Open AccessTailored Molecular Imaging of Pheochromocytoma and Paraganglioma: Which Tracer and When
Author(s) -
Giuseppe Danilo Di Stasio,
Vincenzo Cuccurullo,
Giuseppe Lucio Cascini,
Chiara Maria Grana
Publication year - 2022
Publication title -
neuroendocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.493
H-Index - 101
eISSN - 1423-0194
pISSN - 0028-3835
DOI - 10.1159/000522089
Subject(s) - paraganglioma , pheochromocytoma , context (archaeology) , functional imaging , positron emission tomography , neuroendocrine tumors , multiple endocrine neoplasia type 2 , biology , bioinformatics , neuroscience , computational biology , germline mutation , medicine , endocrinology , pathology , mutation , genetics , paleontology , gene
Pheochromocytoma and paraganglioma are rare neoplasms that fall within the category of neuroendocrine tumors. In the last decade, their diagnostic algorithm has been modified to include the evaluation of molecular pathways, genotype and biochemical phenotype, in order to correctly interpret anatomical and functional imaging results and tailor the best therapeutic choices to patients. More specifically, the identification of germline mutations has led to a three-way cluster classification: pseudo-hypoxic cluster, cluster of kinase receptor signaling and protein translation pathways, and cluster of Wnt-altered pathway. In this context, functional imaging gained a crucial role in the management of these patients in agreement with the ever-growing concept of personalized medicine. In this paper we provide an overview of three specific molecular pathways targeted by positron-emitting tracers to image pheochromocytomas and paragangliomas: catecholamine metabolism, somatostatin receptors and glucose uptake. Finally, we recommend different flow charts for use in the selection of tracers for specific clinical scenarios, based on sporadic/inherited tumor and known/unknown mutation status.