PET/CT Superior to MRI for Lesion Detection in Head and Neck Paragangliomas

⁶⁸Ga-DOTATATE PET/CT more accurately differentiates residual/recurrent tumors from post-surgery scar tissue in patients with head and neck paragangliomas (HNPGLs) compared to MRI. Providing functional information about the tumors, ⁶⁸Ga-DOTATATE PET/CT has the potential to play a vital role in improving preoperative and postoperative treatment planning strategies for HNPGL patients, according to research presented at the 2024 Society of Nuclear Medicine and Molecular Imaging Annual Meeting.

HNPGLs are rare neuroendocrine tumors that pose diagnostic and therapeutic challenges due to their complex anatomical locations. The role of imaging modalities is crucial in the management of these tumors. While MRI is the gold standard for preoperative evaluation and postoperative surveillance, its ability to differentiate residual tumor from postoperative changes, such as scar tissue, is limited.

“We know that HNPGLs typically express somatostatin receptors (SSTRs) on the surface of neuroendocrine cells,” said Patrick Wojtylak, MSHA, CNMT, Radiology System Manager for Nuclear Medicine at University Hospital Cleveland Medical Center in Cleveland, Ohio. “Since ⁶⁸Ga-DOTATATE has a high sensitivity and specificity for SSTR, we sought to determine whether ⁶⁸Ga-DOTATATE PET/CT could detect HNPGLs more accurately than MRI, specifically post-surgery.”

The study included 25 patients with preoperative clinical suspicion of HNPGLs (five patients) or postoperative pathology-proven HNPGLs (20 patients). Patients underwent ⁶⁸Ga-DOTATATE PET/CT and MRI scans. All studies were then reviewed by a specialized nuclear medicine physician experienced in ⁶⁸Ga-DOTATATE PET/CT interpretation.

Compared to contrast-enhanced MRI alone, ⁶⁸Ga-DOTATATE PET/CT offered superior lesion detection and more accurate delineation of tumor extent in patients with HNPGLs. It also provided improved differentiation between recurrent or residual tumor and scar tissue post-surgery, exhibiting heightened sensitivity and specificity compared to MRI alone.

“⁶⁸Ga-DOTATATE PET/CT holds promise as a reliable imaging biomarker for HNPGLs, offering enhanced sensitivity and specificity compared to conventional imaging modalities,” noted Wojtylak. “Integrating ⁶⁸Ga-DOTATATE PET/CT into the clinical management of HNPGLs can lead to more accurate diagnosis, better treatment planning, and improved patient outcomes.”