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Comparative Study
. 2024 Jun 15;14(1):13828.
doi: 10.1038/s41598-024-64607-2.

Evaluating the diagnostic efficacy of whole-body MRI versus 123I-mIBG/131I-mIBG imaging in metastatic pheochromocytoma and paraganglioma

Hiroshi Mori  1 , Hiroshi Wakabayashi  2 , Shintaro Saito  2 , Kenichi Nakajima  3 , Kotaro Yoshida  4 , Tomo Hiromasa  2 , Seigo Kinuya  5
Affiliations
Comparative Study

Evaluating the diagnostic efficacy of whole-body MRI versus 123I-mIBG/131I-mIBG imaging in metastatic pheochromocytoma and paraganglioma

Hiroshi Mori et al. Sci Rep. .

Abstract

This study aimed to compare tumor lesion detectability and diagnostic accuracy of whole-body magnetic resonance imaging (WB-MRI) and radioiodine-labeled meta-iodo-benzylguanidine (mIBG) imaging techniques in patients with metastatic pheochromocytoma and paraganglioma (PPGL). This retrospective study included 13 patients had pheochromocytoma and 5 had paraganglioma, who were all suspected of having metastatic tumors. Each patient underwent WB-MRI and 123I-mIBG as a pretreatment screening for 131I-mIBG therapy. Two expert reviewers evaluated WB-MRI, 123I-mIBG images, and post-therapy 131I-mIBG images for the presence of metastatic lesions in the lungs, bones, liver, lymph nodes, and other organs. Diagnostic measures for detecting metastatic lesions, including sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristics (ROC)-area under the curve (AUC), were calculated for each imaging technique. We analyzed WB-MRI images for detecting metastatic lesions, which demonstrated sensitivity, specificity, accuracy, PPV, NPV, and AUC of 82%, 97%, 90%, 96%, 86%, and 0.92, respectively. These values were 83%, 95%, 89%, 94%, 86%, and 0.90 in 123I-mIBG images and 85%, 92%, 89%, 91%, 87%, and 0.91 in post-therapy 131I-mIBG images, respectively. Our results reveal the comparable diagnostic accuracy of WB-MRI to one of the mIBG images.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
A case of multiple bone metastases (patient No. 6). A male patient with multiple bone metastases of pheochromocytoma (left scapula, thoracic, and lumbar vertebra, as indicated by black arrows). 123/131I-mIBG images detected more lesions compared with WB-MRI. Lumbar vertebral metastases were detected clearly by 131I-mIBG images. (a,b) 123I-mIBG scintigrams (anterior and posterior). (c) The MIP of WB-MRI. (d,e) Post-therapy 131I-mIBG scintigram (anterior and posterior). mIBG meta-iodo-benzylguanidine, MIP maximum intensity projection, WB-MRI whole-body magnetic resonance image.
Figure 2
Figure 2
A case of multiple lung metastases with confusing liver accumulation in mIBG images (patient No. 7). A male patient in his 60s with multiple metastases of pheochromocytoma (lung and pelvis). Post-therapy 131I-mIBG image clearly detected multiple lung metastases (black arrows) compared with the 123I-mIBG image and WB-MRI. Conversely, mIBG images were confusing between liver metastases and physiologic accumulation (white arrows). (a) 123I-mIBG scintigram (anterior). (b) The MIP of WB-MRI. (c) Post-therapy 131I-mIBG scintigram (anterior). (d) DWI (axial). (e) 123I-mIBG SPECT/CT (axial). (f) Post-therapy 131I-mIBG SPECT/CT (axial). WB-MRI whole-body magnetic resonance image, MIP maximum intensity projection, DWI diffusion-weighted image, T2WI T2 weighted image, mIBG meta-iodo-benzylguanidine, SPECT/CT single-photon emission computed tomography/computed tomography.
Figure 3
Figure 3
A case of liver metastasis that could only be detected by WB-MRI (patient No. 14). A female patient in her 40s with multiple metastases of paraganglioma (liver, vertebra, pelvis, peritoneum). Liver metastasis could only be detected by WB-MRI (arrows). Conversely, mIBG images could not detect metastasis due to physiologic liver accumulation. (a,b) The MIP of WB-MRI and DWI coronal image (WB-MRI). (c) Post-therapy 131I-mIBG scintigram (anterior). WB-MRI whole-body magnetic resonance image, MIP maximum intensity projection, DWI diffusion-weighted image, mIBG meta-iodo-benzylguanidine.
Figure 4
Figure 4
A case of WB-MRI confusing liver metastases with benign hepatic lesions (patient No. 9). A male patient in his 50s with multiple bone metastases of pheochromocytoma. Liver metastases, in addition to the metastases, were suspected by WB-MRI alone (arrows). Abnormal signal density and structures of DWI and T2WI revealed liver cysts, with no abnormal accumulation on post-therapy 131I-mIBG images. (a) 123I-mIBG scintigram (anterior). (b) The MIP of WB-MRI. (c) Post-therapy 131I-mIBG scintigram (anterior). (d,g) DWI (axial). (e,h) 123I-mIBG SPECT/CT (axial). (f,i) Post-therapy 131I-mIBG SPECT/CT (axial). WB-MRI whole-body magnetic resonance image, MIP maximum intensity projection, DWI diffusion-weighted image, T2WI T2 weighted image, mIBG meta-iodo-benzylguanidine.
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