Advertisement

L’Endocrinologo

, Volume 11, Issue 2, pp 54–64 | Cite as

Diagnostica per immagine integrata dei feocromocitomi e paragangliomi

  • Domenico Rubello
  • Gaia Grassetto
Article
  • 36 Downloads

Riassunto

La diagnostica del femocromocitoma e dei paragangliomi, oltre a prevedere un’iniziale valutazione biochimica che accerti le caratteristiche secretive del tumore, consta dell’applicazione di metodiche di imaging integrato, morfologico e funzionale, al fine della localizzazione del tumore stesso. Nella maggior parte dei casi l’imaging integrato risulta sinergico ai fini di ottenere una diagnosi corretta e un’accurata valutazione dell’estensione della malattia. Abitualmente l’imaging morfologico, principalmente tomografia assiale computerizzata (TAC) e risonanza magnetica nucleare (RMN), viene utilizzato nella prima fase dell’iter diagnostico di localizzazione e consente di valutare l’anatomia della lesione primitiva, mentre quello funzionale medico-nucleare entra in gioco in un secondo tempo per confermare la diagnosi, caratterizzare la lesione e stadiare la malattia. A questo scopo la medicina nucleare offre numerosi traccianti radiomarcati idonei per esami ad emissione di singolo fotone (scansione whole-body e SPECT) e per indagini ad emissione di positroni /doppio fotone (PET). La presente review, alla luce delle rilevanti innovazioni avvenute negli ultimi anni in termini di tecnologia avanzata, si pone il fine di descrivere le metodiche che rappresentano attualmente lo stato dell’arte nella diagnostica di queste patologie, proponendo anche delle flowchart diagnostiche.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Bibliografia

