. Author manuscript; available in PMC: 2020 Aug 25.

Published in final edited form as: Eur J Nucl Med Mol Imaging. 2019 Jun 29;46(10):2112–2137. doi: 10.1007/s00259-019-04398-1

Table 3.

Proposed clinical algorithm for nuclear imaging investigations in cases of phaeochromocytomas and paragangliomas

	First choice	Second choice	Third choice (if [¹⁸F]FDOPA or [⁶⁸Ga]Ga-SSA is not available)
PHEO (sporadic)	[¹⁸F]FDOPA or [¹²³I]MIBG	[⁶⁸Ga]SSA	[¹⁸F]FDG
Inherited PHEO (except SDHx): NF1/RET/VHL/MAX	[¹⁸F]FDOPA	[¹²³I]MIBG or [⁶⁸Ga]SSA	[¹⁸F]FDG
HNPGL (sporadic)	[⁶⁸Ga]SSA	[¹⁸F]FDOPA	[¹¹¹In]SSA/[^99mTc]SSA
Extra-adrenal sympathetic and/or multifocal and/or metastatic and/or SDHx mutation	[⁶⁸Ga]SSA	[¹⁸F]FDG and [¹⁸F]FDOPA	[¹⁸F]FDG and [¹²³I]MIBG or [¹⁸F]FDG and [¹¹¹In]SSA/[^99mTc]SSA

The above algorithm can be proposed as per the clinical situation. This algorithm should be practically adapted in each institution and evolve with time. PHEO: phaeochromocytoma, [¹²³ I]MIBG: iodine-123-labelled meta-iodobenzylguanidine, [¹⁸ F]FDA: fluorine-18-labelled fluorodopamine, [¹⁸ F]FDOPA: fluorine-18-labelled fluorodihydroxyphenylalanine, [¹⁸ F]FDG: fluorine-18-labelled fluorodeoxyglucose, [⁶⁸ Ga]SSA: gallium-68-labelled somatostatin analogue, [¹¹¹ In]SSA: indium-111-labelled somatostatin analogue, [^99m Tc]SSA: technetium-99-labelled somatostatin analogue, NF1/RET/VHL/MAX: neurofibromin 1/rearranged during transfection proto-oncogene/von Hippel-Lindau/myc-associated factor X, HNPGL: head and neck paraganglioma, SDHx: succinate dehydrogenase subunits.