Personalized Management of Pheochromocytoma and Paraganglioma

. 2021 Jun 19;43(2):199–239. doi: 10.1210/endrev/bnab019

Practical tip/synthesis:
• A general diagnostic flow-chart is provided by Fig. 2; a cluster-specific diagnostic flow-chart is provided by Fig. 3. • High screening sensitivity for cluster 2–related PCCs: abdominal CT imaging (native phase >10 HU plus contrast-enhanced phase) or contrast-enhanced abdominal MRI. • MRI overall preferable for children and long-term follow-up of children and adults. • CT superior to MRI for lung metastases, MRI superior to CT for liver metastases. • For PCCs ≥5 cm: Additional presurgery contrast-enhanced thoracic CT or functional imaging to exclude metastases. • For inconclusive results on anatomic imaging or staging of metastatic/multifocal disease, the most sensitive functional imaging method for cluster 2–related PCCs is [¹⁸F]FDOPA PET/CT (the second most sensitive one is most likely [⁶⁸Ga]-DOTA-SSA PET/CT).

Practical tip/synthesis:

• A general diagnostic flow-chart is provided by Fig. 2; a cluster-specific diagnostic flow-chart is provided by Fig. 3.
• High screening sensitivity for cluster 2–related PCCs: abdominal CT imaging (native phase >10 HU plus contrast-enhanced phase) or contrast-enhanced abdominal MRI.
• MRI overall preferable for children and long-term follow-up of children and adults.
• CT superior to MRI for lung metastases, MRI superior to CT for liver metastases.
• For PCCs ≥5 cm: Additional presurgery contrast-enhanced thoracic CT or functional imaging to exclude metastases.
• For inconclusive results on anatomic imaging or staging of metastatic/multifocal disease, the most sensitive functional imaging method for cluster 2–related PCCs is [¹⁸F]FDOPA PET/CT (the second most sensitive one is most likely [⁶⁸Ga]-DOTA-SSA PET/CT).