Abstract
Pheochromocytomas and paragangliomas (PPGLs) present diagnostic challenges due to their diverse clinical manifestations. This study aims to evaluate the diagnostic accuracy of [(99m)Tc]Tc-HYNIC-TOC SPECT/CT in patients with clinically suspected PPGLs. A retrospective analysis was conducted on 75 patients (36 males, 39 females, mean age 47.7 ± 14.9 years) with suspected PPGLs. All patients underwent [(99m)Tc]Tc-HYNIC-TOC SPECT/CT imaging, and the results were compared with histopathological findings. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of the imaging modality were calculated. Additionally, visual and semiquantitative evaluations were performed using Krenning score (KS) and tumor-to-background ratio (TBR), and their diagnostic performances were analyzed. Of the 75 patients, 54 had PPGLs (40 pheochromocytomas, 7 paragangliomas, and 7 metastatic PPGLs), and 21 had non-PPGL tumors. [(99m)Tc]Tc-HYNIC-TOC SPECT/CT showed positive imaging in 63 patients, of whom 51 were confirmed as PPGLs and 12 as non-PPGLs. The sensitivity, specificity, PPV, NPV, and overall accuracy were 94.4% (51/54), 42.9% (9/21), 80.9% (51/63), 75.0% (9/12), and 80.0% (60/75), respectively. Visual and semiquantitative evaluations indicated higher KS and TBR values in PPGLs compared to non-PPGLs (median KS: 3.0 vs. 1.0, P < 0.001; median TBR: 2.10 vs. 0.92, P < 0.001). The Receiver operating characteristic (ROC) analysis revealed AUCs of 0.803 for KS and 0.791 for TBR, with no significant difference in their diagnostic performance (P = 0.710). Metastatic PPGLs were detected in 7 cases, with metastases observed in multiple organs. [(99m)Tc]Tc-HYNIC-TOC SPECT/CT effectively diagnoses PPGL and identifies metastatic disease. Despite lacking comparative evaluation with established tracers, it represents a cost-effective alternative for PPGL evaluation, particularly in resource-limited settings where PET/CT access is restricted, bridging diagnostic gaps while maintaining acceptable accuracy.