The value of a rapid contrast-enhanced angio-MRI protocol in the detection of head and neck paragangliomas in SDHx mutations carriers: a retrospective study on behalf of the PGL.EVA investigators*

Abstract

• Rapid angio-MRI protocol and the usual lengthy protocol show equal diagnostic performance. • The CE-MRA is the key sequence for the detection of HNPGLs. • The T1WIV sequence assists in localizing HNPGLs.

Can subunit‐specific phenotypes guide surveillance imaging decisions in asymptomatic SDH mutation carriers?

“…One of the concerns about sole use of radiological imaging (eg, CT/MRI) in screening is missing tumours, particularly in the thorax and some authors have suggested that nuclear imaging could be used to detect these, although of note the lower sensitivity in detecting PGL in the thorax with CT in this study was ameliorated by a second imaging review in expert hands. If MRI is to be adopted for surveillance a consensus needs to reached with regards to weighing the benefits and risks of different types, for example, rapid sequence vs conventional, angio‐MRI in HNPGL, with and without contrast, and the importance and use of different sequences.…”

“…68 Ga‐Dodecanetetraacetic acid‐Octreotate (DOTATATE) PET/CT has been shown to be superior in the localization of SDHB ‐associated metastatic PPGLs and HNPGLs . A retrospective sub‐analysis of the PGL.EVA cohort evaluated the use of a rapid contrast‐enhanced angio‐MRI, which has a much shorter duration of scanning of 5‐10 minutes, in detecting HNPGL in SDHx mutation carriers and found no difference in performance with standardized MRI . The most sensitive method in the evaluation of non‐head and neck primary PPGLs is suggested to be 18F‐fluorodopamine PET, but availability is limited .…”

Diffusion‐weighted imaging (DWI) highlights SDHB‐related tumours: A pilot study

“…Our experience of MRI as the primary imaging modality in a longitudinal series of SDHB mutation carriers was recently reported, and others have reported on the use of whole body rapid sequencing MRI, and angio‐MRI in cohorts of SDHx mutation carriers . In line with the Endocrine Society guidelines that state radiation‐free imaging modalities should be the preference in tumour prone groups, interest in, and evidence for, the use of interval MRI for screening is increasing.…”

Reply: 68Ga-DOTATATE PET/CT Versus MRI: Why the Comparison of 68Ga-DOTATATE PET/CT to an Appropriate MRI Protocol Is Essential

“…However, in our paper, we assessed sensitivity of the detection of HNPGLs, not specificity. Furthermore, in their letter, the authors include references citing that the sensitivity of CE-MRA versus conventional MRI was very comparable (3). Therefore, their claim that we did not use a state of the art imaging method is not convincing.…”

“…Any deviation from this protocol following study commencement several years ago would be scientific error. It is not scientifically sound to add new imaging modalities to an ongoing study when a new imaging modality and its application to a particular cancer appears in the literature (3). The same criticism could apply to study cited by the authors (4) where 111 In-pentetreotide (Octreoscan, Mallinckrodt/Covidien) was used, despite the fact that 68 Ga-DOTATATE PET was already on the horizon and was suggested to be a very promising agent for primary and metastatic PGLs, including head and neck (5,6).…”