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Volume 15
Issue 11
10.3390/diagnostics15111305
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

The Biochemical–Imaging Connection: Urinary Noradrenaline and Fluorodeoxyglucose-Positron Emission Tomography in Unresectable or Metastatic Pheochromocytomas and Paragangliomas

by
Junki Takenaka
1,2,
Shiro Watanabe
1,2,3,*,
Takashige Abe
4,
Satoshi Takeuchi
5,6,
Kenji Hirata
1,2,3,6,7,
Rina Kimura
1,8,
Hiroshi Ishii
1,2,
Naoto Wakabayashi
1,9,
Mungunkhuyag Majigsuren
1,10 and
Kohsuke Kudo
1,3,7,8
1
Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
2
Department of Nuclear Medicine, Hokkaido University Hospital, Sapporo 060-8648, Japan
3
Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo 060-8638, Japan
4
Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
5
Department of Medical Oncology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
6
Center of Neuroendocrine Neoplasms, Hokkaido University Hospital, Sapporo 060-8648, Japan
7
Medical AI Research and Development Center, Hokkaido University Hospital, Sapporo 060-8648, Japan
8
Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo 060-8648, Japan
9
Department of Diagnostic Radiology, National Hospital Organization, Hokkaido Cancer Center, Sapporo 003-0804, Japan
10
Department of Radiology, Diagnostic Imaging Center, Second State Central Hospital, Ulaanbaatar 210349, Mongolia
*
Author to whom correspondence should be addressed.
Diagnostics 2025, 15(11), 1305; https://doi.org/10.3390/diagnostics15111305
Submission received: 7 April 2025 / Revised: 16 May 2025 / Accepted: 21 May 2025 / Published: 22 May 2025
(This article belongs to the Special Issue Nuclear Medicine and Molecular Imaging in Cancer Diagnosis, Therapy, and Treatment Assessment)
Versions Notes

Abstract

Background/Objectives: Pheochromocytomas and paragangliomas (PPGLs) are rare tumors of neural crest origin that secrete varying levels of catecholamines. [18F]Fluorodeoxyglucose-positron emission tomography (FDG-PET) is a valuable tool for the detection of metastases and the prediction of prognoses. However, varying FDG avidities in PPGLs raise concerns regarding cost-effectiveness and unnecessary radiation exposure. Catecholamine secretion patterns are associated with metastasis and clinical outcomes. This study aimed to explore the relationships among FDG avidity, catecholamine levels, and clinical factors in patients with PPGLs. Methods: This retrospective study included 25 patients with unresectable or metastatic PPGLs scheduled for [131I]metaiodobenzylguanidine therapy with FDG-PET data available within 40 days of urine catecholamine measurements. FDG avidity was assessed using semiquantitative parameters such as the maximum standardized uptake value (SUVmax), total metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Urine catecholamine levels were quantified. Logistic regression and Spearman’s correlation were performed to evaluate the relationship between FDG parameters and urinary catecholamine levels. Results: Urinary noradrenaline levels were significantly higher in patients with FDG-avid lesions than in those without (726.25 μg/day vs. 166.3 μg/day, p = 0.001). Noradrenaline levels showed significant positive correlations with SUVmax, MTV, and TLG (ρ = 0.527, 0.541, and 0.557, respectively; all p < 0.01). Urinary noradrenaline levels predicted FDG avidity with an AUC of 0.849; a cutoff value of 647.5 μg/day achieved 55.6% sensitivity and 100% specificity. Conclusions: Urinary noradrenaline levels were significantly associated with FDG avidity in PPGLs, suggesting their potential utility in predicting FDG-PET outcomes. Therefore, FDG-PET may be unnecessary in PPGL patients with low urinary noradrenaline levels. These findings may help optimize imaging strategies for patients with PPGLs.
Keywords: pheochromocytomas; paragangliomas; FDG-PET; catecholamine pheochromocytomas; paragangliomas; FDG-PET; catecholamine

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MDPI and ACS Style

Takenaka, J.; Watanabe, S.; Abe, T.; Takeuchi, S.; Hirata, K.; Kimura, R.; Ishii, H.; Wakabayashi, N.; Majigsuren, M.; Kudo, K. The Biochemical–Imaging Connection: Urinary Noradrenaline and Fluorodeoxyglucose-Positron Emission Tomography in Unresectable or Metastatic Pheochromocytomas and Paragangliomas. Diagnostics 2025, 15, 1305. https://doi.org/10.3390/diagnostics15111305

AMA Style

Takenaka J, Watanabe S, Abe T, Takeuchi S, Hirata K, Kimura R, Ishii H, Wakabayashi N, Majigsuren M, Kudo K. The Biochemical–Imaging Connection: Urinary Noradrenaline and Fluorodeoxyglucose-Positron Emission Tomography in Unresectable or Metastatic Pheochromocytomas and Paragangliomas. Diagnostics. 2025; 15(11):1305. https://doi.org/10.3390/diagnostics15111305

Chicago/Turabian Style

Takenaka, Junki, Shiro Watanabe, Takashige Abe, Satoshi Takeuchi, Kenji Hirata, Rina Kimura, Hiroshi Ishii, Naoto Wakabayashi, Mungunkhuyag Majigsuren, and Kohsuke Kudo. 2025. "The Biochemical–Imaging Connection: Urinary Noradrenaline and Fluorodeoxyglucose-Positron Emission Tomography in Unresectable or Metastatic Pheochromocytomas and Paragangliomas" Diagnostics 15, no. 11: 1305. https://doi.org/10.3390/diagnostics15111305

APA Style

Takenaka, J., Watanabe, S., Abe, T., Takeuchi, S., Hirata, K., Kimura, R., Ishii, H., Wakabayashi, N., Majigsuren, M., & Kudo, K. (2025). The Biochemical–Imaging Connection: Urinary Noradrenaline and Fluorodeoxyglucose-Positron Emission Tomography in Unresectable or Metastatic Pheochromocytomas and Paragangliomas. Diagnostics, 15(11), 1305. https://doi.org/10.3390/diagnostics15111305

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