18F-DOPA positron emission tomography for tumour detection in patients with medullary thyroid carcinoma and elevated calcitonin levels

In spite of the availability of numerous procedures, diagnostic imaging of tumour manifestations in patients with medullary thyroid carcinoma and elevated calcitonin levels is often difficult. In the present study, the new procedure of fluorine-18 dihydroxyphenylalanine positron emission tomography (F-18-DOPA PET) was compared with the established functional and morphological imaging methods. After evaluation of the normal distribution of F-18-DOPA, 11 patients with medullary thyroid carcinoma were examined using F-18-DOPA PET. Results of F-18-fluorodeoxyglucose (F-18-FDG) PET, somatostatin receptor scintigraphy (SRS) and morphological tomographic imaging (CT/MRI) were available for all patients. All individual procedures were evaluated without reference to prior information. Data assessment for each patient was based on cooperation between experienced radiologists and specialists in nuclear medicine, who considered all the available findings (histological results, imaging, follow-up studies). This cooperation served as the gold standard against which the results of the individual procedures were evaluated. A total of 27 tumours were studied [three primary tumours (PT)/local recurrence (LR), 16 lymph node metastases (LNM) and eight organ metastases (OM)]. F-18-DOPA PET produced 17 true-positive findings (2 PT/LR, 14 LNM, 1 OM), F-18-FDG PET 12 (2 PT/LR, 7 LNM, 3 OM), SRS 14 (2 PT/LR, 8 LNM, 4 OM) and morphological imaging 22 (3 PT/LR, 11 LNM, 8 OM). The following sensitivities were calculated with respect to total tumour manifestations: F-18-DOPA PET 63%, F-18-FDG PET 44%, SRS 52%, morphological imaging 81%. Thus, the morphological imaging procedures produce the best overall sensitivity, but the specificity for PT/LR (55%) and LNM (57%) was low. With respect to lymph node staging, the best results were obtained with F-18-DOPA PET. F-18-DOPA PET is a new functional imaging procedure for medullary thyroid carcinoma that seems to provide better results than SRS and F-18-FDG PET. Moreover, the data indicate that no single procedure provides adequate diagnostic certainty. Therefore,F-18-DOPA PET is a useful supplement to morphological diagnostic imaging improving lymph node staging and enabling a more specific diagnosis of primary tumour and local recurrence.