Multi-molecular imaging showing tumour heterogeneity and differing diagnostic performance in a case with metastatic pheochromocytoma

A patient with multiple endocrine neoplasia 2A (MEN2A) and a suspicion of metastasized pheochromocytoma, underwent multi-molecular positron emission tomography (PET) imaging with the recently presented radiopharmaceutical [(18)F]-metafluorobenzylguanidine (mFBG), [(68)Ga]Ga-DOTA-TOC and [(18)F]F-dihydroxyphenylalanine (DOPA) as well as scintigraphy with [(123)I]-metaiodobenzylguanidine (mIBG). The methods showed different diagnostic performance, with the highest number of suspected malignant lesions detected by [(18)F]-mFBG-PET, and revealed insights into tumour heterogeneity.