘤标志物嗜铬粒蛋白A以及尿液和血浆中的（去甲）间甲肾上腺素密切相关。在小样本队列所限的范围内，我们的结果表明，[F]SiTATE - PET/CT中的TLU和MTV可作为SSTR成像生物标志物，用于监测PPGL患者的疾病进展和分泌活性。
