Takenaka Junki, Watanabe Shiro, Abe Takashige, Takeuchi Satoshi, Hirata Kenji, Kimura Rina, Ishii Hiroshi, Wakabayashi Naoto, Majigsuren Mungunkhuyag, Kudo Kohsuke
Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan.
Department of Nuclear Medicine, Hokkaido University Hospital, Sapporo 060-8648, Japan.
Diagnostics (Basel). 2025 May 22;15(11):1305. doi: 10.3390/diagnostics15111305.
: Pheochromocytomas and paragangliomas (PPGLs) are rare tumors of neural crest origin that secrete varying levels of catecholamines. [F]Fluorodeoxyglucose-positron emission tomography (FDG-PET) is a valuable tool for the detection of metastases and the prediction of prognoses. However, varying FDG avidities in PPGLs raise concerns regarding cost-effectiveness and unnecessary radiation exposure. Catecholamine secretion patterns are associated with metastasis and clinical outcomes. This study aimed to explore the relationships among FDG avidity, catecholamine levels, and clinical factors in patients with PPGLs. : This retrospective study included 25 patients with unresectable or metastatic PPGLs scheduled for [I]metaiodobenzylguanidine therapy with FDG-PET data available within 40 days of urine catecholamine measurements. FDG avidity was assessed using semiquantitative parameters such as the maximum standardized uptake value (SUVmax), total metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Urine catecholamine levels were quantified. Logistic regression and Spearman's correlation were performed to evaluate the relationship between FDG parameters and urinary catecholamine levels. : Urinary noradrenaline levels were significantly higher in patients with FDG-avid lesions than in those without (726.25 μg/day vs. 166.3 μg/day, = 0.001). Noradrenaline levels showed significant positive correlations with SUVmax, MTV, and TLG (ρ = 0.527, 0.541, and 0.557, respectively; all < 0.01). Urinary noradrenaline levels predicted FDG avidity with an AUC of 0.849; a cutoff value of 647.5 μg/day achieved 55.6% sensitivity and 100% specificity. : Urinary noradrenaline levels were significantly associated with FDG avidity in PPGLs, suggesting their potential utility in predicting FDG-PET outcomes. Therefore, FDG-PET may be unnecessary in PPGL patients with low urinary noradrenaline levels. These findings may help optimize imaging strategies for patients with PPGLs.
嗜铬细胞瘤和副神经节瘤（PPGLs）是起源于神经嵴的罕见肿瘤，可分泌不同水平的儿茶酚胺。氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）是检测转移灶和预测预后的重要工具。然而，PPGLs中FDG摄取的差异引发了对成本效益和不必要辐射暴露的担忧。儿茶酚胺分泌模式与转移及临床结局相关。本研究旨在探讨PPGLs患者中FDG摄取、儿茶酚胺水平和临床因素之间的关系。：这项回顾性研究纳入了25例不可切除或转移性PPGLs患者，这些患者计划接受间碘苄胍治疗，且在尿儿茶酚胺测量的40天内有FDG-PET数据。使用最大标准化摄取值（SUVmax）、总代谢肿瘤体积（MTV）和总病变糖酵解（TLG）等半定量参数评估FDG摄取。对尿儿茶酚胺水平进行定量分析。采用逻辑回归和Spearman相关性分析来评估FDG参数与尿儿茶酚胺水平之间的关系。：FDG摄取阳性病变患者的尿去甲肾上腺素水平显著高于无FDG摄取阳性病变的患者（726.25μg/天对166.3μg/天，P = 0.001）。去甲肾上腺素水平与SUVmax、MTV和TLG均呈显著正相关（ρ分别为0.527、0.541和0.557；均P < 0.01）。尿去甲肾上腺素水平预测FDG摄取的曲线下面积（AUC）为0.849；截断值为647.5μg/天，灵敏度为55.6%，特异性为100%。：尿去甲肾上腺素水平与PPGLs中的FDG摄取显著相关，提示其在预测FDG-PET结果方面的潜在效用。因此，对于尿去甲肾上腺素水平低的PPGL患者，FDG-PET检查可能不必要。这些发现可能有助于优化PPGL患者的成像策略。
