B) I-123 MIBG
I-123 MIBG SPECT CT demonstrates uptake in the mass seen on prior MRI consistent with paraganglioma. I-131 MIBG is rarely used as I-123 offers better image quality and lower radiation dose. MIBG is a norepinephrine analog that localizes to presynaptic adrenergic nerves and sympathomedullary tissue by an active amine transport system. F-18 FDG is not specific for paragangliomas and is not a first line agent, however it can be useful for imaging dedifferentiated tumors that lack the amine transport system and no longer take up MIBG. More specific PET ligands such as F-18 fluorodopamine and DOPA offer improved sensitivity over MIBG, but they are not yet in widespread use.
Imaging revealed no evidence of metastasis. What is the primary treatment.
A) Surgical resection
B) CT-guided microwave ablation
E) I-131 MIBG radiotherapy
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