  1. 1.
    Giovanella L. Tumori neuroendocrini: diagnosi e fisiopatologia clinica. Caleidoscopio, Genova, 1999.Google Scholar
  2. 2.
    Pearse AGE. The diffuse neuroendocrine system: peptides, amines placodes and the APUD theory. Progr Brain Res 68: 25, 1986.CrossRefGoogle Scholar
  3. 3.
    Fontaine J, Le Dourin NM. Analysis of endoderm formation in the avian blastoderm by the use of quail-chick chimeras. J Endocrinol Exp Morphol 41: 209, 1977.Google Scholar
  4. 4.
    Abbona Baylin SB. APUD cells fact and finction. Trends Endocrinol Metab 1: 198, 1990.CrossRefGoogle Scholar
  5. 5.
    Percopo V. Neuroendocrine tumours: general aspects. In: Percopo V, Kaplan EL (Eds.) GEP and multiple neuroendocrine tumors. Piccin, Padova, 1996, p 3–15.Google Scholar
  6. 6.
    Naddaf S, Elgazzar AH. Adrenal gland. In: Elgazzar E (Ed.) The pathophysiologic basis of nuclear medicine. Springer, Heidelberg, 2006, p 147.Google Scholar
  7. 7.
    Klein RD, Lloyd RV, Young WF. Hereditary paraganglioma-pheochromocytoma syndromes. www.ncbi.nlm.nih.gov/bookshelf, GeneReviews founded by NIH, last revision September 2009.
  8. 8.
    Pia A. Impiego clinic dei test genetici nel feocromocitoma. www.associazionemediciendocrinologici.it, AME flash, marzo 2007.
  9. 9.
    Pacak K, Eisenhofer G, Ahlman H, Bornstein SR, Gimenez-Roqueplo AP, Grossman AB, Kimura N, Mannelli M, McNicol AM, Tischler AS. International Symposium on Pheochromocytoma: Pheochromocytoma: recommendation for clinical practice from the first international symposium. Octeober 2005. Nat Clin Pract Endocrinol Metab 3: 92, 2007.PubMedCrossRefGoogle Scholar
  10. 10.
    Lenders JWM, Eisenhofer G, Mannelli M, Pacak K. Phaeochromocytoma. Lancet 366: 665, 2005.PubMedCrossRefGoogle Scholar
  11. 11.
    Lenders JWM, Pakac K, Walther MM, Linehan WM, Mannelli M, Friberg P, Keiser HR, Goldstein DS, Eisenhofer G. Biochemical diagnosis of pheochromocytoma: Which test is best?. JAMA 287: 1427, 2002.PubMedCrossRefGoogle Scholar
  12. 12.
    Eisenhofer G, Goldstein DS, Walther MM, Friberg P, Lenders JW, Keiser HR, Pacak K. Biochemical diagnosis of pheochromocytoma: how to distinguish true- from false-positive test results. J Clin Endocrinol Metab 88: 2656, 2003.PubMedCrossRefGoogle Scholar
  13. 13.
    Gujrathi CS, Donald PJ. Current trends in the diagnosis and management of head and neck paragangliomas. Curr Opin Otolaryngol Head Neck Surg 13: 339, 2005.PubMedCrossRefGoogle Scholar
  14. 14.
    Mazza A, Zamboni S, Zerizer I, Al-Nahhas A, Rubello D, Casiglia E. Anatomical or functional imaging in endocrine hypertension: competition or synergy?. Nucl Med Comm 30: 581, 2009.CrossRefGoogle Scholar
  15. 15.
    Gross MD, Wong KK, Rubello D. Scintigraphic imaging of adrenal disease. Minerva Endocrinol 33: 175, 2008.PubMedGoogle Scholar
  16. 16.
    Gross MD, Avram A, Fig L, Rubello D. Contemporary adrenal scintigraphy. Eur J Nucl Med Mol Imaging 34: 547, 2007.PubMedCrossRefGoogle Scholar
  17. 17.
    Rufini V, Calcagni ML, Baum RP. Imaging of neuroendocrine tumors. Sem Nucl Med 36: 228, 2006.CrossRefGoogle Scholar
  18. 18.
    Gross MD, Korobkin M, Bou-Assaly W, Rubello D. Incidentally-discovered adrenal masses. www.discoverymedicine.com/Milton-D-Gross/2010/01/04.
  19. 19.
    Boland GW, Blake MA, Hahn PF, Mayo-Smith WW. Incidental adrenal lesions: principles, techniques and algorithms for imaging characterization. Radiology 3: 756, 2008.CrossRefGoogle Scholar
  20. 20.
    Gross MD, Gauger PG, Djekidel M, Rubello D. The role of PET in the surgical approach to adrenal disease. Eur J Surg Oncol 35: 1137, 2009.PubMedCrossRefGoogle Scholar
  21. 21.
    Timmers HJL, Chen CC, Carrasquillo JA, Whatley M, Ling A, Havekes B, Eisenhofer G, Martiniova L, Adams K, Pacak K. Comparison of 18F-Fluoro-DOPA, 18F-Fluoro-Deoxyglucose and 18F-Fluorodopamine PET and 123I-MIBG Scintigraphy in the localization of pheochromocytoma and paraganglioma. J Clin Endocrinol Metab 94: 4757, 2009.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Pacak K, Linehan WM, Eisenhofer G, Walther MM, Goldstein DS. Recent advances in genetics, diagnosis, localization and treatment of pheochromocytoma. Ann Intern Med 134: 315, 2001.PubMedCrossRefGoogle Scholar
  23. 23.
