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Normal biodistribution pattern and physiologic variants of 18F-DOPA PET imaging.

Chondrogiannis S, Marzola MC, Al-Nahhas A, Venkatanarayana TD, Mazza A, Opocher G, Rubello D - Nucl Med Commun (2013)

Bottom Line: The recent introduction and use of hybrid PET/CT scanners has contributed significantly to the management of a series of other pathologies including neuroendocrine tumors, brain tumors, and pancreatic cell hyperplasia.Despite these potentially promising applications in several clinical fields, the role of F-DOPA has not been elucidated completely yet because of associated difficulties in synthesis and availability.Unfortunately, the available literature does not provide recommendations for procedures or administered activity, acquisition timing, and premedication with carbidopa.

View Article: PubMed Central - PubMed

Affiliation: aDepartment of Imaging, Service of Nuclear Medicine, PET/CT Centre bDepartment of Internal Medicine, Santa Maria della Misericordia Hospital, Rovigo cFamilial Cancer Clinic and Oncoendocrinology, Veneto Institute of Oncology, IRCCS, Padova, Italy dDepartment of Nuclear Medicine, Hammersmith Hospital, Imperial College NHS Trust, London, UK.

ABSTRACT
Dihydroxyphenylalanine (DOPA) is a neutral amino acid that resembles natural L-dopa (dopamine precursor). It enters the catecholamine metabolic pathway of endogenous L-DOPA in the brain and peripheral tissues. It is amenable to labeling with fluorine-18(F) for PET imaging and was originally used in patients with Parkinson's disease to assess the integrity of the striatal dopaminergic system. The recent introduction and use of hybrid PET/CT scanners has contributed significantly to the management of a series of other pathologies including neuroendocrine tumors, brain tumors, and pancreatic cell hyperplasia. These pathologic entities present an increased activity of L-DOPA decarboxylase and therefore demonstrate high uptake of F-DOPA. Despite these potentially promising applications in several clinical fields, the role of F-DOPA has not been elucidated completely yet because of associated difficulties in synthesis and availability. Unfortunately, the available literature does not provide recommendations for procedures or administered activity, acquisition timing, and premedication with carbidopa. The aim of this paper is to outline the physiological biodistribution and normal variants, including possible pitfalls that may lead to misinterpretations of the scans in various clinical settings.

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Right adrenal lesion. From the upper left, clockwise: computed tomography (CT), PET, MIP, and fused PET/CT images of l-6-[18F]fluoro-3,4-dihydroxyphenylalanine (18F-DOPA) PET/CT of a 51-year-old woman presenting with very high urinary normetanephrin levels. 123I-MIBG scintigraphy revealed only a mild to moderate uptake of the tracer in the right adrenal. Instead, 18F-DOPA PET/CT shows a very intense uptake in the right adrenal, consistent with pheochromocytoma. Note the concomitant uptake in the body–tail of the pancreas, and the intense uptake in the gallbladder. Images with no carbidopa premedication.
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Figure 3: Right adrenal lesion. From the upper left, clockwise: computed tomography (CT), PET, MIP, and fused PET/CT images of l-6-[18F]fluoro-3,4-dihydroxyphenylalanine (18F-DOPA) PET/CT of a 51-year-old woman presenting with very high urinary normetanephrin levels. 123I-MIBG scintigraphy revealed only a mild to moderate uptake of the tracer in the right adrenal. Instead, 18F-DOPA PET/CT shows a very intense uptake in the right adrenal, consistent with pheochromocytoma. Note the concomitant uptake in the body–tail of the pancreas, and the intense uptake in the gallbladder. Images with no carbidopa premedication.


Normal biodistribution pattern and physiologic variants of 18F-DOPA PET imaging.

Chondrogiannis S, Marzola MC, Al-Nahhas A, Venkatanarayana TD, Mazza A, Opocher G, Rubello D - Nucl Med Commun (2013)

Right adrenal lesion. From the upper left, clockwise: computed tomography (CT), PET, MIP, and fused PET/CT images of l-6-[18F]fluoro-3,4-dihydroxyphenylalanine (18F-DOPA) PET/CT of a 51-year-old woman presenting with very high urinary normetanephrin levels. 123I-MIBG scintigraphy revealed only a mild to moderate uptake of the tracer in the right adrenal. Instead, 18F-DOPA PET/CT shows a very intense uptake in the right adrenal, consistent with pheochromocytoma. Note the concomitant uptake in the body–tail of the pancreas, and the intense uptake in the gallbladder. Images with no carbidopa premedication.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3815120&req=5

Figure 3: Right adrenal lesion. From the upper left, clockwise: computed tomography (CT), PET, MIP, and fused PET/CT images of l-6-[18F]fluoro-3,4-dihydroxyphenylalanine (18F-DOPA) PET/CT of a 51-year-old woman presenting with very high urinary normetanephrin levels. 123I-MIBG scintigraphy revealed only a mild to moderate uptake of the tracer in the right adrenal. Instead, 18F-DOPA PET/CT shows a very intense uptake in the right adrenal, consistent with pheochromocytoma. Note the concomitant uptake in the body–tail of the pancreas, and the intense uptake in the gallbladder. Images with no carbidopa premedication.
Bottom Line: The recent introduction and use of hybrid PET/CT scanners has contributed significantly to the management of a series of other pathologies including neuroendocrine tumors, brain tumors, and pancreatic cell hyperplasia.Despite these potentially promising applications in several clinical fields, the role of F-DOPA has not been elucidated completely yet because of associated difficulties in synthesis and availability.Unfortunately, the available literature does not provide recommendations for procedures or administered activity, acquisition timing, and premedication with carbidopa.

View Article: PubMed Central - PubMed

Affiliation: aDepartment of Imaging, Service of Nuclear Medicine, PET/CT Centre bDepartment of Internal Medicine, Santa Maria della Misericordia Hospital, Rovigo cFamilial Cancer Clinic and Oncoendocrinology, Veneto Institute of Oncology, IRCCS, Padova, Italy dDepartment of Nuclear Medicine, Hammersmith Hospital, Imperial College NHS Trust, London, UK.

ABSTRACT
Dihydroxyphenylalanine (DOPA) is a neutral amino acid that resembles natural L-dopa (dopamine precursor). It enters the catecholamine metabolic pathway of endogenous L-DOPA in the brain and peripheral tissues. It is amenable to labeling with fluorine-18(F) for PET imaging and was originally used in patients with Parkinson's disease to assess the integrity of the striatal dopaminergic system. The recent introduction and use of hybrid PET/CT scanners has contributed significantly to the management of a series of other pathologies including neuroendocrine tumors, brain tumors, and pancreatic cell hyperplasia. These pathologic entities present an increased activity of L-DOPA decarboxylase and therefore demonstrate high uptake of F-DOPA. Despite these potentially promising applications in several clinical fields, the role of F-DOPA has not been elucidated completely yet because of associated difficulties in synthesis and availability. Unfortunately, the available literature does not provide recommendations for procedures or administered activity, acquisition timing, and premedication with carbidopa. The aim of this paper is to outline the physiological biodistribution and normal variants, including possible pitfalls that may lead to misinterpretations of the scans in various clinical settings.

Show MeSH
Related in: MedlinePlus