|LETTER TO THE EDITOR
|Year : 2013 | Volume
| Issue : 4 | Page : 765-767
Positive 68 Ga-DOTANOC PET/CT with negative 131 I- metaiodobenzylguanidine scan in a case of Glomus Jugulare
Nishikant A Damle, Rajeev Kumar, Madhavi Tripathi, Chandrasekhar Bal
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||20-Jun-2013|
Nishikant A Damle
Senior Research Associate, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Damle NA, Kumar R, Tripathi M, Bal C. Positive 68 Ga-DOTANOC PET/CT with negative 131 I- metaiodobenzylguanidine scan in a case of Glomus Jugulare. Indian J Endocr Metab 2013;17:765-7
|How to cite this URL:|
Damle NA, Kumar R, Tripathi M, Bal C. Positive 68 Ga-DOTANOC PET/CT with negative 131 I- metaiodobenzylguanidine scan in a case of Glomus Jugulare. Indian J Endocr Metab [serial online] 2013 [cited 2020 Jan 21];17:765-7. Available from: http://www.ijem.in/text.asp?2013/17/4/765/113781
Paragangliomas of the head and neck are extremely rare tumors (approximately 1 in 30,000 head and neck tumors).  Since these tumors are difficult to access and very vascular, diagnostic biopsy is not feasible due to the risk of significant bleeding and neurovascular damage. Diagnosis of Glomus jugulare or Glomus vagale is therefore difficult. Patients usually present late and with otologic/neurologic symptoms. CT and MRI provide highly suggestive information, including hypervascularity or bony erosions. Howeve&r, in some instances, these modalities may not differentiate paragangliomas from meningioma, schwannoma or metastasis. Arteriography has a limited role and also carries the risk of neurologic complications. Also, head and neck paragangliomas may be biochemically silent, which is another reason why a non-invasive diagnostic method becomes important.
A fifty two year old lady, presented with chief complaints of impairment of hearing and tinnitus in the left ear since one year with left temporal headache. She also had IX, X, XI cranial nerve palsy on the left side. There was no history of hypertension. Otoscopy showed a pulsatile reddish mass behind intact ear drum involving inferior part of pars-tensa. CT scan bone window images in the axial plane showed a soft tissue mass lesion causing irregular bone destruction seen in the location of left jugular foramen. Erosions were also seen in the adjoining left occipital bone. This lesion showed intense uptake of 68 Ga-DOTANOC but no detectable abnormality on 131 I-MIBG scan [Figure 1].
|Figure 1: 131I-MIBG whole body scan anterior and posterior views showing no defi nite abnormality (left) with CT scan bone window images in the axial plane showed a soft tissue mass lesion causing irregular bone destruction seen in the location of left jugular foramen. Erosions were also seen in the adjoining left side occipital bone. This lesion showed intense uptake of 68Ga-DOTANOC on PET/CT|
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Somatostatin receptor scintigraphy (SRS), is a noninvasive nuclear medicine imaging method based on somatostatin receptor expression in paragangliomas. , Thus, SRS excludes schwannomas and non-neuroendocrine tumoral metastasis, from paragangliomas. SRS cannot differentiate paraganglioma from meningioma, as demonstrated by earlier studies.  . However, this is also a limitation of 123 I/ 131 I metaiodobenzylguanidine ( 123 I-MIBG) scintigraphy because 123 I-MIBG uptake is variable in paragangliomas. 
The distinction between meningioma and paraganglioma can then be made by arteriography. SRS could limit the use of arteriography to patients who intend to undergo surgery and require an embolization procedure for these hypervascularized tumors.
Octreotide and MIBG have been shown to exert a complementary role in the detection and treatment of neuroendocrine tumors in occasional patients but SRS is more sensitive for extra-adrenal tumors.  Our case reinforces this hypothesis. Hence, in a case where there is strong clinical suspicion but negative MIBG scan, a 68 Gallium-DOTANOC scan may help to establish the diagnosis of Glomus Jugulare.
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