    Pomares FJ, Canas R, Rodriguez JM, Hernandez AM, Parrilla P, Tebar FJ. Differences between sporadic and multiple endocrine neoplasia type 2A pheochromocytoma. Clin Endocrinol (Oxf) 48: 195, 1998.CrossRefGoogle Scholar
  24. 24.
    Shapiro B, Sisson J, Kalff V, Glowniak J, Satterlee W, Glazer G, Francis I, Bowers R, Thompson N, Orringer M, et al. The location of middle mediastinal pheochromocytomas. J Thorac Cardiovasc Surg 87: 814, 1984.PubMedGoogle Scholar
  25. 25.
    Gross MD, Djekidel M, Hay RV, Rubello D. “Scintigraphic localization of adrenal tumors. Minerva Endocrinol 34: 171, 2009.PubMedGoogle Scholar
  26. 26.
    Rubello D, Bui C, Casara D, Gross MD, Fig LM, Shapiro B. Functional scintigraphy of the adrenal gland. Eur J Endocrinol 147: 13, 2002.PubMedCrossRefGoogle Scholar
  27. 27.
    Lynn MD, Shapiro B, Sisson JC, Beierwaltes WH, Meyers LJ, Ackerman R, Mangner TJ. Pheochromocytoma and the normal adrenal medulla: improved visualization with I-123 MIBG scintigraphy. Radiology 155: 789, 1985.PubMedGoogle Scholar
  28. 28.
    Timmers HJ, Kozupa A, Chen CC, Carrasquillo JA, Ling A, Eisenhofer G, Adams KT, Solis D, Lenders JW, Pacak K. Superiority of fluorodeoxyglucoe positron emission tomography to other functional imaging techniques in the evaluation of metastatic SDHB-associated pheochromocytoma and paraganglioma. J Clin Onc 25: 2262, 2007.CrossRefGoogle Scholar
  29. 29.
    Van Der Horst-Schivers AN, Jager PL, Boezen HM, Schouten JP, Kema IP, Links TP. Iodine-123 metaiodobenzylguanidine scintigraphy in localizing phaechromocytomas-experience and meta-analysis. Anticancer Res 26: 1599, 2006.Google Scholar
  30. 30.
    Shapiro B, Wieland DM, Brown LE. 131I-meta-iodo-benzylguanidine (MIBG) adrenal scintigraphy: interventional studies. In: Spencer RP (Ed.) Interventional nuclear medicine. Grune & Stratton, New York, 1983, p 451.Google Scholar
  31. 31.
    Ilias I, Sahdev A, Reznek RH, Grossman AB, Pacak K. The optimal imaging of adrenal tumours: a comparison of different methods. Endocr Rel Cancer 14: 587, 2007.CrossRefGoogle Scholar
  32. 32.
    Shulkin BL, Ilias I, Sisson JC, Pacak K. Current trends in functional imaging of pheochromocytomas and paragangliomas. Ann NY Acad Sci 1073: 374, 2006.PubMedCrossRefGoogle Scholar
  33. 33.
    Hoegerle S, Nietzsche E, Altehoefer C, Ghanem N, Manz T, Brink I, Reincke M, Moser E, Neumann HPH. Pheochromocytomas: detection with 18F-DOPA whole-boy PET-initial results” Radiology 222: 507, 2002.PubMedCrossRefGoogle Scholar
  34. 34.
    Shapiro B, Gross MD, Shulkin B. Radioisotope diagnosis and therapy of malignant pheochromocytoma. Trends Endocrinol Metab 12: 469, 2001.PubMedCrossRefGoogle Scholar
  35. 35.
    Ilias I, Pacak K. Diagnosis and management of tumors of the adrenal medulla. Horm Metab Res 47: 717, 2005.CrossRefGoogle Scholar
  36. 36.
    Pacak K, Eisenhofer G, Carasquillo JA, Chen CC, Li ST, Goldstein DS. 18F-fluorodopamine positron emission tomography (PET) scanning for diagnostic localization of pheochromocytoma. Hypertension 38: 6, 2001.PubMedCrossRefGoogle Scholar
  37. 37.
    Brink J, Hoegerle S, Klisch J, Bley TA. Imaging of pheochromocytoma and paraganglioma. Familial Cancer 4: 61, 2005.PubMedCrossRefGoogle Scholar
  38. 38.
    Eisenhofer G. The role of neuronal and estraneuronal plasma membrane transporters in the inactivation of peripheral catecholamines” Pharmacol Ther 91: 35, 2001.PubMedCrossRefGoogle Scholar
  39. 39.
    Mamede M, Carasquillo JA, Chen CC, Del Corral P, Whatley M, Ilias I, Ayala A, Pacak K. Discordant localization of 2-[18F]-fluoro-2-deoxy-D-glucose in 6-[18F]-fluorodopamine and [123I]-metaiodobenzylguanidine negative metastatic pheochromocytoma sites. Nucl Med Commun 27: 31, 2006.PubMedCrossRefGoogle Scholar
  40. 40.
    Marzola MC, Pelizzo MR, Ferdeghini M, Toniato A, Massaro A, Ambrosini V, Fanti S, Gross MD, Al-Nahhas A, Rubello D. Dual PET/CT with (18)F-DOPA and (18)F-FDG in metastatic medullary thyroid carcinoma and rapidly increasing calcitonin levels: Comparison with conventional imaging. Eur J Surg Oncol 36: 414, 2010.PubMedCrossRefGoogle Scholar
  41. 41.
    Schwaiger M, Kalff V, Rosenspire K, Haka MS, Molina E, Hutchins GD, Deeb M, Wolfe E Jr, Wieland DM. Noninvasive evaluation os sympathetic nervous system in human heart by positron emission tomography. Circulation 82: 457, 1990.PubMedCrossRefGoogle Scholar
