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Functional imaging as an aid to decision-making in metastatic paraganglioma

J B Bomanji, MBBS, MSc, PhD1, S W Hyder, MB1, M N Gaze, MD, FRCR2, S Gacinovic, MD, MSc1, D C Costa, MD, PhD, FRCR1, C Coulter, FRCR2 and P J Ell, FRCP, FRCR1

1 The Institute of Nuclear Medicine
2 Meyerstein Institute of Oncology, The Middlesex Hospital, Mortimer Street, London W1N 8AA, UK



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  		Figure 1. Case 1. CT showing a destructive soft tissue mass in the back and lateral aspect of the right orbit, displacing the lateral rectus muscle and right globe.

 


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  		Figure 2. (A) 123I-MIBG whole body image 24 h post injection, showing multiple foci of increased tracer uptake in the skull vault, spine, ribs and pelvis. (B) 131I-MIBG whole body image 7 days post therapy (12.1 GBq) shows a pattern similar to (A). (C) After approximately 36.8 GBq (993 mCi) of 131I-MIBG therapy given in three cycles, a follow-up 123I-MIBG scan shows minimal residual disease. (D) A second follow-up diagnostic 123I-MIBG scan shows progression of disease. MIBG-avid lesions are noted in the spine, ribs and soft tissues along the paraaortic region.

 


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  		Figure 3. Case 1. (A) 99Tcm-MDP bone scan (posterior whole body image) shows some distortion of the left iliac crest outline. (B) 111In-pentetreotide whole body scan 24 h post injection shows no abnormality (C,D) 18F-FDG positron emission tomography (coronal sections) show multiple glucose-avid lesions predominantly in the paraaortic region extending above and below the diaphragm. There is minimal involvement of the spine compared with the 123I-MIBG scan (Figure 2DGo).

 


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  		Figure 4. Case 2. (A) 123I-MIBG posterior whole body view 24 h post injection showing abnormal focal but faint uptake in the lung fields, spine and right sacroiliac region. (B) 111In-pentetreotide posterior whole body scan 24 h post injection shows minimal asymmetry in the left sacroiliac joint. (C) 99Tcm-MDP bone scan (posterior whole body view) shows multiple focal areas of increased tracer uptake in the spine, right scapula, some ribs and sacroiliac joints. (D,E) 18F-FDG positron emission tomography (coronal sections) shows multiple glucose-avid lesions predominantly involving lung soft tissues and the spine.

 




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