Comparison of 11C-HED PET/CT with 18F-FDG and 68Ga-DOTATATE PET/CT for Pheochromocytoma and Paraganglioma.

PURPOSE: Evaluate the diagnostic performance of 11C-HED PET/CT in patients with suspected pheochromocytoma and paraganglioma (PPGL), and compare with 68Ga-DOTATATE and 18F-FDG PET/CT. MATERIALS AND METHODS: A single-center retrospective study consecutively enrolled 113 patients with suspected PPGL. Diagnostic performance, semi-quantitative parameter values, and 5-point Likert scores were compared. Immunohistochemical staining for norepinephrine transporter (NET) and somatostatin receptor (SSTR) was performed, and the correlation between immunoreactivity score (IRS) and quantitative indicators was analyzed. RESULTS: 47 patients were ultimately diagnosed with PPGL, with 12 of them having distant metastases. 11C-HED PET/CT showed higher diagnostic performance than 18F-FDG and 68Ga-DOTATATE PET/CT. For lesion detection, 11C-HED outperformed 18F-FDG (all p < 0.05) PET/CT. Compared with 68Ga-DOTATATE PET/CT, 11C-HED PET/CT showed significantly higher detection rates for metastatic and all lesions (both p < 0.05). 11C-HED PET/CT had significantly higher maximum standardized uptake values (SUVmax) of primary/recurrent and metastatic lesions (both p < 0.001) and target-to-background ratio (TBR) of metastatic lesions (p = 0.001) than 18F-FDG PET/CT. The TBR of primary/recurrent and metastatic lesions (both p = 0.001) of 11C‑HED was significantly higher than 68Ga-DOTATATE PET/CT. Immunohistochemical correlation analysis showed that NET IRS was significantly positively correlated with SUVmax, TBR, and Likert scores (all p < 0.05). SSTR IRS was significantly positively correlated with SUVmax and Likert scores (all p < 0.05). CONCLUSION: In this cohort of PPGL, 11C-HED PET/CT demonstrates superior diagnostic performance and lesion detection rates. 68Ga-DOTATATE PET/CT plays a complementary role in detecting patients with metastatic lesions.