  42. 42.
    Shulkin BL, Wieland DM, Schwaiger M, Thompson NW, Francis IR, Haka MS, Rosenspire KC, Shapiro B, Sisson JC, Kuhl DE. PET scanning with hydroxyephedrine: an approach to the localization of pheochromocytoma. J Nucl Med 33: 1125, 1992.PubMedGoogle Scholar
  43. 43.
    De Grado TR, Hutchins GD, Toorongian SA, Wieland DM, Schwaiger M. Myocardial kinetics of 11C-metahydroxyephedrine: retention mechanism and effects of norepinephrine. J Nucl Med 34: 1287, 1993.Google Scholar
  44. 44.
    Shulkin BL, Wieland DM, Baro ME, Ungar DR, Mitchell DS, Dole MG, Rawwas JB, Castle VP, Sisson JC, Hutchinson RJ. PET hydroxyephedrine imaging of neuroblastoma. J Nucl Med 37: 16, 1996.PubMedGoogle Scholar
  45. 45.
    Trampal C, Engler H, Juhlin C, Bergstrom M, Langstrom B. Pheochromocytomas: detection with 11C-hydroxyephedrine PET. Radiology 230: 16, 2004.CrossRefGoogle Scholar
  46. 46.
    van der Harst E, De Herder WW, Bruining HA, Bonjer HJ, de Krijger RR, Lamberts SW, van de Meiracker AH, Boomsma F, Stijnen T, Krenning EP, Bosman FT, Kwekkeboom DJ. [123I]Metaiodobenzylguanedine and [111In] Octreotide uptake in benign and malignant pheochromocytomas. J Clin Endocrinol Metab 86: 685, 2001.PubMedGoogle Scholar
  47. 47.
    Koopmans KP, Jager PL, Kema IP, Kerstens MN, Albers F, Dullaart RPF. 111In-octreotide is superior to 123I-metaiodobenzylguanidine for scintigraphic detection of head and neck paragangliomas. J Nucl Med 49: 1232, 2008.PubMedCrossRefGoogle Scholar
  48. 48.
    Kupferman ME, Hanna EY. Paraganglioma of the head and neck. Curr Oncol Rep 10: 156, 2008.PubMedCrossRefGoogle Scholar
  49. 49.
    Rao AB, Koeller KK, Adair CF. From the archives of the AFIP: paragangliomas of the head and neck: radiologic-pathologic correlation. Radiographics 19: 1605, 1999.PubMedCrossRefGoogle Scholar
  50. 50.
    Bustillo A, Telischi F, Weed D, Civantos F, Angeli S, Serafini A, Whiteman M. Octreotide scintigraphy in the head and neck. Laryngoscope 114: 434, 2004.PubMedCrossRefGoogle Scholar
  51. 51.
    Muros MA, Llamas-Elvira JM, Rodriguez A, Ramírez A, Gómez M, Arráez MA, Valéncia E, Vílchez R. 111In-pentetreotide scintigraphy is superior to 123I-MIBG scintigaphy in the diagnosis and location of chemodectoma. Nucl Med Commun 19: 735, 1998.PubMedCrossRefGoogle Scholar
  52. 52.
    Erickson D, Kudva YC, Ebersold MJ, Thompson GB, Grant CS, van Heerden JA, Young WF Jr. Benign paragangliomas: clinical presentation and treatment outcomes in 236 patients. J Clin Endocrinol Metab 86: 5210, 2001.PubMedCrossRefGoogle Scholar
  53. 53.
    Hoegerle S, Ghanem N, Altehoefer C, Schipper J, Brink I, Moser E, Neumann HPH. 18F-DOPA positron emission tomography for the detection of glomus tumours. Eur J Nucl Med Mol Imaging 30: 689, 2003.PubMedCrossRefGoogle Scholar
  54. 54.
    Weismann AF, Gonzales CE, Shapiro B, Shulkin B, Francis IR, Leach K. Multiple chemodectomas — carotid body tumor masked by salivary gland utake on I-123 MIBG scintigraphy. Clin Nucl Med 19: 527, 1994.CrossRefGoogle Scholar
  55. 55.
    Hoegerle S, Altehoefer C, Ghanem N, Koehler G, Waller CF, Scheruebl H, Moser E, Nitzsche E. Whole-body 18F-DOPA PET for detection of gastrointestinal carcinoid tumors. Radiology 220: 373, 2001.PubMedCrossRefGoogle Scholar
  56. 56.
    Hoegerle S, Altehoefer C, Ghanem N, Brink I, Moser E, Nitzsche E. 18F-DOPA positron emission tomography for tumor detection in patients with medullary thyroid carcinoma and elevated calcitonin levels. Eur J Nucl Med 28: 64, 2001.PubMedCrossRefGoogle Scholar
  57. 57.
    Held P, Breit A. Comparison of CT and MRI methods in diagnosis of tumors of the para- and retropharyngeal space and temporal bobe. Bildgebung 61: 236, 1994.Google Scholar
  58. 58.
    van Gils APG, van Erkel AR, Falke THM, Pauwels EKJ. Magnetic resonance imaging or metaiodobenzylguanidine scintigraphy for demonstration of paraganglioma. Eur J Nucl Med 21: 239, 1994.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2010

Authors and Affiliations

  1. 1.Dipartimento di Medicina Nucleare - Centro PET/CT, Radiologia e Fisica SanitariaOspedale “Santa Maria della Misericordia”RovigoItalia

Personalised recommendations