Diagnostic Performance of [18 F] FDOPA PET/CT and Other Tracers in Pheochromocytoma: A Meta-Analysis

PET-CT is extensively used in the diagnosis of pheochromocytoma (PHEO). However, various PET-CT tracers are recommended for the diagnosis of PHEO. Therefore, this study evaluated the diagnostic performance of all tracers currently used in the PET-CT detection of PHEO.

Studies were retrieved from PubMed, Web of Science, Embase, and Cochrane Library from inception to Feb. 7, 2024. The studies were screened according to the eligibility criteria and the data were extracted. Quality of the included studies was evaluated by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic (sROC) curve (AUC) were pooled in Stata 15, and diagnostic accuracy was pooled in R 4.3.3.

Sixteen studies were included in the meta-analysis. The sensitivity and specificity of [18 F]FDOPA PET/CT for initial PHEO diagnosis were 97% (95% CI: 91%-99%, I² = 46.14%, p > 0.01) and 94% (95% CI: 86%-98%, I² = 87.90%, p < 0.01), respectively. The AUC was 0.99 (95% CI: 0.98-1.00). The diagnostic accuracy of [18 F]FDOPA PET/CT was 98.9% (95% CI: 95%-100%) for PHEO patients and 89.7% (95% CI: 85.4%-92.8%) for PHEO lesions. [68Ga]DOTATATE PET/CT had a diagnostic accuracy of 86.9% (95% CI: 78.2%-93.9%) for PHEO and 87.5% (95% CI: 70.3%-95.4%) for PHEO lesions. FDG PET/CT had a diagnostic accuracy of 85.2% (95% CI: 73.6%-94.1%) for PHEO and 86.8% (95% CI: 73%-94.2%) for PHEO lesions. [68Ga]DOTANOC PET/CT had a diagnostic accuracy of 79.3% (95% CI: 49.2%-98.3%) for PHEO.

In general, PET/CT demonstrates superior performance in the diagnosis of PHEO. In addition, [18 F]FDOPA PET/CT has the best diagnostic performance in PHEO compared with other tracers. Given the limited research on other PET/CT tracers and the potential constraints on their widespread use, additional multicenter and multiregional studies are warranted to further evaluate their diagnostic performance and provide recommendations for clinical use.