Comparison of ¹¹C-HED PET/CT with ¹⁸F-FDG and ⁶⁸Ga-DOTATATE PET/CT for Pheochromocytoma and Paraganglioma

Evaluate the diagnostic performance of ¹¹C-HED PET/CT in patients with suspected pheochromocytoma and paraganglioma (PPGL), and compare with ⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CT.

A single-center retrospective study consecutively enrolled 113 patients with suspected PPGL. Diagnostic performance, semi-quantitative parameter values, and 5-point Likert scores were compared. Immunohistochemical staining for norepinephrine transporter (NET) and somatostatin receptor (SSTR) was performed, and the correlation between immunoreactivity score (IRS) and quantitative indicators was analyzed.

47 patients were ultimately diagnosed with PPGL, with 12 of them having distant metastases. ¹¹C-HED PET/CT showed higher diagnostic performance than ¹⁸F-FDG and ⁶⁸Ga-DOTATATE PET/CT. For lesion detection, ¹¹C-HED outperformed ¹⁸F-FDG (all p < 0.05) PET/CT. Compared with ⁶⁸Ga-DOTATATE PET/CT, ¹¹C-HED PET/CT showed significantly higher detection rates for metastatic and all lesions (both p < 0.05). ¹¹C-HED PET/CT had significantly higher maximum standardized uptake values (SUV_max) of primary/recurrent and metastatic lesions (both p < 0.001) and target-to-background ratio (TBR) of metastatic lesions (p = 0.001) than ¹⁸F-FDG PET/CT. The TBR of primary/recurrent and metastatic lesions (both p = 0.001) of ¹¹C‑HED was significantly higher than ⁶⁸Ga-DOTATATE PET/CT. Immunohistochemical correlation analysis showed that NET IRS was significantly positively correlated with SUV_max, TBR, and Likert scores (all p < 0.05). SSTR IRS was significantly positively correlated with SUV_max and Likert scores (all p < 0.05).

In this cohort of PPGL, ¹¹C-HED PET/CT demonstrates superior diagnostic performance and lesion detection rates. ⁶⁸Ga-DOTATATE PET/CT plays a complementary role in detecting patients with metastatic lesions.