Usefulness of semi-quantitative analysis in 123I metaiodobenzylguanidine SPECT/CT for the differentiation of pheochromocytoma and cortical adenoma

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Objective: 123I metaiodobenzylguanidine (MIBG) scintigraphy is a useful tool for the diagnosis of pheochromocytomas (PHEOs), but some PHEOs are difficult to differentiate from cortical adenoma (CA) or normal adrenal uptake by visual evaluation alone. A new semi-quantitative analysis using 123I MIBG SPECT/CT is thus expected. Herein, we introduce the tumor-to-liver count ratio (T/L) and the tumor-to-muscle count ratio (T/M). Methods: We examined the cases of 21 patients with PHEOs (10 males, 11 females; age 24–80, median 61 years) and 23 patients with CA (15 males and 8 females, age 30–78, median 58 years). The visual scoring based on 123I MIBG planar images (planar score) and SPECT images (SPECT score) was used as the conventional evaluation. Using 123I MIBG SPECT/CT findings, we calculated the semi-quantitative values of the count ratio using the maximum or mean count of the tumor and the liver or muscle as the reference organ (T/Lmax, T/Lmean, T/Mmax and T/Mmean). Each evaluation of the PHEOs and CAs was compared, and the diagnosing performance was evaluated based on an ROC analysis. Results: The area under curve (AUC) values were as follows: the planar score, 0.833; SPECT score, 0.813; T/Lmax, 0.986; T/Lmean, 0.975; T/Mmax, 0.955; and T/Mmean, 0.933. The AUC for T/Mmax was significantly higher than those of the planar score, and SPECT score by ROC analysis (p < 0.01 each). Conclusion: The semi-quantitative value of 123I MIBG SPECT/CT is more useful than the conventional visual evaluation for differentiating PHEOs from CAs.

Original languageEnglish
Pages (from-to)95-102
Number of pages8
JournalAnnals of Nuclear Medicine
Issue number1
Publication statusPublished - Jan 2022

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging


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