case_images: PMC11439680_01
case_images: The anterior maximum intensity projection images of 18F-FDOPA positron emission tomography/computed tomography (PET/CT) (A), 68Ga-DOTATATE PET/CT (B), 18F-FDG PET/CT (C), and 123I-MIBG single photon emission computed tomography/computed tomography (SPECT/CT) (D) of a 67-year-old male (patient 3) with a likely oncogenic somatic ATRX variant (c.2018dup, p.Thr674fs) with a history of a previously resected 8.7 cm right pheochromocytoma demonstrates metastatic lesions in lungs, liver, and bones. 18F-FDOPA PET/CT shows superiority in detection of metastatic lesions compared to 68Ga-DOTATATE PET/CT, 18F-FDG PET/CT, and 123I-MIBG SPECT/CT. Liver lesions are detected by 18F-FDOPA PET/CT and 123I-MIBG SPECT/CT and are not seen on 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT. Furthermore, 18F-FDOPA PET/CT detects more bone and lung lesions compared to 68Ga-DOTATATE PET/CT, 18F-FDG PET/CT, and 123I-MIBG SPECT scintigraphy. Based on widespread avidity of metastatic lesions on 123I-MIBG scintigraphy compared to 68Ga-DOTATATE PET/CT, the patient was recommended for high-specific-activity 131I-MIBG (Azedra ) targeted radiotherapy. Additionally, 18F-FDG PET/CT demonstrates diffuse increased uptake in the colon, likely physiologic and not suggestive of malignancy. The 18F-FDA PET/CT, unfortunately, was not performed in this patient. To note, contrast recovery, sensitivity, and spatial resolution of PET/CT imaging is superior to SPECT/CT imaging, and therefore, smaller lesions on PET/CT scans may not be visible on SPECT/CT scans despite adequate uptake.
case_images: fendo-15-1399847-g001.jpg
case_images: PMC11439680_01_fendo-15-1399847-g001.jpg
case_images: f1
case_images: One year later, he underwent a resection of a C2 paraspinal mass ( Figure 1 ) and intensity-modulated radiation therapy (IMRT, 5400 cGy) to the right sacral area with shrinkage of the lesion.