{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T05:14:24Z","timestamp":1777958064870,"version":"3.51.4"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Neuroendocrinology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"Abstract<\/jats:title>\n \n Early detection of metastases and timely surgical intervention play a crucial role in the management of neuroendocrine tumors. In large\u2010sized pheochromocytomas and sympathetic paragangliomas (PPGL), functional imaging with positron emission tomography (PET) is recommended, as it improves the detection of metastases, which may go undetected on conventional radiologic imaging.\n 11<\/jats:sup>\n C\u2010hydroxyephedrine binds to the norepinephrine transporter receptor and is detected by PET\/CT (HED\u2010PET\/CT). It has previously demonstrated high accuracy in detecting primary and metastatic PPGL; however, its impact on preoperative staging is unclear. In this study, we retrospectively analyzed a selected cohort of 44 patients with large PPGL to evaluate whether HED\u2010PET\/CT influences preoperative clinical decision\u2010making. All patients who underwent\n HED<\/jats:styled-content>\n \u2010\n PET<\/jats:styled-content>\n \/\n CT<\/jats:styled-content>\n at Uppsala University Hospital between 2004 and 2024 were screened for inclusion. In total, 44 patients with pheochromocytomas >5\u2009cm and paragangliomas >4\u2009cm were included.\n HED<\/jats:styled-content>\n \u2010\n PET<\/jats:styled-content>\n \/\n CT<\/jats:styled-content>\n results were compared with\n CT<\/jats:styled-content>\n \/\n MR<\/jats:styled-content>\n findings, and a final consensus was reached on whether preoperative\n HED<\/jats:styled-content>\n \u2010\n PET<\/jats:styled-content>\n \/\n CT<\/jats:styled-content>\n would have altered clinical decision\u2010making. HED\u2010PET\/CT identified previously undetected metastatic disease in three patients (6.8%), which had not been visualized on CT\/MR. Additionally, two patients had discordant findings, where HED\u2010PET\/CT revealed additional metastases. In one case, a liver metastasis was identified postoperatively with HED\u2010PET\/CT, leading to a metastasectomy that could have potentially been avoided. These findings suggest that HED\u2010PET\/CT is highly accurate in detecting metastases; however, its routine preoperative use may be limited and appears to provide significant clinical benefit only in selected patients.\n <\/jats:p>","DOI":"10.1111\/jne.70121","type":"journal-article","created":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T16:10:46Z","timestamp":1764519046000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\n 11<\/sup>\n C\n <\/scp>\n \u2010Hydroxyephedrine\n PET<\/scp>\n \/\n CT<\/scp>\n for preoperative surgical planning in large pheochromocytoma and paraganglioma"],"prefix":"10.1111","volume":"38","author":[{"given":"Achyut Ram","family":"Vyakaranam","sequence":"first","affiliation":[{"name":"Department of Surgical Sciences\u2014Molecular Imaging and Medical Physics Uppsala University Uppsala 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Sciences\u2014Endocrine Surgery Uppsala University Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,30]]},"reference":[{"issue":"4","key":"e_1_2_10_2_1","first-page":"3151","article-title":"Current diagnostic imaging of pheochromocytomas and implications for therapeutic strategy (review)","volume":"15","author":"\u010ctvrtl\u00edk F","year":"2018","journal-title":"Exp Ther 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